肝性脑病的进展.ppt

肝性脑病的最新进展 复旦大学附属华山医院 刘懿 肝性脑病的发病机制 血脑屏障受损：非特异通透性增加；特异性转运系统发生改变 氨中毒学说 神经递质及其受体改变：?-氨基丁酸，谷氨酸，多巴胺，色氨酸 其它：硫醇类毒性物质 肝性脑病的分期 前驱期(I 期) 轻度性格和行为改变 昏迷前期（II期）意识错乱，睡眠障碍，行为反常 昏睡期（III期）昏睡和严重精神错乱 昏迷期（IV期）神志完全丧失，不能唤醒 Memory function in early hepatic encephalopathy Journal of Hepatology 39 (2003) 320–325 PSE--Syndrom--Test The Number Connection Test 数字连接试验 The Digit Symbol Test 数字符号试验 The Line Tracing Test 描线试验 The Serial Dotting Test 系列印迹试验 Conclusion Patients with early HE score lower than controls in memory tasks predominantly because of deficits in attention and visual perception. Influence of Hepatic Encephalopathyon Health-Related Quality of Life in Patients with Cirrhosis Digestive Diseases and Sciences, Vol. 48, No. 8 (August 2003), 1622–1626 ( 2003) Health-related Quality of Life PF=physical function RP=role limitations due to physically health problems BP=bodily pain GH=general health perception VT=vitality, energy/fatigue Health-related Quality of Life SF=social functioning RE=role limitations due to emotional heath problem MH=general mental health, psycological distress and well-being PCS=physical component summary MCS=mental component summary Conclusion(1) Cirrhosis is associated with a decreased HRQOL,especial at advanced stages Increased severity of liver disease is associated with decreased physical aspects Conclusion(2) Over hepatic encephalopathy affects both physical and mental aspects of quality of life Subclinical encephalopathy affects mainly the mental aspects, independently of liver disease severity Molecular Adsorbent Recirculating System MARS 分子吸附再循环系统 分子吸附再循环系统 是一种新的人工肝脏支持系统。 它不同于既往的血液透析、血浆置换和生物人工肝支持系统，对急、慢性肝功能衰竭及其并发症有显著疗效。 国外自1993年研制出MARS到2000年临床应用已有400余例患者使用了此方法，2001年在我国亦开展了此项新技术治疗。 MARS的原理 Stange等报道了一种新的清除血浆白蛋白结合毒素的透析方法MARS：在一个闭环的含白蛋白透析液的循环中，其一侧有一个具有新型膜分离系统、可高通过饱和白蛋白透析液的透析器， 此白蛋白透析液的循环依次经过三个步骤，一个正常透析或过滤的透析器，活性碳吸附，离子交换树脂吸附，然后再回到饱和白蛋白透析器。 MARS的临床应用 急、慢性肝病：Schmidt等观察用MARS治疗8例急慢性肝衰竭伴肝性脑病患者单次MARS治疗10h期间脑血流的变化。用经颅多普勒超声测定大脑中动脉平均血流速率，测定动脉血氨和胆红素水平以