2012.4.19-肝功能衰竭及监护.ppt

-references to major visit 1,2 etc in the slide data is the same as week 1,2 etc. - main visit 1 is the onset of MARS tretment for MARS group Differentiation of Bilirubin as marker from other important liver toxines! Why is bilirubin rising at the end? Because we stopped MARS Treatment after a Maximum of 10 treatments. (Time frame when treatment was administered indicated by dotted blue arrow). 5 out of 12 MARS patients recovered by their own and showed further decreasing Bilirubin, however this was seen in only 2 out of 12 Control Patients. As 7 out of 12 MARS patients did need a Liver as a prerequisition to survive after stopping therapy bilirubin rised again. If Patients can not recover, MARS can only buy time to get a transplant. ICP = intracranial pressure ICP = intracranial pressure 1 mg/dl = 17 mikromol MAP 变化 (mmHg) -40 -30 -20 -10 0 10 20 30 85.5±14 (基础值) 1 7 14 21 28 观察天数 77.6±11 MARS治疗中MAP的变化 Stange et al. J Hepatology 2001; 34 S1: 45 A1289 MARS 治疗对血流动力学的影响 Pre 12 hr 24 hr MAP (mmHg) 71 79 84 (55-78) (67-84) (69-91) Cardiac Output 9.7 7.8 7.6 (L/min) (7.2-11.4) (6.1-9.4) (6.0-8.9) SVR 914 1178 1098 dyn.sec/cm5 (774-918) (1010-1211) (989-1189) Liver Blood Flow 354 456 443 (ml/min) (213-567) (319-672) 289 (256-611) Renal Blood Flow 102 179 202 (ml/min) (78-178) (145-321) (156-388) Jalan et al. Pilot trial on decompensated ALD-patients MARS治疗以及12hr 后血液动力学的变化 MARS 治疗对血流动力学的影响 对NO的直接作用(Nitrosothiol) 通过影响炎性细胞因子从而减少NO的产生 ? MARS 治疗对血流动力学的影响 生存率 ! 血流动力学 ! 肾功能 ? 黄疸 / 胆汁淤积 ? 肝性脑病 ? 颅内压 ? 肝功能 ? MARS? 治疗临床作用 MARS是否对以下各项有作用: 1 5 10 15 20 25 30 35 40 0 500 1000 1500 2000 2500 E.K.,36yof ml 天数 每天血透 尿量 6x MARS MARS治疗HRS增加尿量 MARS治疗对肾功能的影响 0 200 400 600 800 1000 1200 尿量 (ml/day) MARS 治疗前 MARS 治疗后 HDF 治疗前 HDF 治疗后 Mitzner et al. Liver Transpl 2000 6(3); 277-86 MARS治疗对肾功能的影响 0 1 2 3 4 5 6 7 8 9 10 肌酐 (mg/dl) p < 0,01 p < 0,05 MARS 治疗前 MARS 治疗后 HDF 治疗前 HDF 治疗后 Mitzner et a