分子吸附循环系统治疗急性肝衰竭患者后颅内压的变化：病例报告
Modifications of intracranial pressure after molecular adsorbent recirculating system treatment in patients with acute liver failure: case reports.
作者信息
Pugliese F, Ruberto F, Perrella S M, Cappannoli A, Bruno K, Martelli S, Celli P, Summonti D, D'Alio A, Tosi A, Novelli G, Morabito V, Poli L, Rossi M, Berloco P B, Pietropaoli P
机构信息
Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Università degli Studi di Roma La Sapienza, Roma, Italy.
出版信息
Transplant Proc. 2007 Jul-Aug;39(6):2042-4. doi: 10.1016/j.transproceed.2007.05.061.
UNLABELLED
Cerebral dysfunction may be fatal in patients with acute liver failure (ALF); intracranial pressure (ICP) monitoring may be mandatory to direct measures to prevent further cerebral edema. Recently the introduction of dialysis with the molecular adsorbent recirculating system (MARS) has improved the outcomes among patients with ALF. The aim of this study was to evaluate ICP changes after MARS treatment among patients with ALF.
METHODS
Three patients -- 14, 18 and 16 years old -- were admitted to the ICU for acute liver failure induced by HBV in two cases and by acetaminophen in the other one. Because of Glasgow Coma Score (GCS) <8, they were intubated and ventilated to protect the airway and maintain moderate hypocapnia. Invasive monitoring of intracranial pressure MARS treatments were performed in all patients.
RESULTS
The patients received MARS treatments every day after their admission to liver transplantation. After MARS therapy the ICP decreased on average from 21 to 7 mm Hg. Significant hemodynamic modifications were not observed and their neurological conditions improved.
CONCLUSION
MARS treatment improved the clinical pictures of these patients increasing the available time to obtain an urgent liver graft.
未标注
脑功能障碍在急性肝衰竭（ALF）患者中可能是致命的；颅内压（ICP）监测对于指导预防进一步脑水肿的措施可能是必要的。最近，分子吸附循环系统（MARS）透析的引入改善了ALF患者的预后。本研究的目的是评估MARS治疗后ALF患者的ICP变化。
方法
三名患者，年龄分别为14岁、18岁和16岁，因急性肝衰竭入住重症监护病房（ICU），其中两例由乙肝病毒（HBV）引起，另一例由对乙酰氨基酚引起。由于格拉斯哥昏迷评分（GCS）<8，他们接受了气管插管和通气，以保护气道并维持适度的低碳酸血症。所有患者均进行了颅内压的有创监测及MARS治疗。
结果
患者在接受肝移植入院后每天接受MARS治疗。MARS治疗后，ICP平均从21毫米汞柱降至7毫米汞柱。未观察到明显的血流动力学改变，且他们的神经状况有所改善。
结论
MARS治疗改善了这些患者的临床状况，增加了获得紧急肝移植的可用时间。
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