張 釖嶂 大阪大学, 医学部・附属病院, 医員
平田 展章 大阪大学, 医学部, 助手 (70283752)
鍵崎 康治 大阪大学, 医学部・附属病院, 医員
NISHIMURA Motonobu Osaka University Medical School Asistant Professor, 医学部, 助手 (90291442)
MATUDA Hikaru Osaka University Medical School Professor, 医学部, 教授 (00028614)
|Budget Amount *help
¥13,500,000 (Direct Cost : ¥13,500,000)
Fiscal Year 1998 : ¥1,300,000 (Direct Cost : ¥1,300,000)
Fiscal Year 1997 : ¥12,200,000 (Direct Cost : ¥12,200,000)
1. To forecast the hyper bilirubinemia in the patients after operation, we evaluated the preoperative factors (hepatocyte damage, hepatic sinusoid-endothelial dysfunction, liver function and inflammatory response). Operations performed were mitral valve replacement. We measured the serum levels of aspartate transaminase (AST), alanine transaminase (ALT), hyaluronic acid (HA), total bilirubin (TB), choline estelase (ChE), interleukm-6 (IL-6), interleukin-8 (IL-8) and CRP before operation. We evaluated the correlation between these indexes and the peak level of TB in seven post-operative days. The levels of preoperative TB, ChE, I-IA and IL-6 had a good correlation with the peak level of postoperative TB.These results suggested that liver function, hepatic sinusoid-endothelial dysfunction and inflammatory reaction may play a significant role in forecast of postoperative hepatic failure in patients.
2. To clarify the mechanism of hyper-bilirubinemia in the setting of left ventricular assis
t device (LVAS), we evaluated the change of hepatocellular function, hepatic sinusoid-endothelial microcirculation and inflammatory response before and after LVAS implantation. We measured serum levels of total bilirubin (TB), transaminases (ALT,AST), interleukin (IL-6, IL-8), and HA ; a indicater for hepatic sinusoidal circulation, before and after LVAS implantation. The level of I-LA and IL-8, had a good correlation with the level of TB.However, the AST, ALT or 11-6 did not relate to the alternation of TB.These results suggested that hepatic sinusoid-endothelial dysfunction and inflammatory reaction may play a significant role in hepatic failure in patients following implantation of LVAS.
3. Under the current situations we have increasing opportunities to manage the patients with posthepatitis and/or congestive liver dysfunction. In order to prevent postoperative hepatic failure we described perioperative management for those patients. We have no effective methods to estimate the functional reserve, but our data suggested that serum cholineesterase level at the preoperative states might demonstrate prognostic significance. Less