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影响急性肝功能不全预后的重要因素当然是肝实质的损害程度。重症肝病中有严重的精神神经症状以及出血、肾功能不全,呼吸循环系统功能不全等多器官衰竭的,死亡率很高。因此急性肝功能不全的预后不能单从肝实质损害程度进行判断,其临床症状、体征及生化检查所见对预后的估计仍有重要意义。现叙述如下:一、黄疸:血清胆红素的浓度取决于胆红素的生成与清除两方面。肝功能不全时主要是清除方面障碍而致血中胆红素上升,一般急性肝炎时黄疸程度与肝损害成正比,但亦有急性肝功能不全特别是重症肝炎时无明显黄疸而死亡的病例,其真正原因尚不清楚,但应考虑到胆红素的生成障碍及尿中胆红素的排泄量增加。据Christensen 等调查,重症肝炎中重度黄疸(血清胆红素>23mg/dl)者,预后不良。血清胆红素升高除肝功能损害外尚可由溶血亢进所致,故高度黄疸可看作多器官衰竭的指标之一。然而急性肝功能不
Of course, an important factor that affects the prognosis of acute hepatic insufficiency is the extent of damage to the liver parenchyma. Severe liver disease in severe neurological symptoms and bleeding, renal insufficiency, multiple respiratory failure and other organ failure, the mortality rate is high. Therefore, the prognosis of acute liver dysfunction can not be judged solely on the extent of liver parenchymal damage, and its clinical symptoms, signs and biochemical findings are still important prognostic estimates. Are described below: First, jaundice: serum bilirubin concentration depends on the formation and elimination of bilirubin both. Hepatic insufficiency is mainly due to obstacles in the removal of blood bilirubin rise, the general acute jaundice and liver damage is proportional to the degree, but there are acute liver insufficiency, especially in severe hepatitis without obvious jaundice and deaths, The real reason is not clear, but should consider the formation of bilirubin and urinary bilirubin excretion increased. According to Christensen and other investigations, severe hepatitis with severe jaundice (serum bilirubin> 23mg / dl), the prognosis is poor. In addition to elevated serum bilirubin in addition to liver damage can still be caused by hypersecretion, it can be seen as a high degree of jaundice one of the indicators of multiple organ failure. However, acute liver function is not