分子吸附再循环系统治疗慢性乙型重型肝炎患者血清总胆固醇变化的研究

目的 探讨分子吸附再循环系统(MARS)治疗慢性乙型重型肝炎病程中血清总胆固醇(sTC)的变化及临床意义.方法 回顾性对比分析了57例药物与MARS联合治疗(治疗组)和59例单纯药物治疗(对照组)慢性乙型重型肝炎患者治疗前和治疗4周后sTC变化和临床意义.结果 治疗组入院后4周时sTC水平[(4.547±2.309)mmol/L]较人院时[(2.033±0.991)mmol/L]明显升高(t=9.298,P＜0.01);对照组治疗前sTC水平为[(2.440±0.991)mmol/L]与治疗4周后[(2.579±1.379)mmol/L]相比无显著性差异(t=0.775,P=0.441);MARS治疗有效组39例患者治疗后sTC水平[(5.714±1.523)mmol/L]较治疗前[(2.202±0.904)mmol/L]明显增高,差异具有高度显著性(t=14.355,P＜0.001),MARS治疗无效组18例患者治疗前后sTC水平无明显差异(P＞0.05).慢性乙型重型肝炎患者治疗前sTC水平与治疗有效率呈明显的正相关,sTC＜1.0 mmol/L者,预后极差.结论 MARS治疗慢性乙型重型肝炎病程中sTC水平的变化可较好的反映患者肝功能的恢复情况,治疗前sTC水平与慢性乙型重型肝炎预后呈明显的正相关.sTC可作为判断MARS治疗慢性乙型重型肝炎疗效和预后的重要指标.     

终末期肝病模型评分对慢性重型肝炎患者分子吸附循环系统疗效及预后的评价

目的 探讨终末期肝病模型(MELD)评分系统对分子吸附循环系统(MARS)治疗慢性乙型重型肝炎患者疗效及短期预后的预测能力及其临床应用价值.方法 对60例MARS治疗的慢性乙型重型肝炎患者,应用MELD评分系统对患者进行评分,比较治疗后3个月内的病死率,受试者工作特征(ROC)曲线评价MELD评分系统的准确性.结果 根据MELD分值不同将患者分为3组:MELD≤30分、30分＜MELD＜40分和MELD≥40分,3组患者的病死率分别为20.0%、34.3%和94.4%,3个月病死率随MELD分值增高而增高,前两组患者的病死率显著低于第三组,差异有统计学意义(P＜0.05).MELD≤30分和30分＜MELD＜40分两组患者在MARS治疗前后实验室各项检测指标比较差异有统计学意义(P＜0.05).MELD分值在≤30分和30分＜MELD＜40分两组患者的半数生存率均超过3个月,MELD分值达到或超过40分患者的半数生存率在1.54个月,生存率差异有统计学意义(P＜0.05).患者入院时MELD分值能够非常好地预测患者3个月内的病死率,应用MELD评分系统判断MARS治疗患者3个月预后的ROC曲线,其C-统计值为0.789,最佳临界值32,相应的敏感性80.1%,特异性50.1%.结论 MELD评分系统能较准确预测慢性重型肝炎患者的短期临床预后,MELD分值能够作为反映慢性重型肝炎患者病情严重程度的指标,MARS治疗可提高部分慢性重型肝炎患者的短期生存率.     

分子吸附再循环系统治疗慢性重型肝炎病人的护理

应用分子吸附再循环系统(mokcular adsorbent recirculation system,MARS)治疗慢性重型肝炎8例(18例次)。结果治疗后生化指标下降明显．临床症状明显改善。认为完善的心理护理,严格的技术操作规程,严密的病情观察,及时的并发症处理等护理措施是顺利进行MARS治疗的保障。     

重型肝炎患者甲胎蛋白的变化及其护理

对59例重型肝炎患者采用放免法检测AFP,于入院后及每2周1次,并每月行肝脏B超或CT检查.结果 有67.8%的患者AFP增高;在排除肝癌的情况下,其AFP值愈高,重型肝炎的好转率愈高,两者基本呈正相关.提示重型肝炎患者血清中AFP含量愈高预后愈好.对重型肝炎实施个体化护理,对其预后有一定的帮助;对AFP值持续增高者应及时进行相应的检查,以免误诊.     

