Ash S R, Blake D E, Carr D J, Carter C, Howard T, Makowka L
St. Elizabeth Hospital, Lafayette, Indiana.
Int J Artif Organs. 1992 Mar;15(3):151-61.
Fifteen patients with acute deterioration of liver function, high serum ammonium, and an average coma level of 3.9 were identified. Eleven of the patients were on respirator support, and eleven had kidney failure pursuant to the liver failure. The patients were treated for 8-12 hours daily with the BioLogic-DT system, in which membranes of a cellulosic plate dialyzer actively pump blood through a single access at over 200 ml/min, and the dialysate contains a suspension of powdered activated charcoal (300,000 square meters surface area) and cation exchanger (160 meq capacity). No anticoagulant was used. In spite of the declining condition of the patients prior to treatment, there was a statistically significant improvement in neurologic status during individual treatments, and a positive trend over 1-12 (average four) daily treatments. Four patients recovered liver function and another four improved enough to receive a liver transplant operation. The BioLogic-DT system appears to be safe in treatment of patients with hepatic insufficiency and coma. The neurologic improvement of these patients indicates that many toxins of hepatic failure are dialyzable across cellulosic membranes and bound by charcoal.
确定了15例肝功能急性恶化、血清铵水平高且平均昏迷程度为3.9级的患者。其中11例患者需要呼吸机支持，11例因肝功能衰竭出现肾衰竭。患者每天使用BioLogic-DT系统治疗8至12小时，在该系统中，纤维素平板透析器的膜以每分钟超过200毫升的速度通过单一通路主动泵血，透析液含有粉末状活性炭悬浮液（表面积300,000平方米）和阳离子交换剂（容量160毫当量）。未使用抗凝剂。尽管患者在治疗前病情不断恶化，但在个体治疗期间神经状态有统计学意义上的显著改善，且在1至12次（平均4次）每日治疗中呈积极趋势。4例患者肝功能恢复，另外4例改善到足以接受肝移植手术。BioLogic-DT系统在治疗肝功能不全和昏迷患者方面似乎是安全的。这些患者的神经功能改善表明，肝功能衰竭的许多毒素可通过纤维素膜透析并被活性炭结合。
