Genesis and Prophylaxsis of Hepatic Injury due to hyperbilirubinemia after Valvular Heart Surgery

本研究从肝循环、化学、形态学等方面探讨心脏瓣膜手术后肝损伤的发生机制及预防措施。以下是我们的结论。胆汁酸负荷试验显示，胆汁酸最大值和混合血氧饱和度是术后胆汁酸蓄积的预测指标。当前者> 20 μ M/L，后者<60%时，有发生高胆红素血症性肝损伤的倾向，认为是心功能恶化所致.经静脉肝活检技术是相对容易在术后立即进行。然而，也有一些少数情况，如钳子的限制和可能在没有实质标本的情况下拾取静脉壁。术中未发现转氨酶、胆汁酸异常升高.由于犬肝静脉系统复杂，分支较多，虽然局部血流测量是可能的，但不能在动物模型中采用热稀释法测量肝血流。

Our research is to clarify genesis and to find prophylaxis of hepatic injury after valvular heart surgery, by discussing hepatic circulation, chemistry, morphology and so others. The followings are our conclusions.1. Bile acid stress test revealed that a predictor of accumulation of bile acid after surgery had an intimate relation with maximal value of the bile acid and oxygen saturation of the mixed blood. When the former was more than 20uM/L and the latter was less than 60%, hepatic injury gue to hyperbilirubinemia had a tendency to occur and that was considered to be caused by deterioration of cardiac functions.2. A technique of transvenous hepatic biopsy was relatively easy to perform in the immediate postoperative period. However, there were some minorities such as the limitation of the poening of the forceps and possible vein-wall pick-up without parenchymal specimen. During the procedures, abnormal elevation of transaminases and bile acid were not observed.3. Hepatic blood flow measurement by thermodilution technique was not in animal models because a canine hepatic venous system is complicated and many venous branches make the flow measurement incorrect, although local flow measurement makes possible.