【摘要】 目的:探讨和评价MARS人工肝在重症肝炎治疗中的疗效及其作用机理。方法:应用MARS人工肝治疗重症肝炎16例作为治疗组,21例重症肝炎采用综合治疗作为对照组,两组年龄、性别及肝功损害相匹配,分别观察两组患者的预后及单次MARS人工肝治疗前后患者的精神、食纳、肝性脑病、平均动脉压、重要生化指标及肿瘤坏死因子的变化。结果:两组患者预后有明显差别,治疗组存活率62.5%,较对照组38%明显提高,单次治疗前后肝性脑病均不同程度改善、平均动脉压上升,血清胆红素、肿瘤坏死因子及尿素氮明显下降。结论:应用MARS人工肝治疗能明显提高重症肝炎患者的存活率,其作用机理主要为通过清除患者体内的有毒代谢产物包括胆红素、一氧化氮、肿瘤坏死因子及血氨等,从而减轻肝细胞的坏死,改善血流动力学,预防和治疗肝性脑病及肝肾综合征,是重症肝炎安全有效的治疗方法。更多还原

【Abstract】 Objective:To summarize and evaluate the treatment effective and mechanism of Molecular Adsorbents Recirculating System in patients with severe hepatitis.Methods:37 patients with severe hepatitis were divided into two groups.The Molecular Adsorbents Recirculating System (MARS) was used in 16 patients as the treatment group.As the control group,other 21 patients were treated with general methods.The age sex and the liver function between two groups were matching.Their prognosis were observed and the levels serum total bilirubin,non-conjugated bilirubin,tumor necrosis factor(TNF-a) and mean arterial pressure(MAP) were observed in patients during a single 6 to 8 hour treatment with MARS.Results:There are significant difference in prognosis and complications among two groups.In treatment group ten of 16 patients have been cured or improved,4 died,the survival rate was 62.5% and the survival rate was 38% in control group.The levels serum total bilirubin,non-conjugated bilirubin and TNF-a were significantly decreased from 547±187 mmol/L to 312±118 mmol/L(p<0.05);379±134 mmol/L to 185±68 mmol/L(p<0.05) and 76.58±23.21 ng/L to 22.87±20.05 ng/L(p<0.01).MAP were increased from 72±8 mmHg to 81±7 mmHg(p<0.05) in patients during a single 6 to 8 hour treatment with MARS.Conclusions:MARS can effectively clearance the serum total bilirubin,non-conjugated bilirubin and TNF-a;increase the MAP,and then decrease the necrosis of hepatocellular,improve the hepatorenal syndrome and hepatic encephalopathy.It is a safe and effective treatment method in patients with sever hepatitis.更多还原