27例药物性肝衰竭的临床特点与护理

Clinical characteristics and nursing strategies of 27 patients with drug-induced liver failure

目的分析药物性肝损伤（drug—inducedliverinjury，DILI）所致肝衰竭（1iverfailure，LF）的病因和临床特点，并探讨相应的护理对策。方法筛选2011～2013年首都医科大学附属北京佑安医院出院诊断为DILI的病例，对其临床资料进行回顾性分析。结果共551例明确为DILI的患者纳入本研究，其中肝衰竭27例（4．9％），平均年龄（49．2～20．7）岁，女性占81．5％（22／27），高于非肝衰竭DILI患者中的女性比例（65．8％，P=0．092）；17例（63．0％）存在基础疾病；在护理工作中，要特别关注此类人群，对基础疾病进行针对性护理。患者临床症状和体征以乏力、食欲不振为主，并均出现黄疸，程度重于非肝衰竭组患者；临床护理中，要注意观察黄疸的变化，及时处理消化道症状。肝衰竭组患者最常见的并发症是腹水、细菌感染和肝性脑病；临床护理上密切观察病情变化，积极采取相应的护理措施。药物性肝衰竭总体预后不良，仅13例（48．1％）患者顺利恢复，且其中4（30．8％）例发展为慢性DILI；1例患者经肝移植后存活，7例（25．9％）未愈出院，6例（22．2％）在院内死亡；因此，要随时做好抢救准备，及时发现和处理并发症。结论药物性肝衰竭多发生于女性，尤其是有基础疾病的中老年女性，消化道症状明显，易出现腹水、细菌感染和肝性脑病等并发症，总体预后较差。在护理工作中，要重点关注此类人群，针对这些临床特点积极采取相应的护理措施。

Objective To analyze the etiologies and clinical characteristics of liver failure （LF） due to drug- induced liver injury （DILI）, and explore the corresponding nursing strategies. Methods From January 2011 to Decem- ber 2013, the patients diagnosed with DILF in Beijing Youan Hospital Affiliated to Capital Medical University were retro- spectively analyzed. Results A total of 551 individuals were deemed by expert opinion to have DILI and enrolled in this study. 27 cases with LF （4. 9% ） were identified, mean age was （49.2_＋20. 7）. The percentage of women was 81.5% （22/27） , which was higher than the percentage of non-hepatic carcinoma failure （65.8% , P= 0. 092 ） ; 17 cases （63.0%） had basic diseases. Therefore, in the nursing work, special attention should be paid to this population and targeted nursing should be performed according to the basic diseases. The major clinical symptoms and signs included fa- tigue and anorexia. All the patients had jaundice and the degrees of jaundice were more serious than the patients without LF. In the clinical nursing, the jaundice should be closely observed and the gastrointestinal symptoms should be timely treated. The most common complications were ascites, bacterial infection and hepatic encephalopathy. The patient/s con- ditions should be observed closely and corresponding nursing measures should be adopted in time. The overall prognosis of patients with LF due to DILI was poor. Only 13 （48.1%） survived after drug withdrawal, with 4 （30. 8% ） chronic DILI developed, 1 accepted successful transplantation, 7 （25.9%） gave up treatments because of the serious situa- tions and 6 （22.2%） died in the hospital. Therefore, the nurses should get ready for first aid at any time and find the complications and take measures without delay. Conclusion The majority of patients with LF due to DILF are women, especially middle-aged women with basic diseases. The patients usually have significant gastrointestinal symptoms and prone to some complications such as ascites, bacterial infection, hepatic encephalopathy and so on. The overall prognosis is poor. In the nursing work, this population should be focused on and corresponding nursing measures should be taken actively according to the clinical characteristics.