Pediatric Interdisciplinary Intensive Care Unit, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Pediatr Crit Care Med. 2011 May;12(3):257-64. doi: 10.1097/PCC.0b013e3181f35fa2.
To investigate the applicability, efficacy, and safety of single-pass albumin dialysis in children.
Retrospective data review of uncontrolled clinical data.
University-based pediatric intensive care unit collaborating with a local center for liver transplantation.
Nine children, aged 2 to 15 yrs, who were treated with single-pass albumin dialysis for acute liver failure of various origins under a compassionate-use protocol between 2000 and 2006. All patients met high-urgency liver transplantation criteria.
Single-pass albumin dialysis was performed as rescue therapy for children with acute liver failure.
The decrease in hepatic encephalopathy (grades 1-4) and the serum levels of bilirubin, bile acids, and ammonium were measured to assess the efficacy of detoxification. As a measure of liver synthesis function, thromboplastin time and fibrinogen were analyzed. The safety of the procedure was assessed by documenting adverse effects on mean arterial blood pressure, platelet count, and clinical course. Seven out of nine patients were bridged successfully to either native organ recovery (n = 1) or liver transplantation (n = 6), one of them twice. Six out of nine patients undergoing single-pass albumin dialysis (ten treatments) survived. In six patients, hepatic encephalopathy could be reduced at least by one degree. Ammonium, bilirubin, and bile acid levels decreased in all patients. One patient had an allergic reaction to albumin.
In childhood acute liver failure, treatment with single-pass albumin dialysis was generally well tolerated and seems to be effective in detoxification and in improving blood pressure, thus stabilizing the critical condition of children before liver transplantation and facilitating bridging to liver transplantation. It may be beneficial in avoiding severe neurologic sequelae after acute liver failure and thereby improve survival. Single-pass albumin dialysis is an inexpensive albumin-based detoxification system that is easy to set up and requires little training. Whether and to what extent single-pass albumin dialysis can support children with acute liver failure until native liver recovery remains unclear.
探讨单次白蛋白透析在儿童中的适用性、疗效和安全性。
回顾性分析非对照临床数据。
大学附属儿科重症监护病房与当地肝移植中心合作。
9 名年龄 2 至 15 岁的儿童，2000 年至 2006 年期间根据同情使用协议，因各种原因导致急性肝衰竭，接受单次白蛋白透析治疗。所有患者均符合高紧急肝移植标准。
单次白蛋白透析作为急性肝衰竭儿童的抢救治疗。
通过测量肝性脑病（1-4 级）的降低程度以及胆红素、胆汁酸和氨的血清水平，评估解毒效果。作为肝功能合成的指标，分析了凝血酶原时间和纤维蛋白原。通过记录对平均动脉血压、血小板计数和临床病程的不良影响，评估该程序的安全性。9 例患者中有 7 例成功过渡到自身器官恢复（1 例）或肝移植（6 例），其中 1 例患者过渡了 2 次。9 例接受单次白蛋白透析（10 次治疗）的患者中有 6 例存活。6 例患者的肝性脑病至少降低了 1 级。所有患者的血氨、胆红素和胆汁酸水平均降低。1 例患者对白蛋白过敏。
在儿童急性肝衰竭中，单次白蛋白透析治疗通常耐受性良好，似乎在解毒、改善血压方面有效，从而稳定肝移植前儿童的危急状况，有利于肝移植桥接。它可能有助于避免急性肝衰竭后严重的神经后遗症，从而提高生存率。单次白蛋白透析是一种基于白蛋白的廉价解毒系统，易于设置，培训要求低。单次白蛋白透析是否以及在多大程度上可以支持急性肝衰竭儿童恢复自身肝功能尚不清楚。
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