中国实用外科杂志

中国实用外科杂志

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脓毒症相关肝损伤49例临床分析

刘一娜，马晓春   

  1. 中国医科大学附属第一医院重症医学科，辽宁沈阳110001
  • 发布日期:2012-10-19

  • Published:2012-10-19

摘要：

目的    研究脓毒症相关肝损伤的发生率、表现形式、发病及持续时间，分析肝功能异常对预后的影响。方法    回顾性分析2010年1~12月中国医科大学附属第一医院重症医学科诊治150例脓毒症病人的资料，其中49例（32.7%）于诊断脓毒症后的1~23 d发生肝功能异常。 结果    肝功能异常病人中胆红素升高17例（34.7%），转氨酶升高22例（44.9%），胆红素与转氨酶均升高10例（20.4%）。肝功能异常持续时间1~25 d，肝功能异常者的多器官功能障碍综合征（MODS）发生率57.1%（28/49），病死率34.7%（17/49），住ICU时间1~107 d，机械通气时间9~1140 h，与无肝功能异常的脓毒症病人比较MODS发生率、病死率、住ICU时间、机械通气时间的差异均有统计学意义。肝功能异常的病人中，高胆红素升高者的肝功能恢复率最低，高胆红素、高转氨酶病人MODS发生率最高。 结论    脓毒症病人相关肝损伤发生率较高，合并肝功能异常的脓毒症病人预后差，MODS发生率高，以胆红素升高为表现的脓毒症病人肝功能恢复率低。

关键词: 脓毒症, 肝功能异常

Abstract:

Clinical analysis of sepsis-associated liver dysfunction: an analysis of 49 patients        LIU Yi-na，MA Xiao-chun. Department of Intensive Care Unit, the First Affiliated Hospital of China Medical University，Shenyang 110001, China
Corresponding  author ：MA Xiao-chun，E-mail：xcma2972@sina.com
Abstract    Objective    To investigate the incidence，manifestation and duration of sepsis-associated liver injury，and analyze the influence of liver dysfunction on the prognosis of septic patients. Methods    The data of 150 septic patients admitted between January 2010 and December 2010 in Department of Intensive Care Unit, the First Affiliated Hospital of China Medical University were analyzed retrospectively. Among 150 patients, 49 patients（32.7%）began to involve in liver dysfunction from the first day to the twenty-third day after sepsis identified. Results    In patients with liver dysfunction, there were 17 patients （34.7%）with abnormaly high bilirubin level，22 patients（44.9%）with increasing glutamic-pyruvic transaminase, 10 patients （20.4%）with both increasing bilirubin and glutamic-pyruvic transaminase. The duration of liver dysfunction ranged from 1 to 25 days. In liver dysfunction group, the incidence of MODS was 57.1%（28/49）. The fatality rate was 34.7%（17/49）. ICU duration ranged from 1 to 107 days and mechanical ventilation duration was 9 to 1140 hours. The differences of MODS incidence, fatality rate, ICU duration and mechanical ventilation duration were statistically significant between liver dysfunction group and normal liver function group. The recovery rate of liver function was the lowest in septic patients with abnormaly high bilirubin level, while the incidence of MODS was the highest in patients with both increasing bilirubin and glutamic-pyruvic transaminase. Conclusion    Septic-associated liver dysfunction is commonly seen in ICU. Liver dysfunction contributes to a poor prognosis and high incidence of MODS in septic patients. The recovery rate of liver function is the lowest in septic patients with abnormaly high bilirubin level.

Key words: sepsis, liver dysfunction