连续性肾脏替代治疗在治疗肝性脑病中的应用  

Applications of continuous renal replacement therapy for hepatic encephalopathy

作　　者：焦晶 魏岁姣 柏明[2] 张鹏[2] Jiao Jing;Wei Sui-jiao;Bai Ming;Zhang Peng(Xi’an Medical University,Jinan 250012,China;Department of Nephrology,Xijing Hospital,Air Force Medical University,Jinan 250012,China;Department of Nephrology,Qilu Hospital,Shandong University,Jinan 250012,China)

机构地区：[1]西安医学院,西安710021 [2]第四军医大学西京医院肾脏内科,西安710032

出　　处：《临床肾脏病杂志》2022年第11期943-947,共5页Journal Of Clinical Nephrology

摘　　要：连续性肾脏替代治疗(continuous renal replacement therapy,CRRT),又称连续性血液净化(continuous blood purification,CBP),可快速清除患者体内毒素并改善代谢紊乱,已成为危重症患者的重要治疗手段。肝性脑病(hepatic encephalopathy,HE)是肝功能不全或门静脉-体循环分流导致的严重神经精神并发症,病死率高、预后差。氨代谢紊乱是HE核心发病机制。回顾文献发现,CRRT对血氨有清除效果,亦兼有改善炎症状态、干预脑水肿及平衡内环境的作用,有可能成为治疗HE的有效方式之一。本文就CRRT治疗HE的相关理论依据及循证医学证据归纳总结,阐述CRRT对HE的治疗价值,以期为临床应用和临床研究提供指导和参考。Continuous renal replacement therapy(CRRT),also known as continuous blood purification(CBP),is capable of quickly removing blood toxins and improving metabolic disorders.It has become a vital treatment for critically ill patients.As a serious neuropsychiatric complication of liver insufficiency and portosystemic shunt,hepatic encephalopathy(HE)is associated with a high mortality and a poor prognosis.Disorder of ammonia metabolism is a core pathogenesis of HE.CRRT is effective in boosting blood ammonia clearance,improving inflammatory status,alleviating cerebral edema and balancing internal environment.This review summarized the relevant therapeutic mechanism of CRRT to provide useful guidance for routine practices and clinical trials.

关 键 词：肝性脑病 连续性肾脏替代治疗 氨代谢紊乱 血氨 

分 类 号：R692[医药卫生—泌尿科学] R575[医药卫生—外科学] R747.9[医药卫生—临床医学]