Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA.
J Crit Care. 2013 Oct;28(5):783-91. doi: 10.1016/j.jcrc.2013.04.002. Epub 2013 May 15.
Acute liver failure is uncommon but not a rare complication of liver injury. It can happen after ingestion of acetaminophen and exposure to toxins and hepatitis viruses. The defining clinical symptoms are coagulopathy and encephalopathy occurring within days or weeks of the primary insult in patients without preexisting liver injury. Acute liver failure is often complicated by multiorgan failure and sepsis. The most life-threatening complications are sepsis, multiorgan failure, and brain edema. The clinical signs of increased intracranial pressure (ICP) are nonspecific except for neurologic deficits in impending brain stem herniation. Computed tomography of the brain is not sensitive enough in gauging intracranial hypertension or ruling out brain edema. Intracranial pressure monitoring, transcranial Doppler, and jugular venous oximetry provide valuable information for monitoring ICP and guiding therapeutic measures in patients with encephalopathy grade III or IV. Osmotic therapy using hypertonic saline and mannitol, therapeutic hypothermia, and propofol sedation are shown to improve ICPs and stabilize the patient for liver transplantation. In this article, diagnosis and management of hepatic encephalopathy and cerebral edema in patients with acute liver failure are reviewed.
急性肝衰竭虽不常见，但却是肝损伤的一种罕见并发症。它可发生于摄入对乙酰氨基酚和接触毒素及肝炎病毒之后。在无肝损伤既往史的患者中，其主要临床特征为原发性损伤后数天或数周内出现凝血功能障碍和肝性脑病。急性肝衰竭常并发多器官功能衰竭和脓毒症。最具威胁生命的并发症是脓毒症、多器官功能衰竭和脑水肿。颅内压升高（ICP）的临床征象除了即将发生脑疝时的神经功能缺损外并无特异性。脑 CT 检查在评估颅内高压或排除脑水肿方面不够敏感。颅内压监测、经颅多普勒和颈静脉血氧饱和度监测可为监测 ICP 和指导 III 或 IV 级肝性脑病患者的治疗措施提供有价值的信息。高渗盐水和甘露醇的渗透性治疗、亚低温治疗和异丙酚镇静可降低 ICP，稳定患者，为肝移植做准备。本文回顾了急性肝衰竭患者肝性脑病和脑水肿的诊断和治疗。
