141例药物性肝衰竭临床特征及护理策略

目的了解药物性肝衰竭的临床特征、预后,并探讨其护理对策。方法回顾性总结141例药物性肝衰竭患者的临床资料,分析其药物种类、并发症、预后等相关指标。结果女性发生药物性肝衰竭比例高于男性,发病年龄以青中年为主。服药基础疾病前三位的是皮肤病、结核病和上呼吸道感染。引起肝衰竭的前4类药物分别是中药、抗生素、解热镇痛药、抗结核药。141例肝衰竭患者治愈21例(14.9%),好转33例(23.4%)、无效72例(51.1%)、死亡15例(10.6%)。最常见的并发症前三位是胸、腹水,电解质紊乱和肝性脑病。影响预后的并发症为肝性脑病,低钠血症,脑水肿,消化道出血,感染性休克和失血性休克。结论药物性肝衰竭的预后较差,病死率较高。采取相应的护理措施,对于预防和控制并发症的发生具有重要意义。     

慢加急性乙型肝炎肝衰竭并发症与预后的关系研究

选取93例慢加急性乙型肝炎肝衰竭患者的临床资料进行回顾性分析,统计分析患者并发症发生情况及预后。93例慢加急性乙型肝炎肝衰竭患者中36例伴发继发性细菌感染,占38.7%;33例伴发肝肾综合征,占35.5%;11例伴发消化道出血,占11.8%;29例伴发肝性脑病,占31.2%。伴发这些并发症的患者,其好转率均远低于无并发症患者,差异均具有显著统计学意义（P〈0.05）。继发性细菌感染、肝肾综合征、消化道出血、肝性脑病等并发症的出现导致慢加急性乙型肝炎肝衰竭预后较差,临床上应合理预防并对症治疗慢加急性乙型肝炎肝衰竭并发症,改善预后,缓解患者症状,提高治愈率。     

以肝外表现首发的药物性肝损伤临床特征及误诊分析

目的分析以肝外表现为首发症状的药物性肝损伤(drug-induced liver injury,DILI)的临床特点及误诊原因,以早期识别DILI、降低肝衰竭风险。方法回顾性分析我院急诊科2017年3月—2018年3月收治的以肝外表现首发的29例DILI临床资料。结果本组占同期收治DILI患者的22. 3%(29/130)。首发表现为发热10例,皮疹、关节疼痛各5例,肌肉疼痛4例,胸闷3例,高血糖、失眠各1例。29例中5例(17. 2%)误诊,误诊为肺部感染3例,药物过敏、类风湿关节炎各1例。29例经全面检查发现肝功能异常,排除器质性肝脏疾病,明确用药史后确诊为DILI。引起DILI的药物有抗结核药物、抗肿瘤药物、抗感染药物。确诊后及时停药,积极给予保肝及对症处理均恢复,无死亡病例。结论 DILI发病率愈来愈高,部分患者以肝外表现首发,临床表现不典型,临床医师需注意鉴别,确诊后及时妥善处理,以免引起急性肝衰竭。     

1例慢加急性肝衰竭(中期)合并肺部感染患者的护理

正慢加急性(亚急性)肝衰竭(acute-on-chronic liver failure,ACLF)是指在慢性肝病基础上,短期内发生急性或亚急性肝功能失代偿的临床症候群,表现为:1极度乏力,有明显的消化道症状;2黄疸迅速加深,血清TBil大于正常值上限10倍或每日上升≥17.1μmol/L;3出血倾向,PTA≤40%(或INR≥1.5),并排除其他原因者;4失代偿性腹水;5伴或不伴有肝性脑病[1]。慢加急性(亚急性)肝衰竭(acute-on-chronic liver failure,ACLF)     

