双重血浆吸附治疗对急性肝功能衰竭指标的影响

目的 观察双重血浆吸附治疗对急性肝功能衰竭患者的干预效果，为临床提高急性肝功能衰竭的治疗效果提供参考。方法 选择烟台市莱阳中心医院2016年7月—2021年7月收治的急性肝功能衰竭患者90例作为研究对象，依据临床治疗方案的不同分为研究组和对照组各45例，研究组采用双重血浆吸附治疗，对照组采用血浆置换治疗。观察比较两组患者治疗前后血清肝功能指标、血清炎症因子水平。结果 治疗前，两组患者血清肝功能指标、血清炎症因子水平差异均无统计学意义（P>0.05）。治疗后，两组患者TBIL、DBIL以及ALT水平均低于治疗前，且研究组低于对照组；两组患者TNF-α、IL-6、IL-10、TGF-β1水平均低于治疗前，且研究组低于对照组，差异均有统计学意义（P<0.05）。结论 对于急性肝功能衰竭患者来说，双重血浆吸附治疗具有较高的应用效果，既可有效改善患者血清肝功能指标，也可有效降低患者血清炎症因子水平。     

血浆置换联合血液灌流抢救急性重度三氯甲烷中毒

目的 探讨急性重度三氯甲烷中毒合并急性肝功能衰竭的有效治疗方法.方法 对1例确诊为急性重度三氯甲烷中毒合并急性肝功能衰竭的患者,在常规内科治疗的基础上,先后进行血液灌流术(HP)及血浆置换术(PE)治疗各1次.结果 患者在接触三氯甲烷38 d后急性发病,主要症状为黄疸、纳差、腹胀,实验室检查示丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、结合胆红素均增高.同工种357人中112人(31.4％)有肝功能异常.在内科常规护肝、降酶、退黄及支持治疗的基础上,先后予HP及PE各1次,住院42 d后患者痊愈出院.结论 急性重度三氯甲烷中毒合并急性肝衰竭患者应及早进行PE和HP等人工肝治疗,临床疗效显著.     

连续性血液净化技术在肝移植手术后患者中的价值

目的:探讨肝移植手术后急性肾功能衰竭采用连续性血液净化治疗的临床效果及安全性.方法 选择2013年1月至2015年6月期间行肝移植术治疗术后出现早期急性肾功能衰竭的23例患者作为研究对象,本组患者出现早期急性肾功能衰竭症状后均立即行连续性血液净化治疗(CBP),观察患者治疗前后肾功能、肝功能指标变化,并记录患者治疗期间不良反应情况.结果 与治疗前相比,本组患者SCr、BUN、血尿酸、ALT、AST、TB、DB指标水平均显著下降,差异显著p<0.05,认为有统计学意义.本组患者治疗期间均未出现出血、血肿、血栓、心动过速及感染加重等不良反应.结论 肝移植手术后早期急性肾功能衰竭应用连续性血液净化技术治疗,可有效改善患者肝功能、肾功能指标,从而减缓肾功能衰竭病理进程,进而改善患者预后.     

肝脏疾病的胰高血糖素—胰岛素疗法

对急性肝功能衰竭,以往曾广泛应用血液或血浆交换法、体外吸附剂灌流、人工肝辅助装置、猪及人肝灌流、左旋多巴、氨基酸输液和脱氨药等治疗。虽然获得某种疗效,但生存率仍低,多数报告均低于30%。肝脏是一个再生能力很强的脏器,对于急性肝功能衰竭,除一般疗法外,尚须考虑如下     

急性肝功能衰竭并发症及其处理

急性肝功能衰竭的病死率极高,其中很大一部分直接死因为其并发症所致,因此加强急性肝功能衰竭并发症的预防和处理对提高生存率至关重要。本文就脑水肿、肾功能衰竭、出血倾向和出血,以及呼吸循环异常等方面的研究现况作一概要介绍。     

1例CRRT治疗重症青鱼胆中毒引起急性肝衰、肾衰的护理

鱼胆中毒由口服生鱼胆而引起,因鱼胆汁中所含胆酸、胆汁毒素及氰化物损害肝细胞,组胺物质致敏,导致损害肝功能,并合多脏器功能衰竭.笔者对本院1例鱼胆中毒患者伴急性肝功能衰竭及肾功能衰竭衰采用连续性肾替代(CRRT)等综合治疗,精心科学护理,患者康复出院.现将护理体会报道如下.     

