Mullen K D, Gacad R
Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
Gastroenterologist. 1996 Sep;4(3):188-202.
The syndrome of hepatic encephalopathy has mystified physicians since the time of Hippocrates, and it continues to do so. It is difficult to succinctly define, diagnose with certainty, or attempt to explore its pathogenesis. The literature on this topic is confusing and often contradictory. Nevertheless, very effective empirical therapy has been devised for this syndrome. We discuss selected aspects of diagnosis, pathogenesis, clinical manifestations, and treatment of hepatic encephalopathy. Emphasis is placed on the three-pronged clinical strategy to manage hepatic encephalopathy that encompasses both diagnostic and treatment measures. The burgeoning area of subclinical hepatic encephalopathy is discussed in more detail than in most reviews of this topic. We also propose a new term for the field-acute liver failure-associated hepatic encephalopathy (ALFA-HE)-to replace the unsatisfactory older term, fulminant hepatic failure.
自希波克拉底时代以来，肝性脑病综合征一直令医生们困惑不已，如今依然如此。它难以简洁地定义、准确地诊断，也难以探究其发病机制。关于这一主题的文献令人困惑，且常常相互矛盾。然而，针对该综合征已设计出非常有效的经验性疗法。我们讨论肝性脑病的诊断、发病机制、临床表现及治疗等选定方面。重点在于管理肝性脑病的三管齐下临床策略，该策略涵盖诊断和治疗措施。与该主题的大多数综述相比，我们更详细地讨论了亚临床肝性脑病这一新兴领域。我们还为该领域提出了一个新术语——急性肝衰竭相关性肝性脑病（ALFA-HE），以取代不太令人满意的旧术语“暴发性肝衰竭”。