合并慢性乙型肝炎病毒感染的药物性肝损伤的临床特点分析

目的探讨合并慢性乙型肝炎病毒感染的药物性肝损伤的临床特点。方法回顾我院收治的96例药物性肝损伤患者的临床资料,分为单纯药物性肝损伤组(DILI组,n=50)和合并乙型肝炎病毒感染的药物性肝损伤组(DILI+HBV组,n=46),对比分析两组的临床特点。结果 DILI+HBV组年龄小于DILI组,损伤类型以肝细胞型为主、混合型次之,且病情较DILI组重(P 0. 05)。两组造成肝损伤的药物均主要为中药、抗感染药和解热镇痛药,临床症状均主要表现为乏力、黄疸、恶心、腹胀及食欲不振。结论合并慢性乙型肝炎病毒感染的药物性肝损伤病情较单纯性肝损伤重,但其致损伤药物类型及临床症状与单纯药物性肝损伤相比没有特异性。     

原发性胆汁性肝硬化101例的观察与护理

目的：分析原发性胆汁性肝硬化患者的临床特征和护理需求,提出相关临床护理对策。方法：对101例原发性胆汁性肝硬化疾病转归进行回顾性分析。结果：早期临床症状为黄疸、乏力、皮肤瘙痒;晚期出现门静脉高压,腹水和食管胃底静脉曲张,上消化道出血和肝性脑病。结论：应提高对中年女性,症状为黄疸,乏力,血清碱性磷酸酶、谷氨酰转肽酶水平显著升高及转氨酶轻度增高患者的重视,应用整体护理促进患者康复。     

急性药物性肝损伤64例临床分析

目的探讨64例急性药物性肝损伤（drug-induced liver injury,DILI）患者的临床特征。方法采用回顾性分析法对64例急性DILI住院患者的用药史、临床表现及治疗转归进行分析。结果多种药物均可引起急性DILI,以抗结核药物为主,占23.4%,其次为中药23.4%,抗菌药11.0%;临床类型为肝细胞型多见,占84.4%,胆汁淤积型占11.0%,混合型占4.7%;主要临床表现有纳差、乏力、黄疸、恶心、呕吐等;绝大多数患者治疗后预后较好,但重症患者仍可危及生命。结论多种药物均可引起急性DILI,以抗结核药和中药为主;急性DILI以肝细胞损伤型最为常见;大多患者预后良好,但重症患者仍可危及生命。     

7例肝细胞体内移植患者临床护理需求的探讨

目的 观察肝细胞体内移植术的有效性与安全性,探讨相应的护理需求.方法 从自愿捐献者的肝脏内分离纯化肝细胞,制成悬液,经股动脉插管行脾动脉灌注移植,观察治疗后肝衰竭患者的肝功能恢复率、恢复时间、治疗不良反应及患者心态变化,针对不良反应及患者心理给予完善护理,建立肝细胞体内移植术护理规范.结果 7例肝衰竭患者治疗后,4例临床治愈,有效率为57.1%,胆红素、凝血酶原活动度改善50%以上的发生时间约在术后4周.术后患者不同程度出现恶心、呕吐(57.1%),少量腹水(57.1%),肝性脑病(42.9%),发热(42.9%),穿刺点皮下血肿(28.6%),肺部真菌感染(14.3%).术后71.4%的患者有焦虑情绪.经过相应的临床及心理护理,症状均有不同程度的改善.结论 肝细胞体内移植可延长终末期肝病患者生存期,但病情明显改善所需时间约4周,防治肝性脑病、预防穿刺点皮下血肿及运用心理护理消除患者焦虑情绪是重要的护理需求.     

肝性脑病25例临床护理

2005年6月～2007年12月,我们对25例肝性脑病患者给予精心护理,效果满意.现将护理体会报告如下. 1 临床资料 本组25例,均符合肝性脑病诊断标准.男18例,女7例,平均52岁.其中16例为诱因明确且易消除者,7例有腹水、黄疸、出血倾向,2例因暴发性肝衰竭致肝性脑病.     

