A clinical study on the mechamism and early diagnosis of acute liver dysfunction following cardiac surgery.
| Project/Area Number |
62570636
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| Research Category |
Grant-in-Aid for General Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Research Field |
Thoracic surgery
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| Research Institution | Osaka University |
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Principal Investigator |
MATSUDA Hikaru Osaka University Medical School (Assistant Professor), 医学部, 講師 (00028614)
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| Co-Investigator(Kenkyū-buntansha) |
大久保 修和 大阪大学, 医学部附属病院, 医員
OHTANI Masakatsu Osaka University Medical School (Research Assistant), 医学部, 助手 (90168980)
NAKANO Susumu Osaka University Medical School (Assistant Professor), 医学部, 講師 (70028653)
OHKUBO Nobukazu Osaka University Medical School (Resident)
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| Project Period (FY) |
1987 – 1988
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| Project Status |
Completed (Fiscal Year 1988)
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| Budget Amount *help |
¥2,100,000 (Direct Cost: ¥2,100,000)
Fiscal Year 1988: ¥300,000 (Direct Cost: ¥300,000)
Fiscal Year 1987: ¥1,800,000 (Direct Cost: ¥1,800,000)
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| Keywords | Cardiac Surgery / Liver Dysfunction / Hepatic Venous Oxygen Saturation / 肝静脈カテーテル |
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| Research Abstract |
Acute liver dysfunction (ALD) is one of the major complications after cardiac surgery. To elucidate the mechanism of ALD following cardiac surgery and to establish useful predictor for ALD, we introduced hepatic venous oxygen saturation (ShvO_2) monitoring to the patients who underwent cardiac surgery.
In 37 patients: 17 with congenital and 20 with acquired heart disease, ShvO_2 was measured for 1-4 days postoperatively. The mean ShvO_2 value for 24 hours around the lowest point (m-ShvO_2) was compared with the postoperative results of liver functions, hepatic lactate metabolism and hemodynamics. The results were as follows:
1. m-ShvO_2 ranged from 5% to 79% with the average of 44%.
2. In 14 patients with m-ShvO_2 <30%, 11 patients developed ALD with serum alanine aminotransferase (ALT) >100 U/l (the highest value: 4,050 U/l) or serum total bilirubin (TB)>3.0mg/dl (the highest: 11.5 mg/dl), and there were significant inverse correlations between m-ShvO_2 and the highest value of blood chemistry (ALT, GLDH, T-Bil). In 23 patients with m-ShvO_2>40%, the liver function indices stayed within almost normal ranges without significant correlations to m-ShvO_2.
3. In 14 patients with m-ShvO_2 <30%, there was a significant inverse correlation between m-ShvO_2 and hepatic venous lactate pyruvate ratio.
4. m-ShvO_2 showed significant relation to mixed venous oxygen saturation (SvO_2) and CVP in multivariate analysis.
5. In pre, peri and postoperative factors, m-ShvO_2 most significantly contributed to ALD-score in multivariate analysis.
In conclusion, significant decrease in ShvO_2 as below 30% appears to indicate hepatic tissue hypoxia causing ALD from hepatic hypoperfusion with resultant from systemic hypoperfusion and high CVP. And ShvO_2 monitoring may be useful to predict the development of ALD in critical patients after cardiac surgery.
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Report
(3 results)
Research Products
(19 results)
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[Publications] 高野弘志,松田暉,中埜粛,酒井敬,大谷正勝,川口章,大竹重彰,松若良介,宮川周士,新谷英夫,井上智勝,川島康生: 人工臓器. 18. 435-439 (1989)
Description
「研究成果報告書概要(和文)」より
Related Report
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[Publications] Matsuda,H.;Covino,E.;Hirose,H.;Nakano,S.;Kishimoto,H.;Miyamoto,Y.;Nishigaki,K.;Takano,H.;Ohtake,S.,et al.: J.Thorac.Cardiovase Surg.96. 219-226 (1988)
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[Publications] 高野弘志,松田暉,中埜粛,酒井敬,大谷正勝,川口章,大竹重彰,松若良介,宮川周士,新谷英夫,井上智勝,川島康生: 人工臓器. 18. 435-439 (1989)
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