Abstract:

Clinical characteristics and prognosis of liver dysfunction in patients with intra-abdominal infections: A report of 397 cases        GUO Kun，REN Jian-an，WANG Ge-fei，et al. Research Institute of General Surgery of PLA，Nanjing General Hospital of Nanjing Military Command of PLA; Clinical School of Medical College of Nanjing University，Nanjing 210002，China
Corresponding author：REN Jian-an，E-mail：jan@medmail.com.cn
Abstract    Objective    To investigate the clinical characteristics and prognosis of liver dysfunction (LD) in patients with intra-abdominal infections (IAIs). Methods    The clinical data of 397 patients with IAIs from January 2012 to January 2014 in Nanjing General Hospital of Nanjing Military Command of PLA were analyzed retrospectively. All the cases were classified as LD group (193 cases) and non-liver dysfunction (NLD) group (204 cases). The treatment and prognosis of all the cases were examined. Results    LD cases needed open abdomen management，CRRT，and mechanical ventilation were more frequent compared with NLD. Enteral nutrition was initiated later and TPN was applied longer in LD group (P<0.05). Admission and peak total bilirubin, alanine aminotransferase, aspartic transaminase, alkaline phosphatase, and glutamyl transpeptidase in LD group were significantly higher in survivors compared with non-survivors (P<0.05). Besides，the duration of hyperbilirubinemia in survivors was longer relatively. LD prolongs hospital and ICU length of stay (LOS)，increase 60-days and overall mortality compared with NLD (P<0.05). Kaplan-Meier survival analysis indicated that LD group had a significantly lower 60 d cumulative survival rate compared with NLD group (P=0.007). Conclusion    LD can prolong LOS and increase mortality in patients with IAIs. Early source control，early enteral nutrition and support of vital organ function are the important measures to solve the LD in patients with IAIs.

Key words: intra-abdominal infections, liver dysfunction, source control, enteral nutrition

摘要：

目的    探讨腹腔感染合并肝功能障碍（LD）的临床特点及其对病人预后的影响。方法    回顾性分析2012年1月至2014年1月南京军区南京总医院普通外科收治的397例腹腔感染病人的临床资料。根据是否合并LD分为LD组（193例）和非LD组（204例），对比分析两组病人的治疗及预后情况。结果    LD组病人实施机械通气、连续性肾脏替代治疗和腹腔开放疗法的比例相对更高，肠内营养（EN）开始时间相对较晚，肠外营养（TPN）使用时间更长，与非LD组病人比较差异均有统计学意义（P<0.05）。LD组死亡病人血清总胆红素和丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶和谷氨酰转肽酶的入院时检测值及住院期间最高值均高于存活病人，且其高胆红素持续时间相对更长，差异均有统计学意义（P<0.05）。LD组病人ICU时间、住院时间、60 d病死率、总病死率均高于非LD组，差异有统计学意义（P<0.05）。生存分析发现，LD组病人60 d累积存活率低于非LD组，差异有统计学意义（P=0.007）。结论    腹腔感染病人合并LD导致住院时间延长、病死率增高；早期控制感染源、实施EN和维护重要器官功能可能是治疗腹腔感染合并LD的重要措施。

关键词: 腹腔感染, 肝功能障碍, 感染源控制, 肠内营养