人工肝治疗前健康宣教的现状和展望

<正>肝衰竭是由多种因素引起的肝细胞大块、亚大块坏死或严重损害,导致其合成、解毒、排泄和生物转化等功能发生严重障碍或失代偿,出现以黄疸、凝血功能障碍、肝性脑病和腹水等为主要表现的一种临床症候群[1]。急性肝衰竭内科治疗的治愈率不超过20%[2-3]。人工肝支持系统(artificial liver support system,ALSS)一直被认为是治疗肝衰竭的有效方法[4]。ALSS即借助人工干预     

Hospice palliative care for patients with hepatocellular carcinoma in Taiwan

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death in Taiwan. In order to delineate the unique demographic features and clinical profile of terminal HCC, we conducted a retrospective study in a hospital-based hospice in Taiwan. Of a total of 991 terminally ill cancer patients (654 men and 337 women, mean age 66.1 years) admitted to our palliative care unit during a three-year period, 110 patients (11.1%) were diagnosed as having HCC (93 men and 17 women, mean age 60.5 years). The most common metastatic sites were bone and lung. Eighty-five HCC patients (77.3%) also had associated liver cirrhosis. The most common symptoms of HCC patients upon admission to the hospice ward were pain, fatigue or weakness, anorexia/vomiting, peripheral edema, cachexia, and ascites. Hypoalbuminemia, anemia, hyponatremia and jaundice were common laboratory abnormalities. Eighty-four patients (76.4%) required opiates for pain management. Upper gastrointestinal bleeding or varices bleeding developed in 76 patients (69.1%). Ninety-four patients (85.5%) died at the hospital, and the overall median survival time at hospice ward was 12 days. Because of more severe underlying portal hypertension and deteriorated liver function, terminal HCC patients with decompensated liver cirrhosis (Child-Pugh class C) had a significantly higher prevalence of peripheral edema, ascites, dyspnea, jaundice, thrombocytopenia, and stage III-IV hepatic encephalopathy than noncirrhotic or Child-Pugh class A and B terminal HCC patients. Symptoms and signs resulting from these portal hypertensions frequently complicated the symptomatic management of terminal HCC patients in the hospice ward. The treatment of these complications is mostly empirical in hospice ward, where intensive laboratory or diagnostic tests are usually not performed. In conclusion, symptoms and signs of terminally ill HCC patients in hospice are unique and should be managed appropriately.     

Symptoms in the host: infection and treatment model

Aims and objectives. The aim is to devise a decision‐making model to help nurses and allied professionals treat the symptoms of infectious diseases in a logical way that maximizes the benefits of symptoms and minimizes any harm that they might do. Background. This paper considers the symptoms of infectious diseases from an evolutionary perspective, applying theories from ecology and evolution to nursing. Building upon evolutionary theories that suggest symptoms occur as the result of host defences, pathogen manipulations or as pure side‐effects, it is suggested that those symptoms that have evolved as host defences should not always be treated because of their beneficial effects. However, clinical decision‐making is more complex because of the rapid changes in environment and behaviour, which may impact upon the usefulness of symptoms to the host. Conclusions. Although some symptoms can be identified as being beneficial adaptations, this alone is not sufficient indication to decide which symptoms should or should not be treated. Other considerations include any negative outcomes and behavioural and environmental changes that may affect the significance of any adaptation. Relevance to clinical practice. Nurses should aim to maximize the host defences of the patients they are caring for in order to speed recovery and to reduce transmission and the need for antibiotics. This model helps nurses to identify factors that should be considered when these decisions are made and suggests some principles that might be followed in other situations.     

经皮肝穿刺胆道内支架植入治疗恶性胆道梗阻术后并发症的护理

总结了恶性胆道梗阻经皮肝穿刺胆道内支架植入术后并发症的观察和护理.32例患者中,8例出现术后并发症,包括胆道出血2例、胆道感染4例、气胸1例、胆漏1例.经过周密观察和护理,患者安全度过固手术期,生存质量明显改善.     

