Hyperbilirubinaemia after major thoracic surgery: comparison between open-heart surgery and oesophagectomy.
Hyperbilirubinaemia after major thoracic surgery: comparison between open-heart surgery and oesophagectomy.
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DOI：
10.1186/cc691
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
Nishimura S
中科院分区：
文献类型：
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作者：
Hosotsubo KK;Nishimura M;Nishimura S
高胆红素血症在大手术后入住重症监护室（ICU）的患者中很常见，并且与高死亡率相关。我们调查了两种主要胸外科手术后高胆红素血症的发生率：心内直视手术和食管切除术。为了确定与大手术后高胆红素血症相关的危险因素，我们比较了心脏直视手术和食管切除术后的发生率。在51%的心内直视手术患者（n = 133）和64%的食管切除术患者（n = 74）中检测到高胆红素血症。高胆红素血症的发生率与手术时间有关（P< 0.05）。在心内直视手术组中，无高胆红素血症患者的手术持续时间为465 ± 24 min，高胆红素血症患者的手术持续时间为571 ± 26 min。在食管切除术组中，手术持续时间分别为415 ± 17 min和493 ± 20 min。心内直视手术组的总死亡率为8%;高胆红素血症组的死亡率为12%，而无高胆红素血症组的死亡率为5%。无论有无高胆红素血症，食管切除术组均无成员死亡。在心脏直视手术组中，感染显著影响高胆红素血症的发生和死亡率。在心内直视手术组的亚组中，5%（65人中有3人）没有高胆红素血症（或感染证据）的患者死亡;在高胆红素血症患者中，3%（38人中有1人）没有感染的患者死亡，23%（30人中有7人）检测到感染死亡。在心脏直视手术和食管切除术后，大约一半的患者血清总胆红素水平较高。手术时间与高胆红素血症的发生显著相关。心脏直视手术后感染显著影响死亡率和总胆红素水平。控制感染在预防高胆红素血症和降低死亡率方面起着至关重要的作用。
Hyperbilirubinaemia is a common occurrence in patients who are admitted to intensive care units (ICUs) after major surgery, and it is associated with high mortality. We investigated the incidence of hyperbilirubinaemia after two major types of thoracic surgery: open-heart surgery and oesophagectomy. In order to identify the risk factors associated with hyperbilirubinaemia after major surgery, we compared the incidence after open-heart surgery with that after oesophagectomy. Hyperbilirubinaemia was detected in 51% of the open-heart surgery patients (n = 133) and in 64% in the oesophagectomy group (n = 74). The incidence of hyperbilirubinaemia was significantly related to the duration of surgery (P< 0.05). In the open-heart surgery group, duration of surgery was 465 ± 24 min for the patients without hyperbilirubinaemia and 571 ± 26 min for the patients with hyperbilirubinaemia. In the oesophagectomy group, the procedure durations were 415 ± 17 min and 493 ± 20 min, respectively. The overall mortality rate was 8% in the open-heart surgery group; the rate was 12% in those with hyperbilirubinaemia, but 5% in those without hyperbilirubinaemia. No members of the oesophagectomy group died, with or without hyperbilirubinaemia. Infection significantly affected both the occurrence of hyperbilirubinaemia and mortality in the open-heart surgery group. In the subgroups from the open-heart surgery group, 5% (three out of 65) of those without hyperbilirubinaemia (or evidence of infection) died; of the patients with hyperbilirubinaemia, 3% (one out of 38) of those without infection died and 23% (seven out of 30) with detected infection died. After open-heart surgery and oesophagectomy, approximately half of the patients studied had higher levels of serum total bilirubin. Time spent in surgery was significantly related to the occurrence of hyperbilirubinaemia. Infection significantly affected mortality and total bilirubin levels after open-heart surgery. Control of infection plays a crucial role in the prevention of hyperbilirubinaemia and in reducing mortality.