ACUTE LUNG INJURY IN FULMINANT HEPATIC-FAILURE FOLLOWING PARACETAMOL POISONING
ACUTE LUNG INJURY IN FULMINANT HEPATIC-FAILURE FOLLOWING PARACETAMOL POISONING
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DOI：
10.1136/thx.50.4.399
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发表时间：
1995-04-01
期刊：
影响因子：
10
通讯作者：
WEBSTER, NR
中科院分区：
文献类型：
--
作者：
BAUDOUIN, SV;HOWDLE, P;WEBSTER, NR
背景--关于急性肝衰竭时急性肺损伤或肺循环改变的发生率的信息很少。本研究的目的是记录扑热息痛中毒引起的暴发性肝衰竭中急性肺损伤的发生率，记录相关的肺循环变化，并评估肺损伤对患者预后的影响。（改编自Murray）在一年多的时间里，对乙酰氨基酚中毒引起暴发性肝衰竭，入住重症监护室的ah患者中。肝功能衰竭和疾病的严重程度，其他器官系统衰竭，和病人outcome.Results -24例扑热息痛引起的肝功能衰竭和9例肺损伤，其中8例（33%）有严重损伤（Murray评分>2.5）。在2例患者中，低氧血症导致死亡。肺损伤患者的中位脑病分级（非损伤组为4比2）和APACHE II评分（29比16）较高。循环衰竭，需要血管收缩剂的支持，发生在所有肺损伤的患者，但只有40%的人没有。脑水肿，如颅内压异常升高，也发生在所有肺损伤患者，但只有27%的非损伤患者。两组中需要肾脏替代治疗的肾衰竭发生率相似（67%和47%）。肺损伤组肺动脉闭塞压正常。心输出量高（中位数11.2 l/min），全身血管阻力低（中位数503 dynes/s/cm（-5）），肺血管阻力低（中位数70 dynes/s/cm（-5）），但与无肺损伤组无显著差异。肺损伤组的死亡率远高于非损伤组（89%对13%）。结论急性肺损伤常见于扑热息痛引起的暴发性肝衰竭患者，并伴有全身循环衰竭和脑水肿。急性肺损伤的发生与高死亡率相关。
Background - There is little information on the incidence of acute lung injury or changes in the pulmonary circulation in acute liver failure. The aim of this study was to record the incidence of acute lung injury in fulminant hepatic failure caused by paracetamol poisoning, to document the associated pulmonary circulatory changes, and to assess the impact of lung injury on patient outcome.Methods - The degree of lung injury was retrospectively assessed by a standard scoring system (modified from Murray) in ah patients with fulminant hepatic failure caused by paracetamol poisoning, admitted to the intensive care unit over a one year period. The severity of liver failure and illness, other organ system failure, and patient outcome were also analysed.Results - Twenty four patients with paracetamol-induced liver failure were admitted and nine developed lung injury of whom eight (33%) had severe injury (Murray score >2.5). In two patients hypoxaemia contributed to death. Patients with lung injury had higher median encephalopathy grades (4 v 2 in the noninjured group) and APACHE II scores (29 v 16). Circulatory failure, requiring vasoconstrictor support, occurred in all patients with lung injury but in only 40% of those without. Cerebral oedema, as detected by abnormal rises in intracranial pressure, also occurred in all patients with lung injury but in only 27% of the noninjured patients. The incidence of renal failure requiring renal replacement therapy was similar in both groups (67% and 47%). Pulmonary artery occlusion pressures were normal in the lung injury group. Cardiac output was high (median 11.2 l/min), systemic vascular resistance low (median 503 dynes/s/cm(-5)), and pulmonary vascular resistance low (median 70 dynes/s/cm(-5)), but not significantly different from the group without lung injury. Mortality was much higher in the lung injury group than in the non-injured group (89% v 13%).Conclusions - Acute lung injury was common in patients with paracetamol-induced fulminant hepatic failure and was associated with systemic circulatory failure and cerebral oedema. The development of acute lung injury was associated with high mortality.