Lo S K, Wendon J, Mieli-Vergani G, Williams R
Institute of Liver Studies, King's College Hospital, London, UK.
Eur J Gastroenterol Hepatol. 1998 Aug;10(8):635-9.
BACKGROUND/AIMS: This study was aimed at determining if the frequency and pattern of acute liver failure (ALF) following halothane anaesthesia had decreased during the last 11 years in comparison with a previous series of 48 patients referred between 1965 and 1984 and whether clinical outcome had been altered by the introduction of liver transplantation.
Between January 1985 and December 1995, all patients with halothane-induced ALF admitted to the Liver Failure Unit at King's College Hospital were identified. Four other European liver transplant centres with a known interest in acute liver failure also provided data.
Of the 18 patients admitted, the clinical data were complete in 15. Ten of these patients had at least one previous halothane anaesthesia with documented clinical complications following the earlier exposure in six. Four patients had been re-exposed to halothane within 1 month of the penultimate halothane anaesthesia. Of the 15 patients four survived with medical management alone and 11 patients fulfilled transplant criteria. Four of the latter group were not listed because of rapidly deteriorating medical state and died, and of the seven patients who were listed, three died without a liver becoming available and four were transplanted, one of whom survived. No patient who had grade 4 encephalopathy and a prothrombin time > 50 s survived without a transplant. The survey of the other European liver centres recorded a total of 19 patients with halothane-induced ALF including three cases reported in the literature. Of those, 13 patients had been transplanted with nine survivors.
Cases of halothane-induced acute liver failure still occur, albeit at a lower frequency than previously, and the Committee on Safety of Medicines guidelines are not being followed. The results of transplantation in these patients are encouraging.
背景/目的：本研究旨在确定与1965年至1984年间转诊的48例患者的先前系列相比，过去11年中氟烷麻醉后急性肝衰竭（ALF）的频率和模式是否有所下降，以及肝移植的引入是否改变了临床结局。
在1985年1月至1995年12月期间，确定了所有入住国王学院医院肝衰竭病房的氟烷诱导的ALF患者。其他四个对急性肝衰竭感兴趣的欧洲肝移植中心也提供了数据。
在入院的18例患者中，15例的临床资料完整。其中10例患者至少有过一次氟烷麻醉，6例在早期接触后有记录的临床并发症。4例患者在倒数第二次氟烷麻醉后1个月内再次接触氟烷。在这15例患者中，4例仅通过药物治疗存活，11例符合移植标准。后一组中有4例因病情迅速恶化未列入名单而死亡，在列入名单的7例患者中，3例在没有获得肝脏的情况下死亡，4例接受了移植，其中1例存活。没有4级脑病且凝血酶原时间>50秒的患者未经移植存活。对其他欧洲肝中心的调查共记录了19例氟烷诱导的ALF患者，包括文献报道的3例。其中，13例患者接受了移植，9例存活。
氟烷诱导的急性肝衰竭病例仍有发生，尽管频率低于以前，而且药品安全委员会的指南未得到遵循。这些患者的移植结果令人鼓舞。
