人工肝支持系统在肝衰竭和肝脏移植中的临床应用研究  

Application of Artificial Liver Support System in Liver Failure and Liver Transplantation

作　　者：阿永俊[1] 李立[1] 李晓延[1] 唐继红[1] 魏晓平[1] 陈刚[1] 朱洪[1] 

机构地区：[1]昆明医学院第二附属医院肝胆外科,昆明650101

出　　处：《中国普外基础与临床杂志》2005年第5期496-498,共3页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的评价人工肝支持系统(ALSS)在肝衰竭和肝脏移植中的作用。方法对44例肝衰竭患者(包括12例行肝移植者)进行分子吸附循环系统(MARS)或血浆置换治疗,检测治疗前、后各种有毒物质及细胞因子等的改变并进行比较。结果44例肝衰竭患者,经ALSS治疗后临床症状及体征明显改善;血总胆红素、总胆汁酸、谷丙转氨酶、肌酐、尿素氮、血氨及内毒素水平明显降低(P<0.05);血清NO和TNF-α、IL-4、IL-6水平亦明显降低(P<0.05);治疗前、后红细胞、白细胞、血小板无明显变化(P>0.05)。30例重型乙肝肝衰竭患者存活18例,存活率为60.0%;6例肝脏移植术前急性肝衰竭患者均成功接受肝脏移植;6例肝脏移植术后急性肝衰竭患者存活2例;2例胰十二指肠切除术后急性肝衰竭者,死亡1例。结论ALSS通过全面清除肝衰竭患者体内毒素、NO和细胞因子,对肝衰竭有肯定的治疗作用;并对等待肝脏移植的肝衰竭患者发挥过渡性桥梁作用。Objective To evaluate effect of artificial liver support system （ALSS） in liver failure and liver transplantation. Methods Forty-four patients with liver failure （including 12 undergoing liver transplantation） were treated with MARS or plasma exchange. The changes of toxic substances and cytokines in blood were detected before and after treatment. Results ALSS therapy achieved a remarkable improvement in clinical symptoms and physical signs. After ALSS treatment, there was a significant decrease in total bilirubin, total bile acid, alanine amin- otransferase, creatinine, urea nitrogen, blood ammonia and endotoxin levels（P〈0.05）; the levels of serum NO, TNF-α, IL-4 and IL-6 were significantly decreased（P〈0.05） ; there was no statistical change in erythrocytes, leukocytes and platelets. The survival rate of 30 liver failure patients caused by severe hepatitis B was 60. 0 % （18/30）. Six patients with acute liver failure were successfully performed liver transplantation. Two patients in 6 with acute liver failure after liver transplantation survived. One patient in 2 with acute liver failure after pancreatoduodenectomy survived. Conclusion ALSS plays a positive role in treatment of liver failure by removing blood toxins, NO and cytokines. ALSS also plays a substitute role for liver failure patients who are waiting for liver transplantation.

关 键 词：人工肝支持系统 分子吸附循环系统 血浆置换 肝衰竭 肝脏移植 

分 类 号：R657.3[医药卫生—外科学] R318.1[医药卫生—临床医学]