分子吸附循环系统人工肝支持治疗重症肝炎患者血流动力学的变化

目的　探讨和评价分子吸附循环系统 (MARS)人工肝支持治疗对重症肝炎血流动力学的影响及其与治疗效果的关系。方法　应用MARS人工肝支持治疗重症肝炎 16例共 36次作为治疗组 ,对照组为 2 0例重症肝炎 ,采用综合治疗 ,两组年龄、性别及肝功能相匹配 ;观察单次治疗前后平均动脉压、心率的变化及与主要生化指征和预后的关系。结果　治疗组存活率较对照组明显提高 ,存活率分别为 6 2 .5 %和 37.5 % (P <0 .0 1) ,单次人工肝治疗前后总胆红素和结合胆红素明显下降 ,分别由 (5 36± 175 )和 (35 2± 113)下降为 (30 1± 10 5 )和 (16 2± 6 3) μmol·L-1,平均动脉压由 (72± 8)mmHg上升为 (81± 7)mmHg(P <0 .0 1) ,心率由 (10 6± 18)下降为 (86± 12 )次·min-1。结论　MARS人工肝能有效的清除有毒代谢物 ,改善血流动力学状况 ,预防或减轻肝肾综合征及肝性脑病

Changes of hemodynamics in patients with severe hepatitis treated with molecular adsorbents recirculating system

Objective To evaluate the chang es of hemodynamics and the relationship with the outcome in patients with severe h epatitis treated with molecular adsorbents recirculating system (MARS). Methods A total of 16 patients with severe hepatitis were t reated with MARS for 36 times altogether as the treatment group. Twenty patients with severe hepatitis were treated by comprehensive methods as the control grou p. The age, sex and liver function between the two groups matched. Their prognos is was observed and the levels of serum total bilirubin, the non-conjugated bil irubin and mean arterial pressure (MAP), and heart rate were observed in the pat ients during a single 6 h to 8 h treatment with MARS. The relationship between the change and prognosis was observed. Results There were significant differences in prognosis and complications between the two groups. T he survival rate in treatment and control groups was 62.5% and 37.5%, respective ly (P<0.01). The levels of serum total bilirubin, non-conjugated bilirubin were significantly decreased from (536±175) to (301±105) and from (352±113) t o (162±63)μmol·L -1, respectively (P<0.01), while MAP was increa sed from (72±8)mmHg to (81±7)mmHg (P<0.01), and heart rate was decreased f rom (106±18) to (86±12) beats min -1 during a single 6 h to 8 h treatme nt with MARS. Conclusion MARS can effectively clear the serum total bilir ubin, non-conjugated bilirubin and improve the hemodynamics and then decrease t he hepatorenal syndrome and hepatic encephalopathy.