暴发性肝衰治疗-英文课件

IntensiveMedicalCareImprovesPrognosisfor

AcuteLiverFailureandthePerioperativeManagementof

LiverTransplantationTransplantationProceedings,42,4109–4112(2010)PATIENTSANDMETHODSStudygroup:159patientscomprised90casesoffulminanthepatitis(FH),16oflate-onsethepaticfailure(LOHF),and53ofsevereacutehepatitis(SAH)2DiagnosticcriterionFHwasdefinedbythedevelopmentofcoagulopathy(PTA<=40%)andhepaticencephalopathy(HE;gradeIIorgreater)within8weeksofsymptomonsetamongpatientswithoutaknownunderlyingliverdisease.FHhyper-acutetype(HEwithin5days)FHacutetype(HEwithin10days)FHsubacutetype(HEafter11days)3DiagnosticcriterionLOHF:thesameHEandcoagulopathyasFHwithin8to24weeksofsymptomonsetSAH:thesamecoagulopathyasFHbutwithoutorwithgradeIHE4METHODSArtificialliversupport(ALS)Treatmentforunderlyinghepatitisconsistedofimmunosuppressivetherapyandantiviraltreatment55/22/2023

ALSInJAPAN,PEincombinationwithonlineHDForhighflowCHDFhasbecomethestandardALS,about80%ofjapanesehospitalshasadoptedthissystemandevaluateditspracticalvalue5/22/2023ALSWhen?

ImmediatelyaftertheonsetofhepaticcomaHow?

PE+HDFusinghigh-performancemembranesandhugevolumesofbuffer(15to20L/h,flowrateof500mL/min,atleast200Lbufferpersession,ThemedianestimatedplasmaequivalentvolumeofremovedGlnwas

17.9L,ThemediannumberofALSsessions

was21)CircuitdiagramofPEincombinationwithHDFusinghighperformancepolysulfonemembrane5/22/2023Fig1.AsignificantcorrelationwasobservedbetweenthetotalamountofremovedGlnandtotalbuffervolume.ThevolumeofdistributionofGlnwascalculatedasthetotalamountofremovedGlndividedbytheplasmaGlnconcentrationbeforeALS.immunosuppressivetherapy10Antiviraltreatment11RESULTS12

90FHcases3(hyper-acutetype):OnesurvivedLDLT.theother2patientsdiedafter2weeksbecauseof

nodonor42(acute-type):36(86%)survivedALS.45(subacutetype):32(71%)survivedALSandundergoingtreatmentforliverdisease;4underwentLDLTand2ofthemsurvived

16LOHFcases

8(50%)survivedunderthesametreatmentasFHsubacutetype

53SAHcases51survived(96%)2diedofafungalinfectionoraggravationofmalignantlymphoma5/22/2023DISCUSSIONFHTransienttype(rapideradicationt,mostofacuteFH)Persistenttype(persistentorevenchronicreplication,mostofsubacuteFH)InfectionmodeDISCUSSIONTheroleofALSeffectiveALScausesliver

destructiontocease,maintainthepatientsstable.AfterseveralsessionsofALS,109of116(94%)patientsregainedconsciousness.The2-weeksurvivalratewas107of116(92%).

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