Nishida T, Fujita N, Nakao K
Department of Surgery, Osaka Police Hospital, Japan.
Surg Today. 1996;26(6):389-94. doi: 10.1007/BF00311924.
To examine the significance of physiologic and biochemical variables in liver trauma quantitatively, and to establish the early predictors of mortality according to the causes of death, 36 consecutive patients who underwent surgery for liver trauma between 1984 and 1993 were retrospectively studied. A univariate analysis revealed that shock, preoperative systolic blood pressure (SBP), preoperative alanine aminotransferase (ALT), the number of associated organ injuries, the Glasgow Coma Score (GCS), blood replacement requirements, and postoperative blood urea nitrogen (BUN) were significant prognostic factors of survival after liver trauma. However, a multivariate analysis indicated that GCS, postoperative BUN, the number of associated organ injuries, preoperative ALT, and SBP were independent prognostic factors. Because the causes of death after liver trauma can be divided into early hemorrhage and late sepsis, a multiple regression analysis of preoperative and postoperative variables was performed for each cause. The prognostic factors for hemorrhagic death were preoperative ALT, base excess, and the platelet count, whereas those for death due to sepsis were preoperative SBP and the presence of gastrointestinal injuries. These results suggest the value of measuring the preoperative serum level of ALT as a new independent prognostic factor for predicting overall and hemorrhagic death following severe liver trauma.
为了定量研究生理和生化变量在肝外伤中的意义，并根据死亡原因确定早期死亡预测指标，我们对1984年至1993年间连续36例接受肝外伤手术的患者进行了回顾性研究。单因素分析显示，休克、术前收缩压（SBP）、术前丙氨酸转氨酶（ALT）、合并器官损伤的数量、格拉斯哥昏迷评分（GCS）、输血量以及术后血尿素氮（BUN）是肝外伤后生存的重要预后因素。然而，多因素分析表明，GCS、术后BUN、合并器官损伤的数量、术前ALT和SBP是独立的预后因素。由于肝外伤后的死亡原因可分为早期出血和晚期感染，我们针对每种原因对术前和术后变量进行了多元回归分析。出血性死亡的预后因素是术前ALT、碱剩余和血小板计数，而感染性死亡的预后因素是术前SBP和胃肠道损伤的存在。这些结果表明，测量术前血清ALT水平作为预测严重肝外伤后总体和出血性死亡的新的独立预后因素具有重要价值。
