第八章 乙型肝炎重症化和肝衰竭的主要并发症与肝外器官功能衰竭

内容提要

1.乙型重型肝炎患者免疫力下降，极易发生各种感染；发生感染后病情进展快，易发生休克、DIC及多脏器功能衰竭，可严重影响重型肝炎的预后，成为重型肝炎患者主要死亡原因之一。并发的感染主要包括肺部感染、肠道感染、胆道感染、尿路感染、自发性细菌性腹膜炎和败血症等。

2.乙型重型肝炎可引起凝血因子合成减少和功能异常、抗凝血物质增多、血小板异常等改变，导致机体凝血机制发生障碍；感染、肝肾综合征等并发症又可进一步加重凝血障碍，导致DIC发生，严重影响疾病预后。

3.肝肾综合征是终末期肝病常见的临床并发症，以肾功能不全、动脉循环血流动力学改变和内源性血管活性系统显著异常为特征，是重型肝炎预后判断的重要指标之一。

4.乙型重型肝炎患者机体内环境紊乱以水、电解质紊乱(如水潴留、低钠血症、低钾血症、高钾血症等)和酸碱失衡较为常见，这些内环境紊乱可导致患者病情加重和复杂化，影响预后。

5.肝性脑病是以代谢紊乱为基础的神经精神异常综合征，是乙型重型肝炎的预后判断的重要指标之一。肝肺综合征的主要特征是原发性肝病、肺内血管扩张和动脉氧合不足所构成的三联征，及时对症处理可改善疾病预后。

6.内毒素血症是乙型重型肝炎的重要并发症，其在引起肝脏的二次打击的同时，还可促进其他各并发症的发生和发展，严重影响疾病预后。(https://www.daowen.com)

Abstract 8

1.Patients with severehepatitishave impaired immunity and are therefore vulnerable to all kinds of infections.After infection，these patients may experience shock，DIC and multiple organ failure，all of which seriously affect their prognosis and are major causes of death.Concurrent infections consist primarily of infections of the lungs，intestines，biliary tract，urinary tract，as well as spontaneous bacterial peritonitis and septicemia.

2.Severehepatitis B may reduce the synthesis of coagulation factors and enhance their dysfunction and increase anticoagulants and platelet abnormalities，leading to coagulopathy.Complications such as infection，hepatorenal syndrome  can further aggravate coagulopathy，resulting in DIC and seriously affecting patient prognosis.

3.Hepatorenal syndrome，which is characterized by renal failure，hemodynamic changes in arterial circulation and abnormalities in the endogenous vascular system，is a common clinical complication of end-stage liver disease，and one of the important indicators for the prognosis of patients with severehepatitis B.

4.Water and electrolyte disorder (water retention，hyponatremia，hypokalemia，hyperkalemia)and acid-base imbalance are common in patients with severehepatitis B.These internal environment disorders can lead to exacerbation and complication of the illness.

5.Hepatic encephalopathy is a neurological and psychiatric anomaly syndrome based on metabolic disorder，and an important prognostic indicator for patients with severehepatitis B.Hepatopulmonary syndrome is characterized by primary liver disease，pulmonary vascular expansion and reduced oxygenation of arterial blood.Timely treatment can improve prognosis.

6.Endotoxemia，an important complication of severehepatitis B，is not only a secondhit to the liver，but also promotes the development of other complications，which seriously affects the prognosis of patients.