Lie T S, Dengler H J, Gütgemann A, Rommelsheim K, Lelbach W K, Holst A, Marsteller H J, Ueda T, Müller J, Klehr U, von Bergmann K, Kutzner M, Speck D, Gundermann K J
Dtsch Med Wochenschr. 1977 Oct 21;102(42):1506-11. doi: 10.1055/s-0028-1105528.
In 11 patients with hepatic coma (stage IV and V according to Abouna) extracorporeal haemoperfusion using the Scribner shunt (radial or profunda femoris artery) was performed over 12 to 27 hours with 22 baboon and one human livers. Eight patients emerged from coma, six of them showed sufficient regeneration of the diseased liver. Four patients were discharged as cured, one patient died of acute pancreatic necrosis, a further one due to bleeding from an old gastric ulcer. In the 2 remaining patients the coma recurred within 48 hours. Tree patients never came round from coma. After perfusion no antibodies against baboon proteins were demonstrable in the patients. Thus there is very little danger of an anaphylactic reaction when perfusion is repeated. The titre of preformed cytotoxic antibodies against baboon cells in patients' serum rises only after 1-2 weeks and decreases again after 4 weeks. In our experience extracorporeal liver perfusion with baboon or human livers is the most promising method for treatment of hepatic coma.
对11例肝昏迷患者(根据阿布纳标准为Ⅳ期和Ⅴ期),使用斯克里布纳分流管(桡动脉或股深动脉),用22个狒狒肝脏和1个人类肝脏进行了12至27小时的体外血液灌流。8例患者从昏迷中苏醒,其中6例显示病变肝脏有足够的再生。4例患者治愈出院,1例患者死于急性胰腺坏死,另1例死于陈旧性胃溃疡出血。其余2例患者在48小时内昏迷复发。3例患者从未从昏迷中苏醒过来。灌流后患者体内未检测到针对狒狒蛋白的抗体。因此,重复灌流时发生过敏反应的危险性很小。患者血清中预先形成的针对狒狒细胞的细胞毒性抗体滴度仅在1 - 2周后升高,4周后又下降。根据我们的经验,用狒狒或人类肝脏进行体外肝脏灌流是治疗肝昏迷最有前景的方法。