目的 探讨儿童休克并发缺氧性肝炎（HH）的临床特征及其危险因素。 方法 收集2016年1月至2023年12月收治的234例不同类型的儿童休克患者的临床资料，包括休克患儿的一般情况、临床情况及预后情况；收集休克患儿发生HH的第1（d1）、2（d2）、3（d3）、5（d5）、7（d7）天的相关血清生化指标，包括血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、乳酸脱氢酶（LDH）、碱性磷酸酶（ALP）、白蛋白（ALB）、总胆红素（TBIL）、尿素氮（BUN）、C反应蛋白（CRP）、国际标准化时间（INR）及乳酸等指标。对其合并HH的临床特征及其危险因素进行分析。 结果 234例儿童休克患者中，男150例，女84例，年龄1个月至16岁；按休克是否并发HH，将患儿分为HH组（32例）与非HH组（202例），休克导致HH的总患病率为13.7%（32/234）；脓毒性休克是休克并发HH的主要类型，占65.63%（21/32）；按预后情况，将休克并发HH的患儿分为存活组（17例）与死亡组（15例），休克并发HH病死率为46.9%（15/32）；HH患儿的ALT、AST值在正常范围上限的20倍以上。休克并发HH存活组患儿的酶学指标的峰值出现在发病的d1 ~ d2，于发病的d7接近正常范围，而休克并发HH死亡组患儿的酶学指标在整个疾病期间均高。死亡组与存活组比较，死亡组的ALT、AST、ALP、TBIL、CRP、BUN、INR的峰值均高于存活组（P < 0.05）；死亡组的ALB最低值低于存活组（P < 0.05）。多因素logistic回归分析显示儿童危重病例评分（PCIS）、乳酸、多器官功能障碍综合征（MODS）、失代偿性休克及心源性休克是影响休克患儿并发HH的危险因素（P < 0.05，P < 0.01），左心室射血分数（LVEF）及平均动脉压（MAP）是休克伴 HH患儿死亡的危险因素（P < 0.01）。 结论 PCIS降低、乳酸增高、发生MODS、失代偿性休克及心源性休克的患儿易发生HH；病情愈重、左心室射血功能愈差的休克伴HH患儿预后愈差；休克并发HH的患儿病死率较高，因此应密切监测肝功能指标以期早期发现HH，给予合理救治。

Objective To investigate the clinical characteristics and risk factors of the occurrence of hypoxic hepatitis （HH） in children with shock. Methods Clinical data （general situation， clinical situation and prognosis） of 234 children with different types of shock admitted to the pediatrics department of Hainan Women and Children's Medical Center from January 2016 to December 2023 were collected. Serum biochemical indexes on day 1 （d1）， day 2 （d2）， day 3 （d3）， day 5 （d5）， day 7 （d7） of children with shock were collected， including serum alanine aminotransferase （ALT）， glutamate aminotransferase （AST）， lactate dehydrogenase （LDH）， alkaline phosphatase （ALP）， albumin （ALB）， total bilirubin （TBIL）， urea nitrogen （BUN）， C reactive protein （CRP）， international standardized time （INR） and lactate. And the clinical characteristics and risk factors of the occurrence of HH in children with shock were analyzed. Results A total of 234 cases （150 cases of males）of different types of shock in children were enrolled， ages ranged from 1 month to 16 years old. According to whether developed HH， the children with shock were divided into HH group （32 cases） and non-HH group （202 cases）. The total incidence of HH was 13.7% （32/234）. Septic shock was the main disease of the occurrence of HH in children with shock， accounting for 65.63% （21/32）. According to the prognosis， children with shock combined HH were divided into survival group （17 cases） and death group （15 cases）. The case fatality rate of children with shock combined HH was 46.9%. The ALT and AST values in children with shock combined HH were more than 20 times of the upper limits of normal ranges. The peak values of enzymatic indexes in the survival group appeared at the onset time d 1 to d 2， they were close to the normal ranges at the onset time d7， while the enzymatic indexes in the death group were higher than the normal ranges during the whole disease stage. Compared with the survival group， the peak values of ALT， AST， ALP， TBIL， CRP， BUN， and INR in the death group were obviously higher （P < 0.05， both）. The lowest value of ALB in the death group was lower than that in the survival group （P < 0.05）. The results of multivariate Logistic regression analysis showed that pediatric critical illness score（PCIS）， lactate， multiple organ dysfunction syndrome （MODS）， decompensated shock and cardiogenic shock were the risk factors for the occurrence of HH in children with shock（P < 0.05 or 0.01）， and left ventricular ejection fraction（LVEF） and mean arterial pressure （MAP） were the risk factors of the death of HH in children with shock （P < 0.01）. Conclusions Children with shock who have the risk factors as decreased PCIS， increased lactate level， MODS， decompensated shock and cardiogenic shock are apt to suffer from HH. Poor prognosis in the children with shock combined HH is associated with worse condition and lower LVEF. There is a high fatality rate of shock combined HH in children， so that liver function indicators should be closely monitored to early detect HH， and reasonable treatment should be given.