王琨 李海红 邱焕昀 杨建波 卜超颖 纪薇 谢凤杰

[摘要] 肝衰竭是临床常见的严重肝脏损害，病情凶险，死亡率极高。内科药物治疗效果不佳，肝移植是有效的解决手段，但受供体短缺的限制，难以在临床上广泛应用。目前，非人工生物型肝支持系统常作为肝衰竭治疗的一线手段，血浆置换、双重血浆分子吸附及血浆透析滤过为临床常用的三种非生物型人工肝治疗方法，这三种治疗方法均可在一定程度上改善肝脏功能，但均存在不足之处。本文旨在对这三种方法治疗肝衰竭的疗效进行综述，以供临床参考和借鉴。

[关键词] 肝衰竭;非生物型人工肝;血浆置换;双重血浆分子吸附;血浆透析滤过;治疗

[中图分类号] R575.3          [文献标识码] A          [文章编号] 1673-9701（2021）03-0184-04

Research progress of non-biologic artificial liver in the treatment of hepatic  failure

WANG Kun1   LI Haihong2   QIU Huanyun2   YANG Jianbo2   BU Chaoying2   JI Wei2   XIE Fengjie2

1.Mudanjiang Medical University， Mudanjiang   157000， China; 2.Intensive Care Unit， Hongqi Hospital Affiliated to Mudanjiang Medical University， Mudanjiang   157000， China

[Abstract] Hepatic failure is a common and serious liver damage in clinical practice with extremely dangerous conditions and a very high mortality rate. Liver transplantation is an effective solution to the poor therapeutic effects of internal medicines. However， limited by the shortage of donors， it could hardly be widely applied in clinical practice. At present， non-biological artificial liver support system is often used as the first-line means for treating hepatic failure. Plasmapheresis， double plasma molecular adsorption and plasma diafiltration are three commonly used methods for treatment of non-biological artificial liver， all of which can improve liver function to some extent， but all of them have some shortcomings. This paper aims to review the therapeutic effects of these three methods in treatment of hepatic failure to provide clinical reference.

[Key words] Hepatic failure; Non-biologic artificial liver; Plasmapheresis; Double plasma molecular adsorption; Plasma diafiltration; Treatment

肝衰竭是由多種因素所致的严重肝脏损害[1]，为临床多发病和常见病，具有发病率高、病死率高、治愈率低等特点。内科药物治疗主要通过“加强功能”的方式治疗疾病，肝衰竭患者如只应用内科药物治疗，效果较差，病情恢复较慢，可增加并发症的发生率，其病死率可高达60%～80%[2]。与药物治疗相比，人工肝治疗主要通过“替代功能”的方式治疗疾病。近年来，人工肝治疗技术被广泛应用[3]，其优点在于可缩短患者的病程，明显降低死亡率。目前，血浆置换、双重血浆分子吸附和血浆透析滤过是肝衰竭患者常用的三种非生物型人工肝治疗模式，三种方法均可以清除体内有毒物质、降低胆红素及转氨酶水平，明显改善患者的生存状况、控制疾病的进一步发展，但是均存在一定的不足[4-5]。……