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  本文關(guān)鍵詞： 急性肝衰竭 藥物性肝損傷 人工肝支持　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:急性肝衰竭是一種較為復(fù)雜的多系統(tǒng)性疾病,其表現(xiàn)為肝功能逐漸減退和導(dǎo)致發(fā)展成為從昏迷進(jìn)一步惡化至神志不清的肝性腦病。急性肝衰竭死亡率高,需要得到即時快速有效的治療。目前,肝移植已經(jīng)成為最有效的治療方法。由于肝臟數(shù)量有限及和捐獻(xiàn)資源有限,因此進(jìn)行了多項研究,旨在開發(fā)出一種新的治療技術(shù)。人工肝具有多種功能,如解毒、凝血功能障礙矯正、抑制炎癥、促進(jìn)肝細(xì)胞再生,這種方法可以作為延長急性肝衰竭患者生存時間的替代方法。本研究旨在發(fā)現(xiàn)人工肝系統(tǒng)在實驗室參數(shù)下對不同病因的急性肝衰竭患者的有效性,并確定急性肝衰竭患者的預(yù)后因子。方法:2011年1月1日至2016年12月31日收治的急性肝衰竭患者共計197例測定后納入本研究。已從所有患者或其親屬處獲得書面同意。該方法經(jīng)當(dāng)?shù)貍惱砦瘑T會批準(zhǔn),符合《赫爾辛基宣言》。本研究的排除標(biāo)準(zhǔn)如下:患者在入院前接受人工肝支持治療、接受移植、慢加急性肝衰竭、不可控制的全身或顱內(nèi)出血、懷孕、用血管緊張素轉(zhuǎn)換酶抑制劑治療和嚴(yán)重低血壓。以下實驗室參數(shù)得到記錄,包括:年齡、性別、急性肝衰竭的病因、生存或死亡、血液檢查、肝臟血清、INR、APTT、PT和鈉血清。分析所有患者的血清樣本,確定急性肝衰竭的病因。肝性腦病基于臨床表現(xiàn)。首先分析了接受人工肝治療的急性肝衰竭患者作為實驗組,不接受人工肝治療的急性肝衰竭患者作為對照組。將對人工肝支持在不同病因的急性肝衰竭患者中的有效性作出分析。結(jié)果:人工肝治療能顯著改善肝功能。在Dili組里,與實驗組相比,血肌酐顯著降低,盡管在接受人工肝治療后,兩組的肝功能得到了顯著改善。人工肝支持療程數(shù)與二十八天生存率高度相關(guān)結(jié)論:人工肝支持治療對急性肝衰竭患者而言是安全有效的。據(jù)報道,人工肝支持治療后實驗室參數(shù)改善,使得生存率升高。因此,到目前為止,人工肝支持仍被認(rèn)為是肝移植的"橋接工具"。此外,還需要進(jìn)一步的研究來預(yù)測開始人工肝支持治療的準(zhǔn)確時間。多項研究表明,人工肝支持對終末期肝病患者具有積極價值,因此需要對人工肝支持的功能做出優(yōu)化。
[Abstract]:Background: acute liver failure is a complex multisystemic disease characterized by a gradual decline in liver function and the development of hepatic encephalopathy from coma to confusion. Acute liver failure has a high mortality rate. There is a need for immediate, rapid and effective treatment. Liver transplantation is now the most effective treatment. Because of the limited number of livers and limited donor resources, a number of studies have been carried out. In order to develop a new therapeutic technique, artificial liver has many functions, such as detoxification, correction of coagulation dysfunction, inhibition of inflammation and promotion of hepatocyte regeneration. This method can be used as an alternative to prolong the survival time of patients with acute liver failure. The purpose of this study was to find out the effectiveness of artificial liver system in patients with acute liver failure with different etiology under laboratory parameters. Methods: a total of 197 patients with acute liver failure admitted from January 1st 2011 to December 31st 2016 were included in this study. Written identity was obtained from all patients or their relatives. The method is approved by the local ethics committee, In accordance with the Helsinki Declaration, the criteria for exclusion in this study were as follows: patients received artificial liver support treatment prior to admission, received transplantation, slow and acute liver failure, uncontrolled systemic or intracranial hemorrhage, pregnancy, Treatment with angiotensin converting enzyme inhibitors and severe hypotension. The following laboratory parameters were recorded, including age, sex, etiology of acute liver failure, survival or death, blood tests, The serum samples of all patients were analyzed to determine the etiology of acute hepatic failure. Hepatic encephalopathy was based on clinical manifestations. First, the patients with acute liver failure treated with artificial liver were analyzed as experimental group. The effectiveness of artificial liver support in patients with acute liver failure with different etiology was analyzed. Results: artificial liver therapy significantly improved liver function. Compared with the experimental group, serum creatinine decreased significantly, although after treatment with artificial liver, Liver function was significantly improved in both groups. The number of courses of artificial liver support was highly correlated with the 28 day survival rate. Conclusion: artificial liver support therapy is safe and effective in patients with acute liver failure. Laboratory parameters are improved after artificial liver support therapy, which increases survival rate. So far, artificial liver support is still considered as a "bridging tool" for liver transplantation. Further studies are needed to predict the exact time to begin artificial liver support therapy. Several studies have shown that artificial liver support is of positive value in patients with end-stage liver disease and therefore needs to optimize the function of artificial liver support.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.3

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本文編號：1498292