急性甲硝唑中毒致肝功能衰竭及肝性脑病1例报告

报道1例急性口服甲硝唑中毒致肝功能衰竭及肝性脑病病例,并对其临床表现、中毒诊断与抢救治疗进行分析。 更多还原     

还原型谷胱甘肽防治抗结核药物致肝损害的206例临床观察

肝功能损害是抗结核治疗过程中最常见的毒副反应之一。轻者常使抗结核治疗不能继续，影响结核病的疗效；严重者可引起急性肝功能衰竭，甚至死亡。如何减少肝功能损害以保证完成全程化疗方案，是有待解决的问题。本文对206例使用抗结核药物治疗过程中同时应用还原型谷胱甘肽和甘草酸二铵治疗以减少肝功能损害取得了满意的结果。现报告如下：     

肝细胞癌患者靶向治疗期间肝功能衰竭的发生情况及影响因素

目的:观察肝细胞癌患者靶向治疗期间肝功能衰竭发生情况,分析患者发生肝功能衰竭的影响因素。方法:回顾性分析2017年3月至2020年6月在海南省肿瘤医院接受靶向治疗期间发生肝功能衰竭的25例肝细胞癌患者资料,将其纳入发生组,按照1∶1原则收集同期在医院接受靶向治疗期间未发生肝功能衰竭的25例肝细胞癌患者资料,将其纳入未发...     

血液净化技术对小儿急性肝功能衰竭病例的疗效

目的 探讨血浆置换(PE)联合连续性血液透析滤过(CVVHDF)治疗小儿急性肝功能衰竭的临床效果和安全性.方法 应用PE+CVVHDF技术对重症监护病房15例急性肝功能衰竭患儿进行治疗,比较治疗前后总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、凝血酶原时间、血氨、昏迷评分及临床症状的改善程度,同时观察治疗的不良反应,并进行治疗安全性评价.结果 ①经PE+CVVHDF治疗后总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、凝血酶原时间、国际标准化比率、血氨均较治疗前明显下降(t值分别为5.724、5.390、5.321、4.532、4.038、3.06、3.112,均P<0.01);②患儿治疗后意识状态好转(昏迷评分升高),与治疗前比较差异具用统计学意义(t=2.183,P<0.05);黄疸、乏力、恶心、呕吐、腹胀等症状明显缓解;③转归:11例患儿肝功能恢复正常出院,2例治疗过程中死亡,2例因个人原因放弃治疗,后电话随访死亡;④15例患儿治疗过程无1例过敏、血栓等不良反应出现.结论 血浆置换联合连续性血液透析滤过治疗小儿急性肝功能衰竭具有良好的效果,且无明显的不良反应,具有临床应用价值.     

An adolescent with hemolytic anemia and coagulation disorders as manifestation of Wilson's disease, treated with liver transplantation

A 16-year-old woman presented with anaemia, jaundice, vomiting and nosebleed. She had acute hepatic failure and haemolytic anaemia and developed acute respiratory distress syndrome (ARDS). Wilson's disease was diagnosed. After the ARDS resolved the patient underwent a successful orthotopic liver transplantation. Diagnostic combinations for Wilson's disease are ceruloplasmin < 0.2 g/l with Kayser-Fleischer rings, liver copper > 250 micrograms/g (dry weight) with Kayser-Fleischer rings, or homozygosity for a Wilson mutation on the 13th chromosome. In acute liver failure a copper excretion in 24 h-urine above 1 mg is diagnostic for Wilson's disease, while an elevated serum copper concentration makes this diagnosis very likely. Therapeutic options for Wilson's disease are chelation therapy and liver transplantation; in most cases of acute liver failure due to Wilson's disease orthotopic liver transplantation (preceded by albumin dialysis) is indicated. Nazer's index should be used in addition to the regular King's College criteria for liver transplantation indication.     

