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1、肝衰竭的治疗,XXX市人民医院,支持治疗,1,病因治疗,2,并发症治疗,4,其他治疗,3,C,ONTENTS,目录,一、支持治疗,Bed rest, reducing energy consumption, and alleviating(缓解) the burden of the liver ( ); Monitoring PTA/INR, blood ammonia(血氨)and blood biochemical indices, analyzing arterial blood lactate（乳酸）, endotoxin（内毒素）, hepadnavirus markers（嗜肝DN
2、A病毒）, ceruloplasmin（铜兰蛋白）, antibodies of autoimmune liver diseases（自免肝抗体）, and examining abdomen by B-ultrasound (liver, gallbladder, spleen and pancreas, ascites), taking chest X-ray and electro-cardiography (ECG) ( );,一、支持治疗,c. Enteral nutrition is preferred, including high-carbohydrate（碳水化合物）, lo
3、w-fat, moderate protein diet, providing 35-40 kcal/kg total calories; for patients with HE, protein intake by intestinal should be limited; for patients with hypoalimentation（营养不良）, adequate liquid and vitamin supplementation should be delivered intravenously to guarantee a daily total energy intake
4、 ( ); d. It is necessary to actively rectify（纠正） low proteinemia, and supply albumin or fresh plasma and blood coagulation factors as appropriate ( );,e. Monitoring arterial blood gas is done if required, correcting the disturbance of water and electrolytes as well as acid-base equilibrium, especial
5、ly hyponatremia（低钠血症）, hypochloraemia（低氯血症）, hypopotassaemia（低钾血症） and alkalosis（碱中毒） ( ); Hyponatremia is a common complication of decompensated (失代偿)cirrhosis. Hyponatremia, refractory ascites（顽固性腹水） and acute kidney injury (AKI) are commonly interrelated with each other. Water restriction, as app
6、ropriate, combined with diuretics（利尿剂）, is effective for hyponatremia and thus, prevents the subsequent complications;,一、支持治疗,For HBV DNA (+) patients with liver failure, antiviral therapy is relatively effective in the early and middle stages; but for patients with advanced stage of liver failure,
7、due to the severely damage of residual hepatocytes and regenerative capacity of the liver, antiviral treatment is unlikely to improve outcome； For drug-induced liver injury (DILI), any presumed or possible offending agent should be stopped immediately ( ), documenting all agents taken over the past
8、six months including prescription drugs, non-prescription drugs, herbs, dietary supplements ( ),二、病因治疗,For patients affected by paracetamol（醋氨酚）、acetaminophen (APAP)（对乙酰氨基酚）, N-acetylcysteine (NAC) （乙酰半胱氨酸）therapy is preferred；NAC may also improve the outcome for patients with ALF caused by non-APAP
9、. For toadstool(毒菌) poisoning, silymarin（水飞蓟宾） or penicillin G15-18 can be used ( ) For ALF induced by acute fatty liver of pregnancy/HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, the immediate termination of pregnancy is recommended. If the disease continues to progress, artifi
10、cial liver support and liver transplantation are recommended ( ).,二、病因治疗,Glucocorticoid（激素）: Experts have not come to an agreement on the application of glucocorticoid in the treatment of liver failure. It is optimally indicated for non-viral infectious liver failure such as autoimmune liver disease
11、s, etc, and glucocorticoid (prednisone, 40 to 60 mg/d) may be considered. For early stage liver failure caused by other etiologies, if the disease develops rapidly and without complications such as serious infections and hemorrhages（出血）, glucocorticoid is also recommended ( ).,三、其他治疗,Hepatocyte rege
12、neration therapy: To relieve the necrosis（坏死） and promote the regeneration of hepatocytes, drugs including hepatocyte growth-promoting factors（促肝细胞生长因子） and prostaglandin E1 (PGE1)（前列腺素1） liposome ( ) can be used, but their efficacies need further observation.,三、其他治疗,Microecological therapy（微生态治疗）:
13、Patients with liver failure exhibit gut microflora（肠道菌群） imbalance with reduced normal flora and increased pathogenic intestinal bacteria. The application of intestinal probiotics may improve the prognosis. Microecological modulators such as lactulose（乳果糖） or lactitol（乳糖醇） can be used to reduce the
14、enteric bacteria translocation, endotoxemia（内毒素血症）, or HE（肝性脑病） ( ).,Cerebral edema（脑水肿）: a) For patients with intracranial（颅内） hypertension, mannitol （甘露醇）(0.5-1.0 g/kg) can be used (-2); b) Diuretics, usually furosemide（呋塞米）, can be used with osmotic dehydrant alternatively ( ); c) Artificial live
15、r support therapy is used ( ); d) Glucocorticoid is not recommended for intracranial hypertension (); e) Hypothermia therapy（低温治疗） is effective in preventing cerebral edema, and decreasing intracranial pressure ( ).,四、并发症治疗,HE（肝性脑病）: a) eliminating the inciting factors such as serious infections, he
16、morrhage, electrolyte disturbance ( ); b) protein-restricted diet ( ); c) oral lactulose or lactitol, or transferred by high enema（高位灌肠）, which can acidify（酸化） the intestinal tract, accelerate the excretion of ammonia, modulate intestinal microecology, and reduce the absorption of enterotoxin ( ); d) using branched chain amino acid（支链氨基酸） or mixed preparation of branched chain amino and with arginine （精氨酸）to rectify the inbalance of amino acid
