肝功能损害和sepsis管.pptVIP

血氨 血氨 Alison S. Clay, Bryan E. Hainline. Hyperammonemia in the ICU. CHEST 2007; 132:1368–1378 （七）序贯脏器损伤 肾脏功能障碍 呼吸功能障碍 血流动力学异常 感染 Anne M. Larson.Diagnosis and management of acute liver failure.Current Opinion in Gastroenterology 2010,26:214–221. 1、肝肾综合征－发病机制 Andres Cardenas.Hepatorenal Syndrome:A Dreaded Complication of End-Stage Liver Disease.Am J Gastroenterol 2005;100:460-467 肝肾综合征－实验室检查 Elaine M. Fisher,Diane K. Brown.Hepatorenal Syndrome.AACN Advanced Critical Care 2010; 21: 2, 165–184 2、肝肺综合征－发病机制 Roberto Rodríguez-Roisin,Michael J. Krowka.Hepatopulmonary Syndrome — A Liver-Induced Lung Vascular Disorder.N Engl J Med 2008;358:2378-87. Normal alveolar ventilation and pulmonary blood f low 肝肺综合征－发病机制 毛细血管扩张 通气/血流失调 肺内分流 Roberto Rodríguez-Roisin,Michael J. Krowka.Hepatopulmonary Syndrome — A Liver-Induced Lung Vascular Disorder.N Engl J Med 2008;358:2378-87. 肝肺综合征诊断参考 alveolar–arterial oxygen gradient liver disease and/or portal hypertension intrapulmonary vascular dilatation Ulf Hempricha, Peter J. Papadakosa,Burkhard LachmannCurrent Opinion in Anaesthesiology 2010, 23:133–138 3、血流动力学改变－发病机制 血管舒张因子释放 S?ren M?ller, Jens H Henriksen.Cardiopulmonary complications in chronic liver disease.World J Gastroenterol 2006 January 28; 12(4): 526-538 血流动力学改变－循环系统表现 S?ren M?ller, Jens H Henriksen.Cardiopulmonary complications in chronic liver disease.World J Gastroenterol 2006 January 28; 12(4): 526-538 4、感染 免疫功能受损 感染风险增加 病原菌：细菌，真菌，合并感染 感染部位：肺47%，血26%，尿23% Anne M. Larson.Current Opinion in Gastroenterology 2010,26:214–221 Javier Vaquero, Julie Polson,et al.Infection and the Progression of Hepatic Encephalopathy in Acute Liver Failure.Gastroenterology 2003;125:755–764 4.其他判断方法 代谢呼吸试验 影像学检查 代谢呼吸试验 13C-phenylalanine breath tests-苯丙氨酸羟化酶活性 13C-galactose breath tests-半乳糖激酶活性 上述两种可判断肝硬化程度并与Child–Turcotte–Pugh评分密切相关 13C-methionine breath test-肝脏线粒体氧化功能 13C-caffeine breath test-HBV相关性纤维变性以及长期拉米夫定治疗后肝功能的改善 13C-methacetin breath test-急\慢性肝脏损害 Y. ILAN. Review article: