선천성 심기형 환아에서 체외순환후 혈청 및 소변 Amylase치의 변화

The Change of Derum and Urine Amylase Level Following Cardiopulmonary Bypass in the Patients with Congenital heart disease

  • 발행 : 1995.10.01

초록

Pancreatitis is a known complication of cardiac surgery with cardiopulmonary bypass. Although ischemia is believed to be a factor, the exact cause of pancreatitis after cardiopulmonary bypass remains unknown.We prospectively studied 67 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass for evaluation of the pancreatic injury after cardiopulmonary bypas. Serial measurement of amylase level in serum and urine was done postoperatively. Hyperamylasemia was detected in 15 patients[22.4% , of whom no patient had pancreatitis. There was no significant difference between serum amylase level and parameters such as cardiopulmonay bypass time, aortic cross clamp time, mean blood pressure, rectal temperature, flow rate, and use of circulatory arrest during cardiopulmonary bypass. Hyperamylasuria was detected in 8 patients[11.9% , and urine amylase level was elevated significantly in the groups with prolonged cardiopulmonary bypass, mean blood pressure more than 40mmHg, and rectal temperature more than 20 $^{\circ}$C. We recommend that serum amylase level and/or amylase-creatinine clearance ratio is measured for ealy detection and management of pancreatitis after cardiopulmonary bypass.

키워드

참고문헌

  1. New Eng J Med v.325 Risk factors for pancreatic cellular injury after cardiopulmonary bypass Castillo,C.F.;Harringer,W.;Warshaw,A.L.(et al.)
  2. Surgery v.92 Gastrointestinal complications after cardiopulmonary bypass Hanks,J.B.;Cartis,S.E.;Hanks,B.B.(et al.)
  3. Ann Thorac Surg v.39 A Prospective study of hyperamylasemia and pancreatitis after cardiopulmonary bypass Svensson,L.G.;Decker,G.;Kinsley,R.B.
  4. Am J Surg v.131 Pancreatitis after cardiac surgery; A morphologic study Feiner,H.
  5. Am J Surg v.120 Postoperative pancreatitis. A study of 70 case White,T.T.;Morgan,A.;Hopton,D.
  6. Textbook of pediatrics(14th ed.) Behrman
  7. Eur J cardiothorac surg v.2 Pancreatitis after open heart surgery in children Leijala,M.;Louhimo,I.
  8. Clinica Chimica Acta v.77 The nature and origin of hyperamylasemia following open heart surgery with extracoporeal circulation Otsuki,M.;Maeda,M.Yuu,H.(et al.)
  9. 대흉외지 v.28 선천성 심기형 환자에서 체외 순환 후 복부 장기 적정 관류에 대한 예견으로서 혈중 amylase 치의 변화의 의의 백희종;김용진
  10. Ann Thorac Surg v.52 Intraabdomianl complication after cardiopulmonary bypass Ohri,S.K.;Desai,J.B.;Gaer,J.A.R.(et al)
  11. Am J Surg v.136 General surgical complications after Cardiac Surgery Lawhorne,T.W.;Davies,J.L.;Smith,G.W.
  12. Surgery v.104 Intraabdominal complications of cardiopulmonary bypass operations Krasna,M.J.;Flancbaum,L.;Trooskin,S.Z.(et al.)
  13. Am J Surg v.149 Acute Pancreatitis after cardiopulmonary bypass Haas,G.S.;Warshaw,A.L.;Daggett,W.M.(et al.)
  14. Ann Surg v.188 Susceptibility of the pancreas to ischemic injury in shock Warshaw,A.L.;O'Hara,P.J.
  15. Ann Surg v.209 Hyperamylasemia after cardiac surgery : incidence, significance and management Rattner,D.W.;Gu,Z.Y.;Vlahakes,G.J.(et al.)
  16. Harrison's Principles of Internal Medicine(13th ed.) v.2 Approach to the patient with pancreatic disease Phillip,P.T.;Norton,J.E.;Isselbacher,K.J.
  17. Clinical diagnosis and management by laboratory methods(17th ed.) Henry,J.B.
  18. N Engl J Med v.292 Specificity of increased renal clearance of amylase in diagnosis of acute pancreatitis Warshaw,A.L.;Fuller,A.F.(Jr)
  19. Am J Surg v.133 Elevated postoperative renal clearance of amylase without pancreatitis after cardiopulmonary bypass Traverso,L.W.;Ferrari,B.T.;Buckberg,G.D.(et al.)
  20. Surg v.94 Amylase : creatinine clearance retios, serum amylase and lipase after operations with cardiopulmonary bypass Smith,C.R.;Schwartz,S.I.
  21. Surgery v.91 The role of ischemia in acute pancreatitis : Studies with an isolated perfused canine pancreas Broe,P.J.;Zuidema,G.D.;Cameron,J.L.
  22. Ann Surg v.180 The Nature and significance of hyperamylasemia following operation Morrissey,R.;Berk,E.;Rridhandler,L.(et al.)
  23. Clin Chem v.34 Incidence and Souce of hyperaylasemia after cardiac surgery Kazmierczak,S.C.;Lente,F.V.
  24. Cardiol Young v.3 Cardiopulmonary bypass-organ blood flow and metabolism in the pediatric patient Lazenby,W.D.;Krieger,K.H.
  25. Surg Gynecol Obstet v.165 Intraabdominal complications of cardiopulmonary bypass operations Leitman,M.I.;Paull,D.E.;Barie,P.S.(et al.)
  26. Perfusion v.5 Gastrointestinal damage following cardiopulmonary bypass Desai,J.B.;Ohri,S.K.
  27. Jan Cir J v.52 Regional blood flow in the liver, pancreas and kidney during pulsatile and nonpulsatile perfusion under profound hypothermia Mori,A.;Watanabe,K.;Onoe,M.(et al.)
  28. Curr Probl Surg Acute pancreatitis Ranson,J.H.C.
  29. New Eng J Med v.304 Compliment activation during cardiopulmonary bypass-evidence for generation of C3a and C5a anaphylactoxins Chenoweth,D.E.;Cooper,S.W.;Hubli,T.E.(et al.)
  30. Ann Surg v.109 Pattern of severe pancreatic injury following cardiopulmonary bypass Rose,D.M.;Ranson,J.H.C.;Cunningham,J.N.(et al.)