摘要
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6～12h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(30d)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15～30d好转,8例在治疗2～14d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 evaluate the effectiveness of treatment with molecular adsorbent recirculating system(MARS) in liver failure patients. Methods 28 patients with acute and acute on chronic liver failure received 56 intermittent MARS treatments. Each treatment session lasted for 6 to 8 hours. Results In 28 patients (23 males, 5 females) with an average age of (50.57±13.38) years including 12 cases of acute liver failure and 16 cases of acute on chronic liver failure showed significant decrease in serum total bilirubin (31.47%), conjugated bilirubin (29.15%), bile acid (35.91%) and ammonia (53.68%, P<0.01) after a single treatment. There were no significant changes in serum albumin, pre-albumin, cholinesterase and blood pressure. Single treatment contributed to marked improvement of prothrombin time [PT decreased from (32.37±9.96) s to (21.82 ±10.39) s, P<0.01]. Most patients (24/28, 85.7%) achieved a remarkable symptomatic improvement after a single treatment. The 30 days hospital survival rate for the 28 liver failure patients was 71.4%(20/28). 2 patients of acute liver failure recovered, 10 successfully bridged over to liver transplantation, 8 acute on chronic liver failure improved and discharged, another 8 cases all died of multiple organ failure or visceral hemorrhage within 2 to 14 days. Conclusions MARS method can serve as an optimistic treatment for liver failure patients with improving immediate survival rate and inspiring bridge support to liver transplantation.
出处
《上海医学》
CAS
CSCD
北大核心
2005年第3期209-213,共5页
Shanghai Medical Journal
基金
上海市卫生局医苑新星计划资助项目
