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目的:探讨肝衰竭孕妇的死亡危险因素。方法:回顾分析2002年7月至2011年8月我院收治的43例妊娠合并肝衰竭患者的临床资料,根据患者的结局分为存活组(27例)和死亡组(16例)。采用单因素分析和二元变量Logistic逐步回归筛选相关的危险因素。结果:妊娠合并肝衰竭患者的病死率为37.21%(16/43),病原学以HBV感染多见(17/43),以无慢性肝病基础的急性和亚急性肝衰竭占多数(26/43)。死亡组的总胆红素(TBIL)、白蛋白(ALB)、凝血酶原活动度(PTA)、感染、≥Ⅱ级肝性脑病、肝肾综合征、产后出血与存活组比较,差异显著(P<0.05)。Logistic回归分析结果显示,PTA水平降低是肝衰竭孕妇死亡的危险因素。结论:严密监测PTA变化,积极纠正凝血功能,及时有效的综合防治并发症是降低肝衰竭孕妇病死率的关键。
Objective: To explore the risk factors of death in pregnant women with liver failure. Methods: The clinical data of 43 patients with pregnancy-induced liver failure admitted in our hospital from July 2002 to August 2011 were retrospectively analyzed. According to the outcome of the patients, they were divided into survival group (n = 27) and death group (n = 16). Univariate analysis and binary variable Logistic stepwise regression were used to screen the relevant risk factors. Results: The mortality of patients with pregnancy-associated liver failure was 37.21% (16/43). The etiology was more common in HBV infection (17/43) and the majority of acute and sub-acute liver failure based on non-chronic liver disease (26/43 ). There were significant differences in TBIL, ALB, PTA, infection, grade II hepatic encephalopathy, hepatorenal syndrome, postpartum hemorrhage and survival group P <0.05). Logistic regression analysis showed that the decrease of PTA was the risk factor of death in pregnant women with liver failure. Conclusion: Close monitoring of changes in PTA, active correction of coagulation, timely and effective comprehensive prevention and treatment of complications is to reduce the mortality of pregnant women, the key to liver failure.