人工肝治疗重症妊娠期急性脂肪肝的临床疗效分析

Therapeutic Effect of Artificial Liver Support System on Severe Acute Fatty Liver of Pregnancy

目的:分析人工肝治疗重症妊娠期急性脂肪肝(AFLP)的临床疗效。方法:收集重庆医科大学附属第一医院产科2002年1月至2007年8月住院并行人工肝治疗的15例重症AFLP患者的临床资料。观察患者的症状、体征、人工肝治疗前后血常规、肝肾功能、电解质、凝血象等指标,判断病情变化。结果:①人工肝治疗后肝肾功能、凝血功能主要指标较治疗前有明显改善(P<0.05);②15例患者中,3例患者经过1次人工肝治疗后,症状及各项实验室指标逐渐好转而痊愈。其余12例经过2次甚至3次人工肝治疗,其中7例痊愈,5例死亡。人工肝治疗过程中患者不良反应轻微,无1例因不良反应而终止治疗;③共17例胎儿出生,其中死胎5例(单胎1例、双胎2例),另12例出生时,新生儿Apgar评分>7分7例,预后良好;Apgar评分<7分5例,新生儿死亡2例,经治疗痊愈3例。结论:人工肝支持治疗是重症AFLP综合治疗中一项重要的治疗手段,且应尽早使用以阻断病情进展。

Objective：To analyse the therapeutic effect of severe artificial liver support system on severe acute fatty liver of pregnancy （AFLP）. Methods： The clinical data of fifteen patients with severe AFLP and treated was artificial liver between Jan. 2002 and Aug. 2007 in our hospital ware collected. We judged the change of patient＇ s condition by observing the patients symptoms, physical signs and blood routine, liver function, kidney function, electrolyte, coagulogram before and after treatment. Results：①Liver function, kidney function and blood coagulation function ware improved significantly after artificial liver treatment（ P〈 0.05） .②In 15 cases, the clinical symptoms and signs in 3 patients ware improved and cured after once artificial liver treatment. The other 12 cases ware underwent 2 to 3 times treatment, ？ cases were cured and 5 cases ware death. The adverse reaction was light during artificial liver treatment. No treatment was interrupted because of adverse reaction.③17 fetus ware bom, 5 fetus ware dead （singleton was 1, twins were 2）. Among 12 fetus, Apgar score 〉7 ware7 cases, with good prognosis. Apgar score 〈7ware 5 cases, among them recovery after treatment ware 3 cases and 2 were death. Corclusions： Artificial liver support system is an important method in the combined therapy of severe AFLP, which should be applied as early as possible to block the progress of the illness.