儿科急性至慢性肝功能衰竭
Seema Alam1, Bikrant Bihari Lal2
1Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. seema_alam@hotmail.com.
Indian journal of pediatrics
|June 22, 2023
概括
儿童急性慢性肝衰竭 (ACLF) 涉及肝脏损伤叠加肝硬化,导致炎症和器官衰竭. 儿童ACLF的预后往往比成人更好,这是由于可治疗的原因和更好的储备.
科学领域:
- 儿科肝病学 儿科肝病学
- 关键护理医学 关键护理医学
- 胃肠病学 胃肠病学
背景情况:
- 急性至慢性肝衰竭 (ACLF) 是肝硬化患者的一种严重综合征,其特征是全身炎症,败血症和器官衰竭.
- 儿科ACLF的定义缺乏共识,亚太肝病研究协会 (APASL) 和欧洲肝病研究协会 (EASL) 的标准不同.
- 在儿童中常见的潜在原因包括威尔逊病 (WD) 和自身免疫性肝炎 (AIH),急性病毒性肝炎或WD/AIH的爆发是导致事件.
研究的目的:
- 审查目前对儿科ACLF的理解,包括定义,病因,结果和管理策略.
- 突出ACLF定义中主要肝脏关联之间的差异和儿科病例的具体挑战.
- 讨论儿科ACLF的预后因素和治疗方法.
主要方法:
- 对ACLF现有文献和指导方针的审查,重点是儿科病例.
- 对报告结果,死亡率和预后得分的分析 (例如,APASL ACLF研究联盟 (AARC) 的得分).
- 讨论治疗方式,包括医疗管理,血交换等桥梁疗法和肝移植 (LT).
主要成果:
- 儿科ACLF结局在死亡或肝移植 (LT) 方面范围为19%至59%.
- 儿科ACLF的预后通常比成人更好,这是由于可治疗的病因,较少的器官衰竭和更好的肝脏储备.
- 一个APASL ACLF研究联盟 (AARC) 的得分>= 11预测28-90天死亡率不佳.
结论:
- 及时诊断和潜在原因的管理对于儿科ACLF治疗至关重要.
- 早期启动桥梁疗法,如高容量血交换,可能是至关重要的.
- 如果病例没有改善,应立即考虑肝移植,以防止败血症或多器官衰竭.
相关概念视频
01:22Acute Kidney Injury I: Introduction
38
Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
38
01:29Acute Kidney Injury II: Pathophysiology
37
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
37
01:29Acute Kidney Injury III: Clinical Manifestations
44
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
44
01:20Acute Kidney Injury V: Interprofessional Care
30
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
30
01:22Acute Kidney Injury VI: Nursing Management
36
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
36
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
40
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
40