Successful treatment of drug‐induced acute liver failure with high‐volume plasma exchange

We report two patients with drug‐induced liver injury (DILI)‐related acute liver failure (ALF) who were successfully treated with high‐volume plasma exchange without liver transplantation. The first patient was a 66‐year‐old man admitted because of a perforated duodenal ulcer complicated with peritonitis and septic shock. After treatment with multiple antibiotics, the patient developed DILI and ALF. Grade 3 hepatic encephalopathy and profound jaundice were present. Symptoms and signs of ALF improved dramatically after initiation of plasma exchange. The patient was discharged uneventfully. The second patient was a 94‐year‐old man admitted for treatment of newly diagnosed pulmonary tuberculosis. DILI and ALF developed 5 days after initiation of anti‐tuberculosis treatment. Grade 4 hepatic encephalopathy was present. After plasma exchange, the patient's level of consciousness improved dramatically, and he recovered from ALF. These 2 cases show the potential of plasma exchange in the treatment of DILI despite occurrence acute liver failure. J. Clin. Apheresis, 28:430–434, 2013. © 2013 Wiley Periodicals, Inc.     

Fluid and electrolyte management of ascites in patients with cirrhosis.

In the patient with cirrhotic ascites, the best treatment is strict medical and nursing management to prevent complications such as renal failure, fluid and electrolyte abnormalities, infection, and encephalopathy. In all but 10% of patients, medical management is successful. In the other 10% of patients, there are various treatment options available. Most of these treatments--LVP, PVS, TIPS, or liver transplantation--are somewhat effective, but none are curative for the patient with cirrhotic ascites.     

Efficiency of respiratory assistance in cirrhotic patients with liver failure

In a 25-month period, 100 cirrhotic patients, in our intensive care unit (ICU) needed endotracheal intubation and mechanical ventilation. The overall mortality rate was 89%; the mortality rate was 100% among patients with septic shock and/or superimposed acute hepatitis and/or severe cirrhosis defined with clinical signs: jaundice and/or ascites and/or spontaneous hepatic encephalopathy and/or severe malnutrition. With these prognostic indices, using Bayes theorem, the probability of fatal evolution ranges from 95%-100% (alpha = 5%). These results allow a group of patients with high cost and poor prognosis to be defined.     

Halothane-Related Hepatitis: A CLINICAL STUDY OF TWENTY-SIX CASES

Twenty-six patients are described who had otherwise unexplainedhepatitis after halothane anaesthesia. Twenty-four (92 per cent)had multiple exposures, and 11 (42 per cent) died. In eightpatients a characteristic pattern of delayed postoperative pyrexiahas been found. Obesity was common, but the clinical featuresand complications were those of any severe hepatitis. Obesity,early onset of jaundice after anaesthesia, and low thrombotest,were associated with a fatal outcome. None of those who werefollowed up after recovery developed clinical or biochemicalevidence of chronic liver disease. The differential diagnosisof postoperative jaundice is discussed, and it is shown thathalothane patients with hepatic encephalopathy are significantlyolder (56.4±11.6 years) than those referred to this unitwith viral hepatitis of equal severity (34.1 ± 16.4 years).Unexplained jaundice or delayed pyrexia after a previous administrationof halothane should be a contraindication to its further use.     

肝癌晚期大量腹水患者的舒适护理

目的:探讨对肝癌晚期大量腹水患者实施舒适护理的方法。方法:对80例肝癌晚期大量腹水患者给予一系列舒适护理措施。结果:本组患者睡眠情况改善68例,有效率85%;进食改善48例,有效率60%;双下肢水肿、渗液症状改善42例,有效率52.5%;腹胀缓解改善53例,有效率66.3%。结论:对肝癌晚期大量腹水患者实施舒适护理可提高患者治疗信心,促进症状缓解,减少并发症的发生,提高患者的舒适度及生存质量,值得临床推广。