非生物型人工肝在肝衰竭患儿中的应用

目的 探讨非生物型人工肝支持治疗在肝衰竭患儿中的应用效果.方法 2003年8月-2009年4月在首都医科大学附属北京儿童医院确诊为肝衰竭患儿11例,采用非生物型人工肝支持治疗,包括应用血浆置换、血液灌流、持续血液滤过、血液透析等治疗方法.结果 非生物型人工肝支持治疗过程中并发症少.11例患儿顺利进行了23次血浆置换治疗,7次血液灌流治疗,5次血液透析治疗,3次持续血液滤过治疗(2例治疗顺利,1例在治疗中出现病情恶化、心跳骤停而终止治疗).10例患儿血液净化治疗后临床症状均有不同程度好转,监测血生化各项指标与治疗前比较亦有明显好转.11例获随访,其中2例毒蕈中毒肝衰竭患儿临床治愈出院,其中包括1例多脏器衰竭患儿,随访1 a,肝功能正常;3例病情好转出院;3例病情进展恶化,放弃治疗死亡;3例自动出院.结论 应用以血浆置换治疗为主的非生物型人工肝治疗急慢性肝衰竭患儿,可使患儿临床症状及各项检测指标有不同程度好转,提高患儿存活率.人工肝治疗技术应用于肝衰竭患儿治疗中应注意充分考虑儿童病理生理特点,制定合理的治疗方案,同时采取有效的预防措施和密切的病情监测,以保障治疗的顺利进行.

Artificial Liver Support System for Treating Hepatic Failure in Children

Objective To observe the therapeutic effects of artificial liver support system for children with hepatic failure.MethodsEleven children with hepatic failure who were hospitalized in Beijing Children′s Hospital Affiliated to Capital Medical University from Aug.2003 to Apr.2009 were treated with artificial liver support system,and plasma exchange,haemoperfusion,continuous blood purification,haemodialysis were conducted on the basis of routine medical therapy.ResultsThe artificial liver support system therapy was applied with very few complications.Eleven cases were treated successfully,including 23 times of plasma exchange,7 times of haemoperfusion,5 times of haemodialysis and 3 times of continuous blood purification(2 cases were treated successfully,but 1 case had given up because of the cardiac arrest).The symptoms and liver functions in 10 patients with artificial liver support system treatment were improved.Eleven cases were followed up.Among them 2 cases got hepatic failure for mushroom poisoning and got fully recovered after therapy;1 case had multiorgan dysfunction syndrome,and after 1-year follow-up,he was all alive and well;the conditions of 3 cases got worse and after 1 year they were all alive and well;3 cases improved obviously and died without therapy;3 cases leave hospital voluntarily without further therapy.ConclusionsArtificial liver support system is an effective method in the therapy of hepatic failure in children.It will help to improve the patients′ symptoms and liver functions,also the survival rate of the patients.It should be more carefully to constitute therapeutic regimen for the artificial liver support system for pediatric patients with hepatic failure.The doctors must consider with physiological functions of pediatric patients,but also to protect effectively and monitor closely to ensure the therapy successful.J Appl Clin Pediatr,2011,26(6): 420-422