摘要：
目的：探讨重度肝损害患儿的临床特点、治疗及预后。方法回顾性分析55例重度肝损害患儿的临床资料。结果55例患儿，年龄为28 d至12岁；男31例、女24例。急性肝损害45例，主要病因为感染性疾病21例（53.3%）、血液肿瘤疾病5例（11.1%）、遗传代谢病4例（8.9%）。慢性肝损害10例，均为肝硬化失代偿。退热药、中药/中成药及感冒药是引起儿童重度肝损害的最主要诱因，其中急性肝损害患儿中有31例（68.9%）、慢性肝损害中有4例（40.0%）。急性肝损害患儿中，有消化道症状32例（71.1%），黄疸26例（57.8%），出血表现9例（20.0%），合并多器官功能障碍13例（28.9%）、肝性脑病6例（13.3%）；10例慢性肝损害患儿均表现有腹胀、腹水，黄疸9例，消化道出血7例，合并肝性脑病3例，多器官功能障碍1例。55例患儿死亡39例，总病死率70.91%。14例合并多器官功能障碍患儿死亡13例（92.9%），3例合并肝性脑病患儿均死亡。结论感染性疾病是引起儿童重度肝功能损害的主要原因，退热药、中药/中成药及感冒药是最重要的诱因；重症肝损害患儿病死率高，应加强合理用药，以预防为主。%ObjectiveTo explore the clinical characteristics, treatment and prognosis of severe liver damage in children.MethodsClinical data of 55 children with severe liver damage were retrospectively analyzed.Results In 55 children (31 boys and 24 girls) aged from 28 days to 12 years, forty-five children had acute liver injury mainly caused by infectious diseases (21 cases, 53.3%), blood tumor diseases (5 cases, 11.1%), hereditary metabolic diseases (4 cases, 8.9%), and unexplained diseases (10 cases, 22.2%), ten children had chronic liver injury with decompensated cir-rhosis. Most of severe liver damage in children was caused by antipyretic drugs, traditional Chinese medicine and cold medicine, including 31 cases of acute liver injury and 4 cases of chronic liver injury. In children with acute liver injury, clinical symptoms included gastrointestinal symptoms (32 cases, 71.1%), jaundice (26 cases, 57.8%), hemorrhage (9 cases, 20.0%), multiple organ dysfunction (13 cases, 28.9%) and hepatic encephalopathy (6 cases, 13.3%). In children with chronic liver damage, clinical symptoms included abdominal distension and ascites (10 cases), jaundice (9 cases), gastrointestinal bleeding (7 cases), hepatic encephalopathy (3 cases) and multiple organ dysfunction (1 case). In 55 chil-dren, 39 children were died and the total mortality was 70.91%. In 14 cases of multiple organs dysfunction syndromes, 13 cases (92.9%) were died. All three cases of hepatic encephalopathy were died.ConclusionsInfectious diseases are the leading cause of sever liver damage in children. The most common inciting factors are antipyretic drugs, traditional Chinese medicine and cold medicine. Children with severe liver damage have a high mortality. Rational use of medicine and the concept of the prevention first should been strengthened.
