入住ICU失代偿性血吸虫性肝硬化和酒精性肝硬化患者临床特征和预后分析  

The Clinical characteristics and prognosis of patients with decompensated schistosomiasis cirrhosis or decompensated alcoholic cirrhosis in ICU

作　　者：余利美 汪月霞 张恺 汪叶松[2] 余兆 罗建[3] 李建纲 刘享平 崔巍[2] 张根生[2] Yu Limei;Wang Yuexia;Zhang Kai;Wang Yesong;Yu Zhao;Luo Jian;Li Jiangang;Liu Xiangping;Cui Wei;Zhang Gensheng(Department of Critical Care Medicine,Kaihua People’s Hospital,Quzhou 324300,Zhejiang,China;Department of Critical Care Medicine,Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,Zhejiang,China;Department of Critical Care Medicine,Quzhou People’s Hospital,Quzhou 324000,Zhejiang,China)

机构地区：[1]浙江省开化县人民医院重症医学科,324300 [2]浙江大学医学院附属第二医院重症医学科,杭州310009 [3]浙江省衢州市人民医院重症医学科,浙江衢州324000

出　　处：《中华急诊医学杂志》2020年第10期1348-1353,共6页Chinese Journal of Emergency Medicine

摘　　要：目的重症医师对入住重症监护室(ICU)失代偿性血吸虫性肝硬化(decompensated schistosomiasis cirrhosis,DSC)患者的认识和治疗经验相对不足,而对失代偿性酒精性肝硬化(decompensated alcoholic cirrhosis,DAC)认识相对较多。为此,本研究比较入住ICU的DSC和DAC患者的临床特征及预后。方法回顾性分析本院和衢州市人民医院在2013年1月至2019年5月期间入住ICU的DSC和DAC患者,记录和分析两组基本资料、实验室检查、肝功能、Child-Pugh分级、并发症、超声影像学特征及胃镜检查结果以及预后。结果共收集DSC患者30例(男12例,女18例),年龄为57~88岁;DAC患者31例,均为男性,年龄为41~75岁。与DAC患者相比,DSC患者更易合并冠心病,而黄疸发生、低钠血症、肝性脑病以及呼吸机使用比例均显著降低(P均<0.05),但两者肝功能和凝血谱等差异无统计学意义(P均>0.05)。与DAC患者相比,DSC患者B超更多表现为斑片状及弥漫性回声改变和肝脏体积缩小(P<0.05),而两组患者胃镜特征表现相似。治疗上,两组生长抑素使用比例以及时间、三腔二囊管使用比例以及时间、胃镜下止血比例、血管活性药物使用比例以及剂量等差异无统计学意义(P均>0.05)。经过治疗后,两组患者消化道出血停止时间[1.75(1~2.375)d vs.1.25(0.5~4.125)d]、ICU入住时间[(3.82±1.99)d vs.(4.96±3.58)d]以及28 d病死率[18.18%vs.14.29%],差异无统计学意义(P均>0.05)。结论总体上,入住ICU失代偿性血吸虫性肝硬化与失代偿性酒精性肝硬化患者临床特征、生化指标与辅助检查结果如超声和胃镜等相似;经过积极治疗,两者预后均较好。Objective Intensive physicians have relatively insufficient knowledge and experience in treating patients with decompensated schistosomiasis cirrhosis(DSC)admitted in intensive care unit(ICU),but are relatively familiar with patients with decompensated alcoholic cirrhosis(DAC).For this purpose,the clinical characteristics and prognosis of these patients were compared and analyzed.Methods A retrospective analysis was performed from January 2013 to May 2019 in our hospital and Quzhou People’s hospital.The demographic data,laboratory examination,liver function,Child-Pugh classification,complications of cirrhosis,ultrasonic imaging gastroscopy manifestations were recorded and analyzed.In addition,the treatments and prognosis were also compared.Results A total of 30 patients(12 males and 18 females)with DSC(aged 57-88)and 31 patients with DAC(aged 41-75)were collected.Compared with patients with DAC,DSC patients were more likely to have coronary heart disease,lower proportion of hyponatremia and lower need of ventilator support.Although the incidences of jaundice and hepatic encephalopathy were significantly reduced(P<0.05),but parameters of liver function and coagulation were no significant differences in both groups(P>0.05).B-mode ultrasound of liver in patients with DSC displayed more proportion of patchy and diffuse echo changes and liver volume reduction(P<0.05),whereas the manifestations of gastroscope in both groups were similar.No significant difference in main treatment measures like uses of somatostatin and three-chamber and two-capsule tube was observed.After treatment,the stop time of gastrointestinal bleeding was similar between groups of DAC and DSC[1.25(0.5-4.125)days vs.1.75(1-2.375)days](P>0.05).In addition,the length of ICU stay in DAC group was similar to DSC group[(4.96±3.58)days vs.(3.82±1.99)days],so did the 28-day mortality[14.29%(2/14)vs.18.18%(2/11)](both P>0.05).Conclusions In genenal,patients with decompensated schistosomiasis cirrhosis have the similar clinical characteristics,major bio

关 键 词：重症医学科(ICU) 失代偿性血吸虫肝硬化 失代偿性酒精性肝硬化 临床特征 预后 

分 类 号：R575.2[医药卫生—消化系统]