急诊脓毒症患者入院时肝功能特征分析  

Analysis of liver function characteristics in patients with sepsis admitted to emergency department

作　　者：白郑海[1] 时雨 王海[1] 裴红红[1] 吕俊华[1] BAI Zhenghai;SHI Yu;WANG Hai;PEI Honghong;LV Junhua(Department of Emergency,the Second Affiliated Hospital of Xi'an J iaotong University,Xi'an,710004,China)

机构地区：[1]西安交通大学第二附属医院急诊科,西安710004

出　　处：《临床急诊杂志》2018年第11期771-774,共4页Journal of Clinical Emergency

摘　　要：目的:分析急诊脓毒症患者入院24h内的肝功能指标特征,探讨脓毒症早期肝功能变化特点。方法:回顾性收集2016-02—2017-02期间我科住院部收治的299例脓毒症患者临床资料,根据肝功能是否受损分为急性肝损伤组(92例)和非急性肝损伤组(207例)。收集患者入院24h内肝功能、血常规、肾功能、电解质等指标并作统计学分析。结果:脓毒症患者第1个24h内急性肝损伤的发生率为30.77%,急性肝损伤组与非急性肝损伤组患者相比,急性肝损伤组患者男性患者比例更大;两组间在年龄、吸烟史、饮酒史、基础病等方面差异无统计学意义;两组组间肾功能、凝血指标、血小板计数的差异有统计学意义,急性肝损伤组与非肝损伤组患者在是否发生休克、qSOFA评分上差异有统计学意义。按qSOFA评分(0~3分)分组,各组肝功能指标的比较提示:脓毒症患者肝功能损伤表现为以总胆红素、间接胆红素升高为主,而各组间谷丙转氨酶、谷草转氨酶的差异在统计学上无意义。结论:脓毒症早期即可引起急性肝损伤,其所致肝损伤以总胆红素、间接胆红素升高为主,且与脓毒症的严重程度一致。Objective:Analyze the related indicators of liver function in sepsis patients after admission within 24 hours,then discuss the characteristics of early liver function changes in sepsis.Method:The clinical data of 299 sepsis patients who were admitted to the emergency department of the Second Affiliated Hospital of Xi’an Jiaotong University from February 2016 to February 2017 were retrospectively collected.According to the liver function the patients were divided into acute liver injury group(n=92)and non-acute liver injury group(n=207).The liver function,blood routine,renal function,electrolytes and other indicators within 24 hours after admission were collected.Result:The acute liver injury in sepsis patients was 30.77% within the first 24 hours.Compared with the non-acute liver injury group,the acute liver injury group had a higher proportion in male patients.The differences in age,smoking history,drinking history,and underlying diseases were not statistically significant.The differences in renal function,coagulation parameters,and platelet levels between the two groups were statistically significant.The incidence of shock and qSOFA between the acute liver injury patients and non-liver injury patients were significantly different.According to the qSOFA score(0-3 points)and the comparison of liver function indexes in each group,it suggested that the acute liver injury patients with sepsis is mainly due to the increase of total bilirubin and indirect bilirubin,the difference in ALT and AST was not significant.Conclusion:The acute liver injury patients with sepsis was mainly due to the increase of total bilirubin and indirect bilirubin,and the severity of sepsis were related with that.

关 键 词：脓毒症 急性肝损伤 quick SOFA评分 

分 类 号：R459.7[医药卫生—急诊医学]