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目的 观察分子吸附再循环系统(MARS)人工肝治疗急、慢性肝功能衰竭的临床效果和近期疗效。方法 急、慢性肝功能衰竭行MARS人工肝治疗共28 例56 例次,采用间歇治疗模式,每次历时6~8 h。结果 28例患者中,男23例,女5例,平均年龄为(50.57±13.38)岁。其中急性肝功能衰竭12 例,慢性肝功能衰竭急性加重16例。单次治疗后总胆红素、结合胆红素、总胆汁酸、血氨分别较治疗前下降31.47%、29.15%、35.91%和53.68% (P值均<0.01)。白蛋白、前白蛋白、胆碱酯酶和血压无显著变化。单次治疗后凝血酶原时间由治疗前的(32.37±9.96) s缩短为(21.82±10.39) s (P<0.01),临床出血倾向明显减轻。24 例(85.7%)在治疗6~12 h后意识障碍好转,乏力、恶心、呕吐、腹胀等症状明显缓解,食欲增加,短期存活率(30 d)为71.4%(20/28例)。2例急性肝功能衰竭患者(7.1%)治疗痊愈出院, 10 例(35. 7%)成功过渡至肝移植, 8 例(28.6%)治疗后15~30 d好转,8例在治疗2~14 d内死亡,死亡原因为多脏器功能衰竭和内脏出血。结论 MARS治疗有助于抢救急、慢性肝功能衰竭患者,安全性好,近期疗效显著,可作为肝移植前的过渡手段。
Objective To observe the clinical effect and short-term efficacy of MARS artificial liver in the treatment of acute and chronic liver failure. Methods A total of 28 cases (56 cases) were treated with MARS artificial liver in acute and chronic liver failure. The intermittent treatment mode was used, which lasted from 6 to 8 hours. Results Among 28 patients, 23 were male and 5 were female, with an average age of (50.57 ± 13.38) years. Including acute liver failure in 12 cases, acute exacerbation of chronic liver failure in 16 cases. Total bilirubin, conjugated bilirubin, total bile acid and blood ammonia decreased by 31.47%, 29.15%, 35.91% and 53.68% respectively after treatment (P <0.01). Albumin, prealbumin, cholinesterase and blood pressure did not change significantly. Prothrombin time shortened from (32.37 ± 9.96) s to (21.82 ± 10.39) s after treatment (P <0.01), and the clinical tendency of bleeding was relieved. Twenty-four patients (85.7%) had improvement of disturbance of consciousness after 6-12 h. The symptoms such as fatigue, nausea, vomiting and abdominal distension were relieved. The appetite increased and short-term survival rate was 30.4% (20/28) Two patients with acute liver failure (7.1%) were cured and discharged, and 10 (35.7%) patients were successfully transferred to liver transplantation. Eight patients (28.6%) improved after 15-30 days and 8 patients d died, the cause of death for multiple organ failure and visceral bleeding. Conclusion MARS treatment is helpful to rescue patients with acute and chronic liver failure. It has good safety and short-term curative effect. It can be used as a transitional means before liver transplantation.