重型肝炎肝脏移植术前人工肝支持系统的应用

目的　探讨人工肝支持系统在重型肝炎肝移植术前的应用价值。方法　患者通过股静脉内单针双腔导管置管建立血管通道 ,将P1S血分离器、HA血液灌流器安装在血液净化装置上进行血浆置换和血液灌流。每次血浆置换量 30 0 0～40 0 0ml,平均为 32 0 0ml,白蛋白 2 0g。体外循环时 ,肝素平均剂量为 2 5mg,鱼精蛋白平均剂量为 2 5mg。置换血流量在 10 0～ 15 0ml/min,分离血浆速度平均 2 6ml/min ,每次治疗时间平均 12 0min。结果　接受人工肝支持系统治疗后TB、DB、ALT、AST、NH3 等肝功能指标获得明显改善。结论　人工肝支持系统能纠正术前患者内环境失衡 ,有效排除体内毒性物质的积聚 ,为等待供肝及移植手术创造最佳时机和条件。

HEPATIC SUPPORT WITH ARTIFICIAL LIVER SYSTEM BEFORE LIVER TRANSPLANTATION FOR SEVERE HEPATITIS

Objective To evaluate the application of artificial liver support system (ALSS) in severe hepatitis patients before liver transplantation. Methods Double lumen catheters were inserted into the femoralvein to construct the blood conduit in patients receiving ALSS. The blood purification apparatus was applied for plasma replacement and blood perfusion with PIS separator and HA hemoperfusion apparatus. The plasma replacement capacity was 3000ml-4000ml (average 3200 ml) with albumin 20g. The average dosages of both heparin and protamine were 25 mg. The separation speed was 26 ml/min. The replacement blood flow was 100-150 ml/min, and the average treatment time was 120 min. Results The liver function markers, including TB, DB, ALT, AST and NH 3, were improved in patients with ALSS. Conclusion ALSS could correct the imbalance of homeostasis of the patients, eliminate the toxic substances effectively and provide valuable support for liver transplantation.