Bartels O, Riemann J F, Groitl H
Fortschr Med. 1977 Aug 11;95(30):1845-50.
The prognosis of hepatic coma is poor if the patient has jaundice, ascites, defects in clotting factors, a low serum-albumin level and haemorrhage from oesophageal varices. After 5 years, the survival rate is less than 20%. Approved methods of intensive care are recommended. Cerebral oedema, respiratory and renal failure, infection and lactate acidosis are dangerous complications with the necessity to early treatment. The difficulty of parenteral nutrition depends on the extent of liver cell failure. In spite of the rise in blood ammonia mixtures of selected amino acids should be given in small doses. In selected cases temporary hepatic support and detoxification methods are indicated in hepatic coma. Charcoal haemoperfusion decreases the depth of coma and regulates the electroencephalogram, some patients fully recover consciousness. But there is no long-term improvement of survival-rates in cases complicated by bleeding oesophageal varices and by septic circulatory failure. The lethality of the first bleeding from varices is about 50%. Diagnostic endoscopy is necessary, sclerosing of oesophageal varicosis and laser-coagulation can be life-saving in hepatic pre-coma. The mortality of surgical procedures is more than 60%. Emergency anastomosis shunting portal blood has a better prognosis than ligation of the varices or oesophageal and high gastric transsection operations, demonstrated by surgical management in 248 cases. Even with this long-term succes is unusual.
如果患者出现黄疸、腹水、凝血因子缺陷、血清白蛋白水平低以及食管静脉曲张出血，肝昏迷的预后较差。5年后，生存率低于20%。建议采用公认的重症监护方法。脑水肿、呼吸和肾衰竭、感染以及乳酸酸中毒是危险的并发症，需要早期治疗。肠外营养的难度取决于肝细胞衰竭的程度。尽管血氨升高，但仍应小剂量给予选定的氨基酸混合物。在某些情况下，肝昏迷需要临时肝脏支持和解毒方法。活性炭血液灌注可降低昏迷深度并调节脑电图，一些患者可完全恢复意识。但对于并发食管静脉曲张出血和感染性循环衰竭的病例，生存率并无长期改善。静脉曲张首次出血的致死率约为50%。诊断性内镜检查是必要的，食管静脉曲张硬化术和激光凝固术在肝昏迷前期可能挽救生命。外科手术的死亡率超过60%。248例手术治疗表明，急诊门体分流吻合术的预后优于静脉曲张结扎术或食管及高位胃横断术。即便如此，长期成功也并不常见。
