開心術後の難治性高ビリルビン血症に対する漢方薬茵蔯蒿湯の使用

Initial Clinical Experience of the Herbal Medicine Inchinkoto for Refractory Hyperbilirubinemia Following Open-heart Surgery

体外循環を使用する心臓大血管手術（開心術）はほかの外科領域に比べ侵襲が大きく，術後に血中ビリルビン値の上昇を認める場合が多い．開心術後に総ビリルビン値が3.0 mg/dl以上となる症例は35.1％に達するとの報告もある1）．しかし，開心術後の高度の難治性高ビリルビン血症に対する有効な治療法はいまだ確立されていない．

We retrospectively assessed our initial clinical experience of the herbal medicine Inchinkoto for refractory hyperbilirubinemia following open-heart surgery. Six patients developed hyperbilirubinemia in an acute phase after surgery and their maximum total bilirubin levels were 6.4～26.4 mg/dl （mean：13.1±8.2 mg/dl）. They were initially treated with ursodeoxycholic acid and/or Stronger Neo-Minophagen C containing monoammonium glycyrrhizinate, glycine, aminoacetic acid, and L-cysteine hydrochloride hydrate. These treatments, however, were ineffective, and Inchinkoto was introduced at 5～34 day （mean：13.3±11.3 days） after surgery. Hyperbilirubinemia improved in all patients after the introduction of Inchinkoto：1 day after in 1 case, 2 days after in 2 cases, 3 days after in 2 cases, and 4 days after in 1 case. These results indicate the potential of Inchinkoto to attenuate refractory hyperbilirubinemia following cardiac surgery with cardiopulmonary bypass.