Matsubara S, Okabe K, Ouchi K, Miyazaki Y, Yajima Y, Suzuki H, Otsuki M, Matsuno S
First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
Crit Care Med. 1990 Dec;18(12):1331-8. doi: 10.1097/00003246-199012000-00005.
In patients with acute liver failure and hepatic coma, an increase in the abnormal "middle molecules" seen on the chromatograms of the sera is suspected of playing an etiologic role in the coma. A pilot study of continuous hemofiltration using a high-performance membrane was conducted in 16 such patients in an attempt to decrease the serum levels of the middle molecules. The procedure was used alternately with plasma exchange. High-performance liquid chromatography showed a notable removal of the substances in the filtrates and a sequential removal from the serum by hemofiltration. Eight (50%) of the 16 patients had amelioration in level of consciousness and were weaned successfully from hemofiltration. Although only three of the 16 patients survived the acute illness, 13 others lived an average of 15 days and five patients survived greater than 3 wk. While the continuous removal of middle molecules from the serum may not reverse liver failure, this procedure used in conjunction with plasma exchange may provide a means of life support, e.g., for patients awaiting a liver transplant.
在急性肝衰竭和肝昏迷患者中，血清色谱图上出现的异常“中分子”增加被怀疑在昏迷中起病因学作用。对16例此类患者进行了一项使用高性能膜的连续性血液滤过的初步研究，试图降低血清中分子水平。该程序与血浆置换交替使用。高效液相色谱显示滤液中的物质有显著清除，并且通过血液滤过血清中的物质被依次清除。16例患者中有8例（50%）意识水平改善，并成功撤出血液滤过。虽然16例患者中只有3例在急性疾病中存活，但其他13例平均存活15天，5例存活超过3周。虽然从血清中持续清除中分子可能无法逆转肝衰竭，但该程序与血浆置换联合使用可能提供一种生命支持手段，例如用于等待肝移植的患者。
