Jalan Rajiv
Liver Failure Group, Institute of Hepatology, University College London Medical School, 69-75 Chenies Mews, London WC1E 6HX, UK.
Neurochem Int. 2005 Jul;47(1-2):78-83. doi: 10.1016/j.neuint.2005.04.010.
In acute liver failure (ALF) patients that have raised increased intracranial pressure (ICP), mortality remains unacceptably high. There has been an explosion in the knowledge about the pathophysiological basis of raised ICP but treatment modalities are limited. Current therapy is aimed at reducing the circulating ammonia levels and attempts to reduce brain swelling which are only moderately effective. More recently, cerebral hyperemia has been suggested as being of major importance in the pathogenesis of increased ICP providing a new look at interventions such as hyperventilation, N-acetylcysteine, thiopentone sodium and propofol. More recently studies have focused upon the role of systemic inflammatory response in the pathogenesis of increased ICP and support the use of antibiotics prophylactically. The application of moderate hypothermia to treat uncontrolled intracranial hypertension seems promising and its exact place will be decided in a large trial being planned in USA and Europe. Early data from studies in an animal model suggests that albumin dialysis is a promising new tool to treat intracranial hypertension in patients with ALF. The recent advance in our understanding of the pathophysiological basis of intracranial hypertension has provided the platform for the discovery of new treatments.
在颅内压（ICP）升高的急性肝衰竭（ALF）患者中，死亡率仍然高得令人难以接受。关于ICP升高的病理生理基础的知识有了激增，但治疗方式有限。目前的治疗旨在降低循环氨水平，并试图减轻脑肿胀，但其效果仅为中等程度。最近，有人提出脑充血在ICP升高的发病机制中至关重要，这为诸如过度换气、N-乙酰半胱氨酸、硫喷妥钠和丙泊酚等干预措施提供了新的视角。最近的研究集中在全身炎症反应在ICP升高发病机制中的作用，并支持预防性使用抗生素。应用中度低温治疗失控的颅内高压似乎很有前景，其确切地位将在美国和欧洲正在计划的一项大型试验中确定。动物模型研究的早期数据表明，白蛋白透析是治疗ALF患者颅内高压的一种有前景的新工具。我们对颅内高压病理生理基础理解的最新进展为发现新的治疗方法提供了平台。
