MARS治疗慢性重型肝炎并多脏器衰竭疗效观察

目的应用分子吸附循环系统(MARS)治疗慢性重型肝炎并多脏器衰竭(MOF)患者,观察其在肝脏支持及治疗由肝功能衰竭引起多脏器衰竭的临床效果.方法治疗组40例慢性重型肝炎并发MOF患者,经MARS治疗110次,平均2.75次,比较治疗前后临床表现、肝功能、血常规、凝血功能等指标,以及血NH3、BUN、血Cr、电解质及酸碱平衡等生化指标.对照组42例同类患者.结果 MARS治疗能明显改善患者的预后指标MELD,与对照组比较,提高了抢救成功率.通过清除毒性物质,改善内环境,对肝脏有较明显的支持作用.在治疗肝性脑病,缓解脑水肿,防治肾功能衰竭等方面优于对照组.在调整电解质、晶体渗透压、酸碱平衡,创造补液及能量补充空间,治疗浮肿等方面具有较好的临床效果.在缓解SIRS状态,改善心、肺功能,缓解中毒性鼓肠及顽固性腹水等方面也有一定的效果.安全性良好.结论 MARS治疗在肝脏支持,并发症处理,治疗多脏器衰竭等方面具有较大的应用价值.

Therapeutic application of molecular adsorbents recirculating system of chronic severe hepatitis patients complicated with multi - organ failure

Objectives To evaluate the therapeutic effects of molecular adsorbents recirculating system(MARS) on chronic severe hepatitis patients complicated with multi-organ failure. Methods Eighty-two patients of chronic severe hepatitis complicated with multi-organ failure were studied and they were randanly divided into two groups, 40 as MARS therapy group and 42 as control group. One hurdred and ten sessions of MARS treatments were performed in MARS therapy group. Liver fundtion, hemogram ammonia level, blood coagulation analysis, blood urea nitrogen (BUN) and creatinine level before and after treatment were evaluatied. Results MARS therapy improved the result of a prognosis index MELD remarkably, presented in significant therapeutic effect on hepatic encephalopathy or brain edema, renal dysfunction, obstinate ascites as well as reversal development of SIRS, improved hemodynamic and respiratory function by selective elimination of accumulated metabolic toxins and adjusted electrolyte, fluid and acid base balance. Conclusions MARS can be applied safely as preferable liver support therapy for liver failure patients complicatied with multi-organ failure.