脓毒症相关肝损伤49例临床

论著

文章编号：1005-2208（2012）11-0916-03

脓毒症相关肝损伤49例临床分析

刘一娜，马晓春

【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1~23d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1~25d，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1~107d，机械通气时间9~ 1140h，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

中图分类号：R6文献标志码：A

Clinical analysis of sepsis-associated liver dysfunction:an analysis of49patients LIU Yi-na，MA Xiao-chun.

Department of Intensive Care Unit,the First Affiliated Hospital of China Medical University，Shenyang110001,China Corresponding author：MA Xiao-chun，E-mail：xcma2972@

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 of150septic patients admitted between January2010and December2010in Department of Intensive Care Unit,the First Affiliated Hospital of China Medical University were analyzed retrospectively.Among150patients,49patients（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 were17patients（34.7%）with abnormaly high bilirubin level，22patients（44.9%）with increasing glutamic-pyruvic transaminase,10patients（20.4%）with both increasing bilirubin and glutamic-pyruvic transaminase. The duration of liver dysfunction ranged from1to25days.In liver dysfunction group,the incidence of MODS was57.1%（28/49）.The fatality rate was34.7%（17/49）.ICU duration ranged from1to107days and mechanical ventilation duration was9to1140hours.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.

Keywords sepsis；liver dysfunction

脓毒症是由感染引发的机体过度炎性反应或炎症失控的动态过程，可导致多器官功能障碍［1］。目前关于脓毒症导致器官功能障碍，如急性肾功能衰竭、急性呼吸窘迫综合征（ARDS）、弥散性血管内凝血、感染性休克，均有明确的诊断标准，而肝功能障碍尚无准确定义及诊断标准，缺乏成人脓毒症相关肝损伤发生率的大样本前瞻性研究，已有的几项小样本回顾性研究调查的数据差异很大［2］。本研究对脓毒症病人的临床资料进行回顾性分析，旨在研究脓毒症相关肝损伤的临床特点及对病人预后的影响。报告如下。

作者单位：中国医科大学附属第一医院重症医学科，辽宁沈阳110001

通讯作者：马晓春，E-mail：xcma2972@