摘要
目的:探讨创伤后早期肝功能损害各指标的变化及其临床意义.方法:分析2006-05/2006-08我院创伤骨科入院患者719例中肝功能损害105例伤后24h及48h内肝功能指标血清丙氨酸氨基转移酶(ALT)、天门氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、乳酸脱氢酶(LDH)、总胆红素(TBIL)、结合胆红素(DBIL)、白蛋白(ALB)、凝血酶原时间(PT).结果:创伤后肝损害的发生率为14.6%,肝功能指标ALT,AST,ALP,GGT,LDH,ALB,TBIL和PT异常发生率分别为91.4%,64.8%,42.9%,61.9%,27.6%,20.9%,30.5%,5.7%:创伤后ALT,AST和GGT升高1-3倍者分别为78例(81.3%),49例(72.1%)和42例(64.6%).严重创伤患者出现ALB降低、TBIL升高及PT延长(P<0.001),创伤后肝功能指标ALT、AST、ALP及GGT 48h与24h相比明显升高(P<0.01).结论:创伤后早期即可出现肝功能损害,肝功能指标一般呈轻中度升高,当创伤伤情严重及并发症多时,可出现ALB降低、黄疸及PT延长,创伤后黄疸为肝细胞性黄疸,可能与胆汁淤积无关.
AIM： To discuss the change in liver function after hepatic trauma in the early stage and its clinical significance.
METHODS： Of the 719 patients with trauma admitted to our hospital from 2006-05 to 2006-08, 105 with hepatic trauma were included in this study. All patients were admitted within 24 hours after trauma. Those who had primary hepatic injuries or acute and chronic dysfunctions of the hepatic-biliary system were excluded. We collected vein blood samples to measure the serum levels of ALT, AST, ALP, GGT, LDH, TBIL, DBIL, ALB, PT, 24 and 48 hours after trauma.
RESULTS： The percentage of hepatic trauma was 14.6%. The abnormality rate of ALT, AST, ALP, GGT, LDH, ALB, TBIL and PT was 91.4%, 64.8%, 42.9%, 61.9%, 27.6%, 20.9%, 30.5% and 5.7%, respectively, in the 105 patients. Of these 105 patients, ALT level increased 1-3 folds in 78, AST level increased 1-3 folds in 49, GGT level increased 1-3 folds in 42. The patients with decreased ALB and increased TBIL and PT had more severe traumas than those without such changes （P〈0.001）. No significant difference was found in the levels of TBIL, DBIL/TBI, ALP and GGT. Thirty patients had significantly higher levels of ALT, AST, ALP and GGT within 48 hours than those within 24 hours after trauma （P〈0.01）.
CONCLUSION： Hepatic trauma is common and often occurs in early stage of trauma. The moderate increase in liver functions is commonly observed. Patients with decreased ALB and increased jaundice and PT usually have more severe traumas or more complications. Jaundice induced by trauma belongs to hepatoceUular jaundice and may not be correlated with cholestasis.
出处
《世界华人消化杂志》
CAS
北大核心
2008年第2期217-220,共4页
World Chinese Journal of Digestology
关键词
肝功能
肝损害
创伤
Liver function
Hepatic injury
Trauma
