重症加强治疗病房肝衰竭患者的临床特征及生存分析  

Clinical features and survival analysis of patients with liver failure in intensive care unit

作　　者：牛丹[1] 张倩楠 白惠惠 NIU Dan;ZHANG Qian-nan;BAI Hui-hui(Department of Intensive Care Unit,Shaanxi Provincial People’s Hospital,Xi’an 710000,China)

机构地区：[1]陕西省人民医院重症医学科,西安710000

出　　处：《肝脏》2023年第4期410-415,共6页Chinese Hepatology

摘　　要：目的分析重症加强治疗病房肝衰竭患者的病因、临床特征、人工肝治疗和预后相关影响因素。方法采用回顾性研究将2019年1月-2021年12月陕西省人民医院重症医学科收治的140例接受人工肝治疗的肝衰竭患者作为研究对象,对其病因、实验室检查、主要并发症/合并症、人工肝治疗的模式、时机及预后相关影响因素进行分析。结果接受人工肝治疗的肝衰竭患者共140例,随访60 d生存组73例(52.1%),死亡组67例(47.9%)。2组患者年龄(t=-2.325,P=0.022)、住院时间(t=-3.439,P=0.001)、病因(χ^(2)=50.239,P<0.001)、肝衰竭分类(χ^(2)=12.779,P=0.002)差异有统计学意义;生存组患者的APACHEⅡ评分(t=-6.792,P<0.001)、终末期肝病模型(MELD)(t=-4.079,P<0.001)、总胆红素(TBil)(t=-3.115,P=0.002)、国际标准化比值(INR)(t=-3.839,P<0.001)、血肌酐(SCr)(t=-2.408,P=0.018)、尿素(UREA)(t=-2.042,P=0.043)、白细胞计数(WBC)(t=-4.853,P<0.001)、降钙素原(PCT)(Z=-3.110,P=0.002)均显著低于死亡组,凝血酶原活动度(PTA)(t=3.443,P=0.001)显著高于死亡组(P<0.05);生存组患者急性肾损伤的发生率(χ^(2)=7.312,P=0.007)显著低于死亡组;肝性脑病和电解质紊乱的发生率两组之间差异无统计学意义(P>0.05);两组患者分别行胆红素吸附(PBA)、血浆置换(PE)、双重血浆分子吸附(DPMAS)及双重血浆分子吸附联合血浆置换(DPMAS+PE)4种不同模式人工肝治疗,其人工肝治疗模式差异无统计学意义(P>0.05),但两组患者接受人工肝治疗时期的差异有统计学意义(χ^(2)=10.419,P=0.005);经多因素COX回归模型分析发现,年龄(HR=1.04,95%CI 1.017~1.065,P=0.001)、肝衰竭晚期(HR=4.889,95%CI 1.103-21.676,P=0.037)、APACHEⅡ评分(HR=1.085,95%CI 1.032-1.141,P=0.001)、INR(HR=3.089,95%CI 1.178-8.097,P=0.022)、TBil(HR=1.006,95%CI 1.002~1.01,P=0.006)、SCr(HR=1.011,95%CI 1.001~1.021,P=0.032)、PCT(HR=1.023,95%CI 1.006-1.04,P=0.009)是影响患者预后的独立危险因素。结论不同�Objective To investigate etiology,clinical characteristics,artificial liver treatment and prognosis-related influencing factors of patients with liver failure in intensive care unit(ICU).Methods A retrospective study was used to analyze the etiology,laboratory tests,major complications/comorbidities,mode and timing of artificial liver therapy and prognosis-related influencing factors in 140 patients with liver failure who received artificial liver therapy in our hospital.Results A total of 140 patients with liver failure who received artificial liver support system were followed up for 60 days,73 patients(52.1%)in the survival group and 67 patients(47.9%)in the death group.There were statistically significant differences in age(t=-2.325,P=0.022),length of stay(t=-3.439,P=0.001),etiology(χ^(2)=50.239,P<0.001)and classification of liver failure(χ^(2)=12.779,P=0.002)between the two groups(P<0.05).APACHEⅡscore(t=-6.792,P<0.001),end-stage liver disease model(MELD)(t=-4.079,P<0.001),total bilirubin(TBil)(t=-3.115,P=0.002),international standardized ratio(INR)(t=-3.839,P<0.001),serum creatinine(SCr)(t=-2.408,P=0.018),urea nitrogen(UREA)(t=-2.042,P=0.043),white blood cell(WBC)(t=-4.853,P<0.001)and procalcitonin(PCT)(Z=-3.11,P=0.002)in survival group were significantly lower than those in death group.Prothrombin activity(PTA)(t=3.443,P=0.001)was significantly higher than that in death group(P<0.05).The incidence of acute kidney injury(χ^(2)=7.312,P=0.007)in survival group was significantly lower than that in death group(P<0.05).There was no significant difference in the incidence of hepatic encephalopathy and electrolyte disorder between the 2 groups(P>0.05).Patients in the 2 groups underwent bilirubin adsorption(PBA),plasma exchange(PE),dual plasma molecular adsorption(DPMAS)and dual plasma molecular adsorption combined with plasma exchange(DPMAS+PE)in four different modes of artificial liver treatment,and the difference in their artificial liver treatment modes was not statistically significant(P>0.05),but there wa

关 键 词：肝衰竭 人工肝 生存分析 

分 类 号：R575.3[医药卫生—消化系统]