Ryska Ondrej, Pantoflicek Tomas, Laszikova Eva, Prazak Josef, Koblihova Eva, Ryska Miroslav
Surgery Department, First Faculty of Medicine, Charles University, Faculty Hospital, Bulovka, Prague, Czech Republic.
Int J Artif Organs. 2012 Jul;35(7):503-10. doi: 10.5301/ijao.5000099.
Extracorporeal liver support (ELS) may play a role in bridging therapy in patients with acute liver failure (ALF). The aim of this study was to compare the influence of nonbiological and biological methods on intracranial pressure (ICP) in an animal model of ALF.
A surgical devascularization model of ALF in pigs (35-40 kg) was used. Elimination therapy started after the onset of hypoglycemia. Biochemical parameters (bilirubin, ammonia, lactate, etc.) as well as ICP and cerebral perfusion pressure (CPP) were monitored for 12 hours. Of the total 31 pigs with ALF, 14 animals were treated by fractionated plasma separation and absorption (FPSA), 10 were treated with a bioartificial liver (BAL), and 7 animals were used as a control group.
FPSA and BAL treatment started on average 3 hours 17 minutes and 2 hours 21 minutes, after devascularization and lasted for 5 hours 54 minutes and 5 hours 43 minutes, respectively. Ammonia levels were lower in the FPSA group, and bilirubin levels differed significantly in both the FPSA and BAL groups compared with controls. However, ICP values were reduced more effectively in pigs treated by FPSA: 19.1 vs. 27.0 mm Hg at 9 hours, 22.5 vs. 28.7 mm Hg at 11 hours, and 24.0 vs. 33.0 mm Hg at 12 hours (p<0.05).
The artificial liver support system FPSA reduced ICP values more effectively than the Performer O. Liver RanD BAL system. Compared with this BAL system, the nonbiological elimination method of FPSA is a simpler application with the advantage that it can be applied in a more continuous way.
体外肝脏支持（ELS）可能在急性肝衰竭（ALF）患者的桥接治疗中发挥作用。本研究的目的是在ALF动物模型中比较非生物和生物方法对颅内压（ICP）的影响。
采用猪（35 - 40 kg）的ALF手术性血管去神经支配模型。低血糖发作后开始清除治疗。监测生化参数（胆红素、氨、乳酸等）以及ICP和脑灌注压（CPP）12小时。在总共31只患有ALF的猪中，14只动物接受了分次血浆分离吸附（FPSA）治疗，10只接受了生物人工肝（BAL）治疗，7只动物作为对照组。
FPSA和BAL治疗分别在去血管支配后平均3小时17分钟和2小时21分钟开始，持续时间分别为5小时54分钟和5小时43分钟。FPSA组的氨水平较低，与对照组相比，FPSA和BAL组的胆红素水平均有显著差异。然而，FPSA治疗的猪ICP值降低更有效：9小时时为19.1 vs. 27.0 mmHg，11小时时为22.5 vs. 28.7 mmHg，12小时时为24.0 vs. 33.0 mmHg（p<0.05）。
人工肝支持系统FPSA比Performer O. Liver RanD BAL系统更有效地降低ICP值。与该BAL系统相比，FPSA的非生物清除方法应用更简单，优点是可以更持续地应用。
