54例抗结核药致儿童药物性肝损伤的临床特点及护理对策  

Clinical features and nursing measures of 54 children with drug-induced liver injury caused by antituberculosis treatment

作　　者：万彬 曾义岚 陈竹 陈丽 

机构地区：[1]成都市公共卫生临床医疗中心,成都610066

出　　处：《中国肝脏病杂志（电子版）》2016年第2期34-38,共5页Chinese Journal of Liver Diseases：Electronic Version

基　　金：国家"十二五"科技重大专项(2012ZX09303-001);四川省卫生和计划生育委员会科研课题(150035)

摘　　要：目的探讨抗结核药所致儿童药物性肝损伤(drug-induced liver injury,DILI)的临床特点,并提出有效的护理对策。方法回顾性分析2010年1月至2014年12月本院收治的54例抗结核药物所致DILI的结核病患儿的临床特点,总结护理措施。结果抗结核药物所致DILI的发生率为11.56%(54/467),以血行播散型肺结核的DILI发生率最高(20%,14/70)。54例患儿中,肝细胞型DILI最多见(48.15%,26/54),其次是胆汁淤积型(33.33%,18/54)及混合型(18.51%,10/54);肝细胞型DILI患儿的ALT水平最高(F=6.993,P=0.003),而胆汁淤积型DILI患儿的AST和TBil水平最高(F=3.884,P=0.031;F=3.884,P=0.001)。复治结核患儿与初治患儿相比,更易发生DILI,且服药至发病的时间更长(124.29天vs.37.52天;t=-5.093,P=0.000)。经治疗后,48例患儿治愈或好转(88.89%,48/54),6例患儿因病情恶化自动出院。基础护理和专科护理相结合的护理措施有助于早期发现DILI,提高依从性。结论临床医师应重视儿童抗结核治疗中不良反应的监测和综合护理,积极防治DILI。Objective To investigate the clinical features and nursing measures of children with drug-induced liver injury（DILI） caused by anti-tuberculosis（anti-TB） treatment. Methods Clinical features and nursing measures of 54 children with DILI caused by anti-TB treatment from January 2010 to December 2014 in Public Health Clinical Center of Chengdu were analyzed retrospectively and the nursing measures were summarized. Results The incidence of DILI caused by anti-TB treatment was 11.56%（54/467）, and in which the hematogenous TB was the most（20%, 14/70）. In the 54 cases, the most common type was hepatocellular damage type（48.15%, 26/54）, mixed type（33.33%, 18/54） and cholestasis type（18.51%,10/54） were followed by. The levels of ALT in children with hepatocellular damage type of DILI were the highest and the levels of AST and TBil in children with cholestasis type of DILI were the highest（F = 3.884, P = 0.031; F = 3.884, P = 0.001）. Compared with primary TB group, the incidence of DILI in recurrent TB group was higher, and the onset time was longer（124.29 d vs. 37.52 d; t =-5.093, P = 0.000）. After treatment, 48 children were cured or improved（88.89%, 48/54）, while 6 children discharged because of deterioration. Basic nursing combined with specialist nursing may help to detect DILI early and may improve the compliance. ConclusionClinicians should pay attention to adverse drug reaction monitoring and comprehensive nursing in order to prevent and cure DILI actively.

关 键 词：肝损伤 抗结核治疗 儿童 临床特点 护理 

分 类 号：R473.72[医药卫生—护理学]