Acute liver failure in a young adult

Acute liver failure is a rare but mostly severe disorder in previously healthy patients. Viral infections and drugs are the most common causes in the Western world. A small percentage of acute liver failure is caused by Wilson's disease. We describe a previously healthy 23-year-old female with acute haemolytic anemia and liver failure as the first manifestations of Wilson's disease. There was rapid deterioration to multi-organ failure and the patient died less than 24 hours after initial presentation. Relatively simple laboratory tests can be used for initial screening of acute liver failure due to Wilson's disease. Liver transplantation is the only way to ensure survival of the patient. Rapid transfer to a specialised centre is, therefore, of the utmost concern.     

The pregnant patient with acute liver disease

Acute liver disease was diagnosed in three pregnant patients: two 30-year-old women had a 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome and acute fatty liver of pregnancy, respectively, and a 20-year-old woman had acute liver failure due to acute hepatitis B. The first two patients had a caesarean section, the third one delivered her child, which died spontaneously shortly after birth at a gestational age of 23 weeks. She was then treated by liver transplantation. All three patients left the hospital in good condition. Liver diseases in pregnancy may be pregnancy-related, e.g. the HELLP syndrome and acute fatty liver of pregnancy, but they may also be coincidental phenomena, e.g. viral hepatitis. The HELLP syndrome is often associated with pre-eclampsia, and presents with epigastric pain and thrombocytopenia with haemolysis. Acute fatty liver disease and acute liver failure due to hepatitis present with liver insufficiency characterised by anorexia, nausea, coagulopathy, hypoglycaemia and elevated serum ammonia levels. Management depends on the diagnosis and the gestational age; pregnancy complicated by acute fatty liver disease should be terminated while pregnancy complicated by the HELLP syndrome early in pregnancy may be maintained to improve the outcome of the foetus. In acute liver failure due to viral hepatitis, termination of pregnancy alone does not affect the disease.     

Alternativen zur Spenderorgantransplantation bei Patienten mit hepatischen Erkrankungen

Liver transplantation is a safe and established treatment method for acute and chronic liver failure due to congenital or acquired liver diseases [1, 2]. With the success of liver transplantation the problem of donor organ shortage developed worldwide. It became obvious that the limited supply of donor organs cannot meet the demand, despite intensive efforts to increase donations. Thus, it is very important to try to prevent the development of liver diseases (i.e., hepatitis B vaccination) and to improve the currently available treatment strategies for diseases leading to liver cirrhosis (i.e., antiviral therapy). A further aspect is the improvement of surgical techniques and the postoperative and long-term treatment of transplanted patients. Hepatocyte transplantation has the potential to cure patients with metabolic liver disease or acute liver failure. It could also serve to bridge the time until an organ is available for transplantation. The use of hepatocytes from organs, which cannot be otherwise used because of injury or prolonged ischemia, or the use of genetically modified hepatocytes can counteract the shortage of available donor organs. Using the methods of tissue engineering can increase the efficiency of hepatocyte transplantation. Extracorporeal liver support systems offer the option for temporal compensation of missing liver function to treat patients with acute liver failure until regeneration of their own liver is achieved or until a donor organ becomes available for transplantation.     