重型肝炎患者甲胎蛋白的变化及其护理

对59例重型肝炎患者采用放免法检测AFP，于入院后及每2周1次，并每月行肝脏B超或CT检查。结果有67．8％的患者AFP增高；在排除肝癌的情况下，其AFP值愈高，重型肝炎的好转率愈高，两者基本呈正相关。提示重型肝炎患者血清中AFP含量愈高预后愈好。对重型肝炎实施个体化护理，对其预后有一定的帮助；对AFP值持续增高者应及时进行相应的检查，以免误诊。     

炭吸附辅助治疗重型破伤风患者的护理

对6例重型破伤风患者在常规处理基础上进行炭吸附治疗,结合心理护理,治疗前后密切监护等措施。结果6例住院14～32d,均获治愈。提示炭吸附法治疗成人重型破伤风患者的护理重点是做好心理护理,密切观察生命体征,抽搐、肌张力变化及预防并发症发生,促进其尽快康复。     

循证护理对重型肝炎患者的心理影响

目的:探讨循证护理对重型肝炎患者的心理状态的影响.方法:2009年1月至2010年6月收治的40例重型肝炎患者,随机分为常规护理组和循证护理组,每组20例.常规护理组采用传统的护理方法,循证护理组依据循证护理的原则对重型肝炎患者进行全面评估,查找资料,阅读文献,寻找科学依据,制定护理计划.观察两组护理前后艾森克个性问卷(EPQ)调查表和焦虑自评量表(SAS)、抑郁自评量表(SDS)的变化.结果:循证护理组护理前、后EPQ比较,除了内向性以外,护理后的评价分值显著降低,P＜0.05;传统护理组则除了内向性以外,护理后后分值明显高于升高,P＜0.05.护理后,循证护理组的SDS、SAS评分比常规护理组显著降低,P＜0.05.结论:循证护理能显著改善重型肝炎患者的心理状态.     

双重血浆吸附在治疗早中期重型肝炎中的临床观察

目的探讨采用中性大孔树脂和离子交换树脂联合应用治疗早中期重型肝炎的临床疗效和护理。方法对35例早中期重型肝炎患者,在常规治疗的基础上采用树脂血液灌流器联合离子交换树脂治疗。观察治疗前后患者的肝功能指标、血常规指标以及灌流前后患者临床症状有无改善,同时记录治疗过程中出现的不良反应。治疗过程中严密观察病情变化,做好导管维护、抗凝护理及并发症的处理。结果行双重血浆吸附系统治疗后患者的临床症状、体征均有不同程度的改善,肝功能指标较治疗前降低。结论双重血浆吸附在治疗早中期重型肝炎效果良好,严密观察病情变化,做好导管护理、抗凝护理及并发症的护理是其要点。     

人工肝支持系统治疗重型肝炎并发症的护理

人工肝支持系统(ALSS)是治疗重型肝炎较新的治疗手段[1],它是通过血浆置换等方法将患者体内中、小分子的内源性及外源性毒性物质过滤或吸附并清除,同时补充血浆中蛋白和各种凝血因子等物质,替代已丧失的肝脏功能,赢得抢救时间,有利于患者的康复.我科1998年10月至1999年2月,使用KM-8800型膜血浆交换ALSS治疗重型肝炎15例(50例次),现将治疗过程中出现的并发症及其护理要点总结如下.     

Orem自理理论在慢性重型肝炎患者护理中的应用

目的 探讨用于慢性重型肝炎护理的效果.方法 将40例慢性重型肝炎患者随机分为对照组和观察组各20例,对照组采用常规护理措施,观察组将0gem自理理论贯穿整个护理过程,分别在入院时和出院前用慢性肝病问卷(CLDQ)测量患者的生存质量.结果 观察组腹部症状、乏力、系统症状、活动能力、焦虑评分、情感职能评分显著高于对照组(均P＜0.05).结论 运用Orem自理理论指导慢性重型肝炎护理,能充分调动患者及家属的积极性,从而实现自我护理,提高患者的生活质量.     

Cytokine Level Modifications: Molecular Adsorbent Recirculating System Versus Standard Medical Therapy

Introduction

Acute-on-chronic liver failure (ACLF) is a systemic inflammatory reaction, which is characterized by a predominantly proinflammatory cytokine profile, causing the transition from stable cirrhosis to ACLF. The aim of the present study was to evaluate the changes in several cytokines associated with inflammatory liver disease and liver regeneration among 15 ACLF patients treated with the Molecular Adsorbent Recirculating System (MARS) compared with 15 patients treated with standard medical therapy (SMT). The subjects showed various disease etiologies but similar values for Model End-stage Liver Disease scores.

