CAJ | 학술논문

目的：探讨肝硬化患者并发缺血性肝炎的临床特点。方法对2008年1月—2013年6月大连市第六人民医院重症监护病房（IC U ）收治的30例肝硬化并发缺血性肝炎患者的临床资料进行回顾性分析。结果发生缺血性肝炎的患者占同期IC U收治患者的1．6％。原发基础疾病包括肝硬化基础上出现的低血容量休克、重度脓毒血症、慢性心力衰竭急性发作、急性呼吸窘迫综合征，监测到患者缺血发生后血清丙氨酸氨基转移酶（ALT）及天冬氨酸氨基转移酶（AST）均急剧升高，并有不同程度的白蛋白（ALB）水平明显下降。治疗针对基础疾病，在护肝治疗的同时，积极纠正休克、抗感染、纠正心力衰竭、呼吸衰竭及加强支持治疗。病死率为66．7％（20／30），其中Child‐Pugh C级患者病死率明显高于A、B级。结论发病的主要诱因有低血容量休克、重度脓毒血症、心力衰竭及呼吸衰竭；典型的实验室检查特点主要为血清ALT在发病后急剧升高，经治疗后可短期内降至正常为缺血性肝炎患者典型的实验室表现，本病病死率较高，Child‐Pugh C级患者病死率尤其高。
목적：탐토간경화환자병발결혈성간염적림상특점。방법대2008년1월—2013년6월대련시제륙인민의원중증감호병방（IC U ）수치적30례간경화병발결혈성간염환자적림상자료진행회고성분석。결과발생결혈성간염적환자점동기IC U수치환자적1．6％。원발기출질병포괄간경화기출상출현적저혈용량휴극、중도농독혈증、만성심력쇠갈급성발작、급성호흡군박종합정，감측도환자결혈발생후혈청병안산안기전이매（ALT）급천동안산안기전이매（AST）균급극승고，병유불동정도적백단백（ALB）수평명현하강。치료침대기출질병，재호간치료적동시，적겁규정휴극、항감염、규정심력쇠갈、호흡쇠갈급가강지지치료。병사솔위66．7％（20／30），기중Child‐Pugh C급환자병사솔명현고우A、B급。결론발병적주요유인유저혈용량휴극、중도농독혈증、심력쇠갈급호흡쇠갈；전형적실험실검사특점주요위혈청ALT재발병후급극승고，경치료후가단기내강지정상위결혈성간염환자전형적실험실표현，본병병사솔교고，Child‐Pugh C급환자병사솔우기고。
Objective To explore the clinical characteristics of liver cirrhosis patients complicated with ischemic hepatitis . Methods The clinical data were reviewed retrospectively for 30 cirrhosis patients complicated with ischemic hepatitis from January 2008 to June 2013 in the intensive care unit of Dalian Sixth People′s Hospital .Results Ischemic hepatitis was identified in 1 .6% of the patients treated at the same period in ICU .In addition to the underlying disease including cirrhosis ,the patients also showed hypovolemic shock ,severe sepsis ,acute attack of chronic heart failure and acute respiratory distress syndrome . Acute increase of serum alanine aminotransferase(ALT) and aspartate aminotransferase(AST) was also reported in association with significant decrease of albumin .The patients were treated with comprehensive measures targeting shock ,infection ,heart failure ,respiratory failure ,and relevant symptoms .The overall mortality was 66 .7% (20/30) .The mortality was significantly higher in Child‐Pugh C cirrhotic patients than Child‐Pugh A or B patients .Conclusions The ischemic hepatitis in association with liver cirrhosis is mainly induced by hypovolemic shock ,severe sepsis ,heart failure ,and respiratory failure .Typical laboratory findings are sharp elevation of serum ALT and normalization after treatment . Liver cirrhosis complicated with ischemic hepatitis features high mortality ,particularly in Child‐Pugh C cirrhosis .