1892例肝衰竭患者并发症及死亡原因分析

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。

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

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.