酒精性肝病治疗方法进展

酒精性肝病包括急性酒精性肝炎和酒精性肝硬化.戒酒一直是治疗所有酒精性肝病的基础.近年来,关于乙醇引起肝损伤机制的研究,提出了酒精性肝病治疗发展的前景.本文作者回顾近期资料关于急性酒精性肝损伤治疗的效果,包括营养治疗、皮质激素类、抗炎因子、抗氧化剂和一些直接抗纤维化过程的要素,如秋水仙碱和抗氧化物质.治疗方法包括直接改变肝损伤和修复进程,但无可持续改善酒精性肝损害的疗法.因此,肝移植仍是因慢性酒精性肝损伤致肝功能衰竭病人的最终选择.     

细胞外组蛋白在急性肝衰竭发病机制中的研究进展

急性肝衰竭是由多种因素引起的短时间内肝脏发生损害的严重临床综合征,死亡率高,且无特效疗法.细胞外组蛋白是一种新发现的炎性介质或危险信号分子,在启动及加重肝损伤中有着重要的作用.本文阐述了细胞外组蛋白结构、生物学特性、来源及导致细胞毒性的机制,从多方面探讨细胞外组蛋白在急性肝衰竭发病中的作用机制.     

Confusion and abnormal liver enzyme levels: problems with diagnosing hepatic encephalopathy

3 patients with liver failure developed hepatic encephalopathy. 2 patients, men aged 60 and 72 years, had chronic liver disease and presented with episodes of confusion. They recovered after being treated with lactulose. The third patient, a 37-year-old woman, became comatose shortly after the onset of acute liver failure due to acute autoimmune hepatitis. She died before a suitable donor liver became available. Hepatic encephalopathy is a syndrome of potential reversible neurological symptoms. Especially in the early stages of the condition, hepatic encephalopathy can be difficult to diagnose. Patients may present with mild cognitive impairment or episodes characterized by neurological symptoms. Hepatic encephalopathy is a clinical diagnosis. The pathophysiologic mechanism is only partly understood but toxicity of ammonia on the central nervous system seems to be of major importance. Raised ammonia concentrations or EEG findings consistent with metabolic encephalopathy may support but are not essential to the diagnosis. Episodes of hepatic encephalopathy are often elicited by an underlying disease such as infection or gastro-intestinal bleeding. It is important to recognize hepatic encephalopathy in its early stages because adequate treatment of the condition and any underlying disease reduces morbidity and mortality.     

Occult malignancy presenting as acute fulminant hepatic failure

Only six cases of hepatic metastatic disease presenting as acute fulminant liver failure have been recorded in the literature. A seventh case is reported here where, after presenting in acute liver failure, it was not possible to establish a tissue diagnosis but evidence of massive liver replacement by tumour was provided by ultrasound imaging and radionuclide scintiscanning.     

慢性肝病患者肠外肠内营养支持与膳食干预专家共识

肝脏是人体最重要的代谢器官，肝脏发生疾病时可出现复杂的营养素代谢改变和不同程度的营养不良（不足），而营养状态又反过来影响肝病的发生、发展和预后，形成恶性循环。营养支持（肠外营养支持、肠内营养支持、膳食干预）在慢性肝病患者（代偿期/失代偿期肝硬化、慢加急/亚急性肝衰竭、慢性肝衰竭）的治疗中起重要作用。但此领域缺少大样本、高质量的临床研究报告，且国内尚无有关临床诊疗的“共识”。从合理应用营养支持疗法，改善慢性肝病患者临床结局出发，本“共识”专家组系统总结相关文献，并结合我国慢性肝病的临床实践，完成此共识，以期为慢性肝病诊疗有关的医师、护士（师）、营养师、药剂师们提供临床参考。     

高迁移率族蛋白B-1及其在急性肝衰竭中的作用

高迁移率族蛋白B-1(HMGB1)是一种重要的晚期炎症介质,可以由坏死细胞被动释放,也可以由被激活的巨噬细胞或单核细胞主动分泌到细胞外介导炎症反应.急性肝衰竭时,内毒素血症发生率极高,HMGB1可能参与了急性肝衰竭的病理生理过程并发挥了重要作用.HMGB1将在临床上为抗急性肝衰竭提供新的治疗靶点.