严重多发伤后危重症患者的肝功能实时评估与临床结局相关。

Real-time assessment of hepatic function is related to clinical outcome in critically ill patients after polytrauma.

作者信息

Dresing Klaus, Armstrong Victor William, Leip Casper-Lennart, Streit Frank, Burchardi Hilmar, Stürmer Klaus-Michael, Oellerich Michael

机构信息

Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine Goettingen, Georg-August University, Robert-Koch-Strasse 40, D 37075 Göttingen, Germany.

出版信息

Clin Biochem. 2007 Nov;40(16-17):1194-200. doi: 10.1016/j.clinbiochem.2007.06.013. Epub 2007 Jul 18.

DOI:10.1016/j.clinbiochem.2007.06.013

PMID:17707362

Abstract

OBJECTIVES

The aim was to investigate the outcome MODS/MOF in critically ill patients with regard to early hepatic dysfunction.

METHODS

Thirty adult polytrauma patients admitted to the ICU, with ISS >or=16 were prospectively investigated. Real-time liver function was assessed using the MEGX test and arterial ketone body ratio (AKBR) 12-24 h after admittance to ICU, and on days 3, 5, 8, 12.

RESULTS

Six patients (19%) died between days 4 and 29. Non-survivors were older (64.2 vs. 31.5 years), had a significantly higher ISS (40.5 vs. 30; p=0.002) and MODS score (9.5 vs. 5; p=0.001) on admittance to the ICU than survivors. On day 3 MEGX values (31 vs. 71.3 microg/L; p=0.001) and the AKBRs (0.6 vs. 1.3; p=0.001) were significantly lower in non-survivors than in survivors whereas IL-6 levels were significantly higher in the former group (519 vs. 61 microg/L; p=0.05).

CONCLUSIONS

The MEGX test and AKBR are sensitive early indicators of hepatic dysfunction in severely injured polytrauma patients at risk for developing MODS/MOF.

摘要

目的

旨在研究危重症患者早期肝功能障碍情况下多器官功能障碍综合征/多器官功能衰竭（MODS/MOF）的转归。

方法

前瞻性调查30例入住重症监护病房（ICU）的成年多发伤患者，损伤严重度评分（ISS）≥16。在入住ICU后12 - 24小时以及第3、5、8、12天，使用MEGX试验和动脉酮体比率（AKBR）评估实时肝功能。

结果

6例患者（19%）在第4天至29天之间死亡。与幸存者相比，非幸存者年龄更大（64.2岁对31.5岁），入住ICU时ISS显著更高（40.5对30；p = 0.002），MODS评分也更高（9.5对5；p = 0.001）。在第3天，非幸存者的MEGX值（31对71.3μg/L；p = 0.001）和AKBRs（0.6对1.3；p = 0.001）显著低于幸存者，而前一组的白细胞介素 - 6水平显著更高（519对61μg/L；p = 0.05）。