儿童暴发性肝衰竭人工肝治疗

Artificial liver support for fulminant hepatic failure in children

儿童暴发性肝衰竭的发病率还不明确,发生虽然少见,但短期内可以导致患儿因肝性脑病、弥散性血管内凝血(DIC)、多脏器衰竭等原因死亡。肝移植是其主要治疗方法,但长期肝源缺乏却限制了这一有效治疗。本文在介绍儿童暴发性肝衰竭的现状基础上,重点对人工肝技术的应用的效果评价进行探讨,认为人工肝对儿童暴发性肝衰竭治疗的作用举足轻重。根据人工肝的分类,主要讨论非生物型人工肝分子吸附循环系统(MARS)的应用,包括人工肝适应证和各种方法的优点和缺点。目前,人工肝治疗也面临许多问题,人工肝支持系统对患儿的治疗评估和研究尚不足,在改善生存方面尚未形成一致共识。

The true incidence of fulminant hepatic failure in the pediatric population is unknown, though fulminant hepatic failure is a rare but devastating syndrome （such as hepatic encepha- lopathy, DIC, MODS） that results in the death of most children affected. The mainstay of the treatment is liver transplantation, however, organ shortage limits its use.The purpose of this review is to introduce the current situation of fulminant liver failure in children, focusing on assessing the application of artificial liver, which is considered to play a pivotal role in the treatment of fulminant liver failure.According to its classification, we mainly discussed the application of non-biological artificial liver, in- cluding its indications, advantages and disadvantages, especially the MARS. At present, the artificial liver treatment also faces many problems. None of the ELS techniques has yet been eval- uated systematically in children, and survival benefits have not vet been demonstrated.