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目的:探讨儿童肝衰竭的临床特征及影响生存时间的相关因素,以加深对儿童肝衰竭的认识。方法:收集本院收治住院的37例儿童肝衰竭的临床资料,描述性分析儿童肝衰竭的病因、临床表现、实验室检查以及病程中出现的并发症或合并症,并运用SPSS17.0软件进行统计学分析,多因素生存分析用COX回归,生存曲线图用Kaplan-Meier法。结果:(1)纳入病例37例,男女比例2.7∶1,23例救治无效死亡,14例放弃治疗。(2)急性肝衰竭20例,亚急性肝衰竭8例,慢加急性(亚急性)肝衰竭6例,慢性肝衰竭(肝硬化)3例。(3)儿童肝衰竭病因复杂,45.9%病因不明。(4)发热、黄疸、意识改变为儿童肝衰竭最常见的临床表现。(5)肝性脑病、电解质紊乱、感染、多器官功能不全综合征(MODS)为主要并发症,发病率均在70%以上。(6)多因素生存分析发现低血糖(RR=2.713)和MODS(RR=2.741)为影响儿童肝衰竭生存时间的危险因素。(7)儿童肝衰竭生存时间短,病死率高,中位生存时间为5d。结论:儿童肝衰竭内科治疗存活率低,并发感染、肝性脑病、电解质紊乱、MODS发生率高,低血糖和MODS是影响生存时间的危险因素,积极防治并发症,尽早行肝移植治疗才是提高存活率的关键。
Objective: To explore the clinical characteristics of children with liver failure and related factors that affect the survival time in order to deepen the understanding of children with liver failure. Methods: The clinical data of 37 children with liver failure admitted to our hospital were collected. The etiology, clinical manifestations, laboratory tests and complication or complication of childhood liver failure were descriptively analyzed and analyzed by SPSS17.0 software Statistical analysis, multivariate survival analysis with COX regression, survival curve with Kaplan-Meier method. Results: (1) 37 cases were enrolled in the study. The ratio of men to women was 2.7:1. Twenty-three patients died of treatment failure and 14 patients gave up treatment. (2) 20 cases of acute liver failure, 8 cases of subacute liver failure, 6 cases of acute and subacute liver failure, and 3 cases of chronic liver failure (cirrhosis). (3) The cause of liver failure in children is complex, 45.9% of the etiology is unknown. (4) fever, jaundice, change of consciousness to the most common clinical manifestations of liver failure in children. (5) Hepatic encephalopathy, electrolyte imbalance, infection, multiple organ dysfunction syndrome (MODS) as the main complication, the incidence rates are above 70%. (6) Multivariate survival analysis found that hypoglycemia (RR = 2.713) and MODS (RR = 2.741) were the risk factors affecting the survival time of children with liver failure. (7) Children with liver failure survival time is short, high mortality, the median survival time of 5d. Conclusion: The medical treatment of children with liver failure, low survival rate, complicated by infection, hepatic encephalopathy, electrolyte imbalance, high incidence of MODS, hypoglycemia and MODS are risk factors affecting survival time, active prevention and treatment of complications, as soon as liver transplantation is The key to improving survival.