肝移植围手术期中的人工肝支持

Artificial liver support system used in the perioperative period of liver transplantation

人工肝脏支持系统是以血液净化为基础的体外循环系统,包括血液透析、血液滤过、血液灌流、血浆置换等方法。临床应用非生物型人工肝脏尤其是血浆置换技术,能有效地解决高胆红素血症、内毒素血症、毒性物质积蓄与氨基酸代谢障碍及水、电解质、酸碱失衡等问题,改善患者内环境,促进肝细胞再生,纠正肝性脑病、降低重型肝炎的病死率,使患者能渡过危险的肝功能衰竭难关而获得生存。通过人工肝治疗,不仅可明显改善肝衰竭患者的全身情况,为手术降低风险,为寻找供肝争得保贵的时间,而且能有效地改善肝移植术后早期患者的生理紊乱状况,帮助渡过排斥反应期,有利于移植肝功能的恢复。因此,人工肝可成为肝移植的桥梁。文章从人工肝脏支持系统的功能出发,分析其特点,探讨其应用于人体原位肝移植围手术期的方法及其发展方向。

An artificial liver support system （ALSS） is a body circulatory system aims to blood purification, which consists of plasma exchange, hemodialysis, hemoperfusion, in combination with hemodiafiltration. The clinical application of non-biological artificial liver, especially plasma exchange technology, can solve the problem such as hyperbilirubinemia, endotoxemia, toxic substance accumulation and disorder of amino acid metabolism, which would save patients＇ lives. ALSS can significantly improve the general physical condition, reduce operative risk, as well as relieve physiologic derangement after liver transplantation. Therefore, artificial liver serves as a bridge for liver transplantation. This paper analyzes the characteristics of ALSS, explores the methods of ALSS application in perioperative period of liver transplantation, and discusses its developing orientation.