目的 研究探讨体外膜氧合（extracorporeal membrane oxygenation， ECMO）治疗期间缺血性肝炎（ischemic hepatitis， IH）的发生率、危险因素及结局。 方法 回顾性收集了82例因心源性疾病接受静脉-动脉（venous-arterial， VA）ECMO支持的成年患者（≥18周岁）资料，排除有肝、肾疾病病史者。患者分为IH组和非缺血性肝炎（NIH）组，对患者临床资料进行分析比较。 结果 20例（24.4%）患者发生IH，且均出现在使用ECMO 24 h内。AST随着时间的延长逐渐下降，而总胆红素（total bilirubin， TBIL）却逐步增高。IH组的生存率显著低于NIH组（15% 比 50%，P=0.006）。此外，IH组急性肾功能衰竭的发病率显著高于NIH组（70.0% 比 41.9%, P=0.029）。多元回归模型发现，内科心功能衰竭［比值比（odds ratio， OR） =149.71，95%CI 6.22～3 602.58，P=0.002］、乳酸最大值（OR=1.41，95%CI 1.14～1.76，P=0.002）、TBIL最大值（OR=1.02，95%CI 1.01～1.04，P=0.010）是ECMO支持24 h内发生IH的危险因素。 结论 IH在ECMO中较为常见，而且发生IH的患者预后较差。内科心功能衰竭、乳酸和TBIL最大值是VA ECMO支持期间IH的危险因素。
Ｏｂｊｅｃｔｉｖｅ Ischemic hepatitis(IH) is acute ischemic damage in liver caused by hypoxemia and hypoperfusion. However, the prevalence, risk factors and prognosis of IH during venous-arterial extracorporeal membrane oxygenation(ECMO) were rarely reported. Methods A total of 82 adult patients (≥18 years) with cardiac diseases were enrolled for venous-arterial(VA) ECMO in this study. These patients afflicted with IH and non-IH (NIH) were assigned into two groups. Results A total of 20 patients (24.4%) were afflicted with IH within 24 h during ECMO. In these patients, AST decreased over time, but the levels of total bilirubin(TBIL) increased gradually. The survival rate of IH group was significantly lower than that of NIH group (15% vs 50%， P=0.006). The incidence of acute renal failure was higher in IH group(70.0% vs 41.9%, P=0.029). More albumin was required in IH group (P=0.002). In the multivariable regression model, medical heart failure ［(odds ratio, OR) =149.71, 95%CI 6.22-3 602.58, P=0.002］, peak lactate (OR=1.41, 95%CI 1.14-1.76, P=0.002) and peak TBIL (OR=1.02, 95%CI 1.01-1.04, P=0.010) within the first 24 h during ECMO were risk factors for IH. The survival rate of IH group was significantly lower than that in NIH group (50% vs 15%, P=0.006). Conclusions Patients with medical heart failure, high levels of peak lactate and peak TBIL during ECMO have higher risk to develop IH.
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