非生物型人工肝在急性重度中毒性肝病中的临床应用

Clinical application of non-biologic artificial liver for acute severe toxic hepatopathy

目的研究非生物型人工肝支持系统在急性重度中毒性肝病治疗中的疗效及治疗时机。方法选择符合急性重度中毒性肝病诊断标准的患者61例,分成人工肝组28例及对照组33例。对照组给予内科综合对症处理;人工肝组在内科综合治疗的基础上联合非生物型人工肝治疗。结果行人工肝治疗后患者血清学指标(转氨酶、总胆红素、血氨、胆碱酯酶、凝血时间)有显著改善(P<0.01),并发症发生率20.8%,没有发生严重并发症影响患者预后;与对照组比较肝功能指标、临床表现均有明显好转,死亡率降低,住院天数缩短,差异有统计学意义(P<0.01)。结论非生物型人工肝在急性重度中毒性肝病治疗中疗效显著;在内科综合治疗期间若出现血胆红素、转氨酶成倍增长,血氨持续升高,凝血时间明显延长或出现肝性脑病症状者以及明确有对肝脏直接损害的毒物在早期肝功能出现异常时宜及早行人工肝替代治疗,可取得较好的效果及缩短病程。

Objective To study the effectiveness and the optimal disease course in the application of nonbiologic artificial liver support system in patients with acute severe toxic hepatopathy. Methods A total of 61 patients diagnosed with acute severe toxic hepatopathy were enrolled in this study. Twenty-eight of them were treated with the non-biologic artificial liver support system in addition to routine medicinal therapy as the treatment group, and 33 patients were treated with routine medicinal therapy as the control group. Results In the treatment group, the improvement of clinical manifestations and laboratory indices including transaminases, total bilirubin, blood ammonia, cholinesterase and coagulation time was obviously better than that in the control group （P〈0.01）. Mortality rate and hospitalization day decreased （P〈 0.01）, and no severe complications occurred in the treatment group. Conclusion Non-biologic artificial liver support system is effective for acute severe toxic hepatopathy. Artificial liver support should be considered when the patients exhibit the increase of transaminases and total bilirubin more than two folds, significant prolongation of coagulation time, and hepatic encephalopathy after routine medicinal therapy.