人工肝支持系统成功抢救妊娠急性脂肪肝合并多器官衰竭患者1例报道

目的 分析妊娠急性脂肪肝患者的病例特点、抢救措施及预后,提高对此病的认识及早期诊治水平.方法 回顾性分析1例妊娠急性脂肪肝合并多器官衰竭患者病情演变以及抢救治疗情况,并结合相关文献分析讨论.结果 患者以妊娠晚期出现重度黄疸伴消化道症状起病,常规保肝、退黄等治疗未能逆转病情,并迅速出现肺、肝、肾等多器官衰竭以及DIC等严重并发症,经积极终止妊娠、辅助呼吸及人工肝支持系统等综合抢救最终病情缓解,并经肝组织病理检查明确诊断.结论 妊娠急性脂肪肝病情凶险,极易并发多器官衰竭,早期诊断,多学科、全方位综合救治是提高本病成功抢救的关键.

Successful experience of artificial liver support system in rescuing a case with multiple organ failure and acute fatty liver of pregnancy

Objective To analyze clinical features, treatment and prognosis of acute fatty liver of pregnancy (AFLP) in order to improve the awareness, diagnosis and treatment. Methods The clinical data of an AFLP case with multiple organ failure (MOF) were retrospectively collected and analyzed in combination with literature review. Results The patient was admitted to hospital for severe jaundice and gastrointestinal symptoms in late trimester. The routine methods of protecting hepatocyte and eliminating jaundice could not reverse the disease progression. Furthermore, complications such as acute respiratory distress syndrome (ARDS), hepatic and renal failure, and disseminated intravascular coagulation (DIC) occurred rapidly. The definite diagnosis was identified by liver biopsy, and finally the patient was successfully rescued through termination of pregnancy, ventilatory support, and artificial liver support system and so on. Conclusion AFLP is a rapidly progressive disease, and MOF may occur in early period of its onset. Early diagnosis, omnidirectional therapy of multidisciplinary combination is the key point for successful rescue.