1892例肝衰竭患者并发症及死亡原因分析

Analysis of complications and death causes of 1892 patients with liver failure

目的探讨肝衰竭的并发症和死亡原因及两者之间的关系。方法回顾性总结1892例肝衰竭患者的临床资料,对年龄、性别、病因、并发症和临床转归等方面进行比较分析。结果 1892例患者中,男性1206例(63.74%),女性686例(36.26%),平均年龄(48.9±11.3)岁;肝衰竭病因主要为乙型肝炎病毒感染(1319例,69.7%)、HEV感染102例(5.4%)、药物(102例,5.4%)、酒精(89例,4.7%)和不明原因(107例,5.7%);1543例(81.6%)患者发生了肝衰竭相关的并发症,包括感染、出血、肝性脑病、肝肾综合征和脑水肿,发生率分别为69.82%、30.97%、23.04%、16.97%和2.59%;急性肝衰竭患者在肝性脑病、肝肾综合征和脑水肿的发生率分别为77.14%,45.71%和20.0%,发生率均明显高于其它几型肝衰竭(P<0.05);发生脑水肿的49例患者死亡率为100%,发生肝肾综合征的291例患者死亡率为90.65%;1092例发生一种并发症的患者死亡率为62.09%,288例发生两种并发症的患者死亡率为78.47%,163例患者发生3种及3种以上并发症的患者死亡率高达98.16%。结论肝衰竭易发生并发症,感染是肝衰竭患者最常见的并发症,脑水肿和肝肾综合征是最严重的并发症;肝衰竭患者的死亡率随并发症增多而升高。

Objective To investigate the complications and death causes,and their relationship,in patients with liver failure. Methods The age,gender,etiology,complication,and prognosis of the 1892 patients with liver failure were retro-prospectively analyzed. Results There were 1206（63.74%） cases of male and 686 cases（36.26%） of female included in this study,with an average age of （48.9±11.3） years;The major causes of liver failure in-cluded hepatitis B virus infection （1319,69.7%）,hepatitis E virus infection （102,5.4%）,drug-induced liver injury （102,5.4%）,alcohol （89,4.7%）and unknown etiology（107,5.7%）;A total of 1543 patients with liver failure suf-fered from complications including infection,hemorrhage,hepatic encephalopathy,hepatorenal syndrome,and en-cephaledema,and their incidence were 69.82%,30.97%,23.04%,16.97%,and 2.59%,respectively;The incidences of hepatic encephalopathy （77.14%）,hepatorenal syndrome （45.71%）,and encephaledema （20.0%） were significantly higher in patients with acute liver failure than all other kinds of liver failure （P〈0.05）;The mortality of patients with encephaledema was 100%,while the mortality of patients with hepatorenal syndrome was 90.65%;The mortality of 1092 patients with one complication was 62.09%,and 288 patients with two complications was 78.47%;Further-more,the mortality of 163 patients with three or more complications was up to 98.16%. Conclusion Patients with liver failure was prone to suffering from complications,and the most common complication was infection,while the worst complications were encephaledema and hepatorenal syndrome;The mortality of patients with liver failure in-creases with the numbers of complications.