肝硬化腹水并发肝肾综合征的医源性因素

latrogenic factors for the percipitation of hepatorenal syndrome in cirrhotic patients with ascites

目的分析各种医源性因素在肝硬化腹水并发肝肾综合征患者中的不良影响,以便更好地加强医院管理及指导临床。方法 2005年8月至2010年10月在建湖县第三人民医院住院的142例慢性乙型肝炎肝硬化腹水患者,将其中26例同时并发肝肾综合征的患者设为研究组,其余116例未并发肝肾综合征的患者设为对照组。回顾性分析2组一般资料及14种医源性因素:大量放腹水;院内感染;良好的医患沟通;肾毒性药物的使用;强力利尿;血容量纠正不足;腹部穿刺后局部感染;限钠饮食的标准;电解质紊乱发现与纠正的及时性;合并其他疾病的漏诊;降低门静脉高压药物的使用;低蛋白血症纠正的及时性;使用非甾体抗炎药;使用血管紧张素转化酶抑制剂、血管紧张素Ⅱ受体拮抗剂、α1肾上腺素受体阻滞剂。结果研究组与对照组在良好的医患沟通、合并其他疾病的漏诊两方面差异无统计学意义(P>0.05)。研究组与对照组在院内感染、肾毒性药物的使用、强力利尿、腹部穿刺后局部感染方面差异有统计学意义(P<0.01)。在大量放腹水血容量纠正不足,限钠饮食的标准,使用非甾体抗炎药,降低门静脉高压药物的使用,低蛋白血症纠正的及时性,电解质紊乱发现与纠正的及时性,使用血管紧张素转化酶抑制剂、血管紧张素Ⅱ受体拮抗剂、α1肾上腺素受体阻滞剂等方面差异亦有统计学(P<0.05)。结论对肝硬化腹水患者而言,不良的医源性因素极易诱发肝肾综合征。

Objective To analyze the adverse effect of various iatrogenic factors on the complication of hepatorenal syndrome in cirrhotic patients with ascites in order to improve the hospital management and clinical care. Methods One hundred and forby two cases of cirrhotic hepatitis B patients with aseites admitted in the Third People Hospital of Jianhu County within August 2005 and October 2010 were reenrolled in the study. All patients were divided into the study group （n = 26） and control group （n = 116） according whether the patients have hepatorenal syndrome or not. General data were collected and 14 iatrogenic factors were analyzed including large amount of paracentesis, hospital acquired infection, better physician-patient communication, renal toxic drugs, the use of potent diuretic, insufficient supplement for the hypovolemia, local infection post abdominocentesis, criteria for sodium restricted diet, the identification and correction of electrolyte disturbances, mis-diagnosis of other complicated diseases, medicine to lower portal hypertension, the prompt replenishment of hypoalbuminemia, the use of non-steroid anti-inflammatory drugs, the use of angiotensin converting enzyme inhibitor, angiotensin II receptor antagonist and a-adrenaline receptor antagonist were analyzed retrospectively. Results There was no significant difference on the extent of physician-patient communication and the misdiagnosis rate of the other diseases within patients in the study group and the control group（P〉0.05）, whereas significant differences were in the study and control group on hospital infection, the use of renal toxic drugs, potent diuretic therapy and local infection post paracentesis（P〈0.01）. The differences on the aspects of insufficient replenishment of blood volume post large amount of paraeentesis, criteria for sodium restricted diet, the use of non-steroid anti-inflammatory drugs and the medicine to lower portal hypertension, the prompt replenishment of hypoalbuminemia, the identification and correction of electrolyte disturbance, and the use of angiotensin converting enzyme inhibitor, angiotensin Ⅱ receptor antagonist and aadrenaline receptor antagonist were also significantly different（P〈0.05）. Conclusion The patients with cirrhotic ascites are prone to hepatol-renal syndrome under the predisposition of undesirable iatrogenic factors.