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頁籤選單縮合
題名 | The Outcome of Terminal Liver Cirrhosis Patients Requiring Mechanical Ventilation=末期肝硬化病患使用呼吸器之預後 |
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作者姓名(中文) | 李錦中; 姜安波; | 書刊名 | 中華醫學雜誌 |
卷期 | 59:2 1997.02[民86.02] |
頁次 | 頁88-94 |
分類號 | 415.415 |
關鍵詞 | 重症加護病房; 肝硬化; 機械性通氣; 預後; 呼吸衰竭; Intensive care unit; Liver cirrhosis; Mechanical ventilation; Outcome; Respiratory failure; |
語文 | 英文(English) |
中文摘要 | 背景:肝硬化在臺灣是常見的一種疾病。晚期肝硬化病患未能作肝臟移植者多死於多種合併症,且死亡前大多使用呼吸器支持。本文特別探討此類病患住院中之短期預後狀況。 方法:以回溯性病歷查閱, 研究自1990年11月至1993年9月住院中診斷為肝硬化並使用過呼吸器之病患共47位,作疾病過程及預後分析。 結果:在47位此類病患中,有一位屬Child氏A類者,因只短暫使用呼吸器作選擇性去血管手術治療,而被排除於本研究外。46位中位有33位屬Child氏C類、9位屬B類、另4位因數據不足未作分類。插上氣管內管及使用呼吸器的主要原因包括維持氣道通暢、急性氣促及休克。此類病患中,產生休克者有39位、上消化道出血34位、全身發炎反應症侯群32位、腎功能不全32位、菌血症14位、實質性肺疾病16位、自發性細菌腹膜炎10位、另有一位產生腦內出血。有38位病人(佔 83%)於裝置呼吸器後72小時內死亡。使用呼吸器病患於住院中,當發生菌血症、實質性肺疾病或腎功能不全時皆無一倖免。成功地脫離呼吸器者有3位(佔 8.7%),其中2位(佔 4.3%)出院回家後可存活超過六個月。 結論:使用呼吸器的肝硬化病患之預後極差。對此類病患及其家屬應告以預後實情,並且不鼓勵常規性使用呼吸器於此類末期肝患者。 |
英文摘要 | Background: Liver cirrhosis is a common problem in Taiwan. Without liver transplantation, patients with end-stage liver cirrhosis frequently die of various complications and often require mechanical ventilatory support prior to their death. The purpose of this study was to investigate the in-hospital and short-term outcome of such patients. Methods: A retrospective review of 47 medical records of mechanically ventilated patients with primary diagnosis of liver cirrhosis, admitted from November 1990 to September 1993, allowed analysis of disease course and outcome for these patients. Results: Among the 47 patients, a Child-Pugh's class A patient receiving temporary mechanical ventilation (MV) after elective devascularization surgery was excluded from analysis. Among the remaining medically treated 46 patients, there were 33 Child-Pugh's class C patients, 9 class B patients and 4 unclassified patients. Primary reasons for endotracheal intubation and MV included airway protection, acute respiratory distress and shock. Of these patients, shock was present in 39 cases, upper gastrointestinal bleeding in 34, systemic inflammatory response syndrome in 32, renal insufficiency with creatinine greater than 1.3 mg/dl in 32, bacteremia in 14, parenchymal lung disease in 16, spontaneous bacterial peritonitis in 10, and intracerebral hemorrhage in 1 during their hospital courses. Thirty-eight patients (83%) died within 72 hours after being placed on mechanical ventilation. Patients requiring MV with complications of bacteremia, parenchymal lung disease or renal insufficiency during hospitalization were found to have a 100% mortality rate. Successful weaning occurred in only 3 of 46 patients (8.7%). Of these three, two (4.3%) went home alive and had survived over six months after discharge. Conclusions: It was concluded that cirrhotic patients requiring MV have an extremely poor prognosis. Patients and their families should be fully informed of the prognosis, and routine use of MV should not be encouraged in patients with terminal stage liver disease. |
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