探讨人工肝支持治疗对判断重型肝炎患者预后的临床意义

The study on assess wether the patients with gravis hepatitis can recovery spontaneously by treatment with artificial liver

目的 观察161例经人工肝治疗的重症肝炎患者的转归,探讨人工肝治疗对判断患者预后的临床意义。方法 161例重症肝炎肝功能衰竭患者各行血浆置换(plasma exchange,PE)、胆红素特异性吸附(bilirubin specific adsorption,BSA)、活性炭灌流(hemoperfusion,HP)、分子吸附循环系统(molecular adsorbent recy—cling system,MARS)、组合型生物人工肝(hybrid bioartificial liver,HBL)、人工肝治疗,平均治疗2.7次。于治疗前、治疗中、治疗后分4个不同时段取血分别测肝功能、血氨、凝血酶原活动度及血清内毒素水乎,并观察临床症状及体征变化。结果 20例治疗前伴肝性脑病患者昏迷程度减轻。与治疗前比较,患者血清总胆红素及内毒素水平明显降低(P<0.01),凝血酶原活动度及胆碱脂酶显著升高(P<0.O1和P<0.05)。92例患者痊愈,33例成功的实施肝移植,其余36例分别死于严重感染者、消化道大出血和肝肾综合征,存活率为77.64％。结论 人工肝可能作为治疗重型肝炎肝衰竭的有效方法之一,并作为判断患者能否自然恢复或必须进行肝移植的主要指标。

Objective To investigate the hybrid bioartificial liver(HBL)as a meaningful therapy to assess the patient with hepatic failure if can spontaneously recovery or transplantation. Methods 161 patients with liver failure were treated with plasma exchange (PE),bilirubin specific adsorption(BSA) ,hemoperfusion(HP)molecular adsorbent recycling system (MARS), hybrid bioartificial liver(HBL) . The clinical signs and syptoms, total serum bilirubin (TBIL) , ammonia, en-dotoxin and prothrombin activity (PTA) ,cholinesterase(CHE)were recorded or detected before, during and after treatment. Results 20 patients with hepatic coma improved in level of encephalopathy. All patients' s PTA and CHE were increased significantly ( P < 0.01) , while the serum TBIL and endotoxin were decreased ( P < 0.01 and P < 0.05 respectively) . 33patients were bridged for spontaneous recovery and 1 patient bridged for OLT successfully, another 36 cases died cause of severe infection, gastroenterology hemorrhage and hepatorenal syndrome. Conclusion The HBL may be an effective method to treat patients with acute and sub - acute liver failure and an effective sign to assess wether the liver can recovery spontaneously.