Morimoto T, Matsushima M, Sowa N, Ide K, Sawanishi K
Division of Artificial Kidney, Kyoto University Hospital, Japan.
Artif Organs. 1989 Oct;13(5):447-52. doi: 10.1111/j.1525-1594.1989.tb01556.x.
In order to achieve a higher degree of improvement in patients with postoperative hepatic failure, the effects of plasma adsorption (PA) using a serial connection of noncoated charcoal (N 350) and a new bilirubin adsorbent material, styrenedivinylbenzene (BR350), were investigated both experimentally and clinically. After in vitro perfusion of high bilirubin containing plasma through these columns for 3 hours, total bilirubin levels were drastically reduced to 21% of the preperfusion level in the serial connection of N 350 and BR 350, while it remained high at over 40% in the single use of each column. Total branched chain and aromatic amino acid levels were also drastically reduced in the serial connection of these columns to 50, 40, and 7%, respectively, while the total amino acid levels remained high at 87% in the single use of BR 350. The combination of these columns enhanced rather than interfered with one another. Patients who received this treatment achieved an initial reduction of plasma total bilirubin and aromatic amino acids of 57 +/- 6 and 84 +/- 7, respectively. Although the long-term prognosis for these patients was negative, improvement of clinical and laboratory findings were actually obtained by this treatment. This PA system could provide a possibility for an improved supportive therapy for hepatic failure, especially for patients with hepatic coma and hyperbilirubinemia.
为了使术后肝衰竭患者获得更高程度的改善，对使用未包被活性炭（N 350）和新型胆红素吸附材料苯乙烯二乙烯基苯（BR350）串联的血浆吸附（PA）效果进行了实验和临床研究。将含高胆红素的血浆在体外通过这些柱体灌注3小时后，在N 350和BR 350串联的情况下，总胆红素水平急剧降至灌注前水平的21%，而单独使用每个柱体时总胆红素水平仍高达40%以上。在这些柱体串联的情况下，总支链氨基酸和芳香族氨基酸水平也分别急剧降至50%、40%和7%，而单独使用BR 350时总氨基酸水平仍高达87%。这些柱体的组合起到了增强而非相互干扰的作用。接受该治疗的患者血浆总胆红素和芳香族氨基酸水平最初分别降低了57±6和84±7。尽管这些患者的长期预后不佳，但该治疗确实使临床和实验室检查结果得到了改善。这种PA系统为改善肝衰竭的支持治疗提供了可能性，特别是对于肝昏迷和高胆红素血症患者。