Methods

In the MARS group, 15 (10 male and 5 female) patients were treated with MARS (Gambro). The number of MARS applications was nine; the length of applications was 8 hours. In the SMT group; 15 (10 male and 5 female) patients were treated with SMT. The patients were monitored for 30 days from inclusion with a survival follow-up at 3 months. Statistical results were calculated with SPSS14.0 (SPSS Inc, Chicago, Ill). A P < .07 was considered significant.

Results

In the MARS group, we observed significant changes in the levels of Interleukin (IL)-6, IL-1, IL-10, and tumor necrosis factor (TNF)-α in association with improved hepatocyte growth factor. Patient survival at 3 months was 60%. The SMT group showed only a significant change in TNF-α (P = .03). Patient survival at 3 months was 30%.

Conclusion

The MARS liver support device corrected pathophysiologies of ALF and may be used to enhance spontaneous recovery or as a bridge to transplantation.     

Impact of Molecular Adsorbent Recirculating System Therapy on Tacrolimus Elimination: A Case Report

Background

We report a unique case which quantifies the effect of molecular adsorbent recirculating system (MARS [Gambro, Sweden]) therapy on blood concentrations of tacrolimus in a patient treated for refractory pruritus associated with recurrent hepatitis C of the liver allograft. Tacrolimus is a low-molecular-weight, highly protein-bound drug with the potential to be removed during MARS therapy.

Case Report

Results of therapeutic drug monitoring revealed extracorporeal tacrolimus elimination accounted for only 0.3% of total drug removal during the session.

Conclusions

Although no explanation can be offered as to why MARS contributed so little to overall tacrolimus elimination, the data clearly show minimal impact of MARS on tacrolimus blood level.     

Molecular Adsorbent Recirculating System Support Followed by Liver Transplantation for Multiorgan Failure From Heatstroke

Background

Exertional heatstroke is an extremely rare cause of fulminant hepatic failure. Maximal supportive care has failed to provide adequate survival in earlier studies. This is particularly true in cases accompanied by multiorgan failure.

Comparison of the Molecular Adsorbent Recirculating System and Plasmapheresis for Patients With Graft Dysfunction After Liver Transplantation

Background

Graft dysfunction after liver transplantation (OLT) is a life- threatening condition. Molecular adsorbent recirculating system (MARS) or plasmapheresis (PLP) may be effective supportive therapy of graft dysfunction for patients who cannot undergo retransplantation. The aim of this study was to compare the effects of MARS and PLP in patients with graft dysfunction after OLT.

Methods

Between January 2002 and July 2007, 31 OLT recipients who experienced graft dysfunction, defined as hyperbilirubinemia (>10 mg/dL) without bile duct obstruction and/or presence of hepatic encephalopathy, were treated with MARS or PLP. Biochemical and hemodynamic data and survival were compared in MARS and PLP groups.

Results

Fifteen patients were treated with 41 MARS sessions and 16 with 105 PLP sessions. After a single MARS session, patients showed significant reductions in creatinine, urea nitrogen, bilirubin, and ammonia. After a single PLP session, patients showed significant improvements in prothrombin time, bilirubin, alanine aminotransferase, alkaline phosphatase, and albumin. After the completion of treatment, Both MARS and PLP significantly improved bilirubin values. at 90 days there were no differences in overall survival rates; 53% in MARS versus 56% in PLP.

Conclusion

Both MARS and PLP are alternative supportive treatments for graft dysfunction after OLT.     

慢性重症肝炎低钾血症大剂量补钾的护理

对13例慢性重症肝炎合并低钾血症患者采用微量泵大剂量高浓度补钾,结果 3～14 d血钾均达到正常水平,无严重不良反应出现.提示利用微量泵补钾安全有效,但应注意高浓度钾时血管的刺激以及注意观察患者症状和心电图变化.     

慢性重症肝炎低钾血症大剂量补钾的护理

对13例慢性重症肝炎合并低钾血症患者采用微量泵大剂量高浓度补钾，结果3～14d血钾均达到正常水平，无严重不良反应出现。提示利用微量泵补钾安全有效，但应注意高浓度钾对血管的刺激以及注意观察患者症状和心电图变化。