在急性肝衰竭中,肝支持系统和肝移植
1Department of Intestinal Failure and Liver Diseases, Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark.
概括
急性肝衰竭 (ALF) 管理涉及人工肝支持,以清除氨和损伤相关分子模式 (DAMPs) 等毒素. 这有助于改善患者在等待肝移植 (LT) 期间的稳定性和生存率.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 关键护理医学 关键护理医学
- 移植手术 移植手术
背景情况:
- 急性肝衰竭 (ALF) 导致多器官衰竭,原因是高氨血和损伤相关分子模式 (DAMPs) 的释放.
- 超血症会损害尿素的合成,导致肝脏脑病和大脑.
- DAMPs引发全身炎症,模仿败血症休克.
研究的目的:
- 审查ALF的病理生理学及其管理策略.
- 评估人工肝支持和肝移植 (LT) 在改善结果中的作用.
- 讨论目前对LT选择的标准和最近在移植后生存方面的进展.
主要方法:
- 对ALF病理生理过程的审查.
- 对人工肝支持技术的分析,包括连续置换疗法 (CRRT) 和血交换.
- 检查肝移植 (LT) 选择标准和结果.
主要成果:
- 联合CRRT和血交换有效地去除氨和DAMP,改善ALF患者的生存率.
- 人工肝脏支持增强了等待LT患者的重要器官稳定性.
- 经过LT治疗后的生存率显著改善,达到大约90%.
结论:
- 人工肝脏支持,特别是CRRT与血交换或白蛋白透析相结合,为ALF提供了可行的管理策略.
- 精细的LT选择标准至关重要,特别是在吸食过醇的病人身上.
- 在LT的进步导致了优异的生存率,与慢性肝病的生存率相比.
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