Cogbill T H, Moore E E, Feliciano D V, Jurkovich G J, Morris J A, Mucha P
Department of Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wisconsin.
Am Surg. 1992 Jul;58(7):395-9.
A multi-center experience with 210 severe liver injuries was reviewed to define postoperative changes in hepatic enzyme levels and body temperature profile. The 129 patients who survived initial operation comprised the data base. Serum glutamic oxaloacetic transaminase (SGOT) and lactate dehydrogenase (LDH) peaked within 24 hours (750 +/- 92 IU/L, 870 +/- 120 IU/L) and decreased rapidly during the first 4 days. Serum bilirubin was maximal at 7 days, while alkaline phosphatase rose slowly throughout 14 days. Hepatic enzyme elevations were more dramatic after blunt trauma, reflecting greater hepatocellular disruption. Maximum daily temperatures exceeding 38.0 degrees C and 39.0 degrees C were recorded for the first 3 postoperative days in 82 (64%) patients and 14 (11%) patients, respectively. No infectious source was evident in 13 (93%) of 14 patients with severe hyperpyrexia, implicating release of inflammatory mediators associated with major hepatic trauma. Convalescence from severe hepatic injury is marked by release of SGOT and LDH, as well as fever, which may be anticipated during the first 4 days postinjury.
回顾了210例严重肝损伤的多中心经验，以确定术后肝酶水平和体温曲线的变化。129例初次手术后存活的患者构成了数据库。血清谷草转氨酶（SGOT）和乳酸脱氢酶（LDH）在24小时内达到峰值（750±92 IU/L，870±120 IU/L），并在最初4天内迅速下降。血清胆红素在第7天达到最大值，而碱性磷酸酶在14天内缓慢上升。钝性创伤后肝酶升高更为显著，反映了更大程度的肝细胞破坏。分别有82例（64%）和14例（11%）患者在术后第1至3天记录到每日最高体温超过38.0℃和39.0℃。14例严重高热患者中有13例（93%）未发现明显感染源，提示与严重肝外伤相关的炎症介质释放。严重肝损伤恢复的特点是SGOT和LDH释放以及发热，这在受伤后的前4天可能会出现。
