Expert consensus on clinical application of artificial liver and blood purification (2022 edition)
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Key words:
- Liver, Artificial /
- Blood Purification /
- Liver Failure /
- Consensus
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表 1 人工肝各种模式特点
Table 1. Characteristics of various models of artificial liver
人工肝模式 优点 缺点 注意事项 含外源性血浆补充的模式 PE/SPE 操作简单,广谱清除毒素,补充血浆成分 受血浆来源限制,水溶性毒素清除差,血浆过敏、血制品相关感染风险 有明显肝性脑病者不建议单独行PE/SPE模式,可与其他模式联合应用 PDF 同时清除蛋白结合毒素和水溶性毒素,补充血浆成分,调节电解质及酸碱平衡 受血浆来源限制,血浆过敏、血制品相关感染风险 根据患者具体情况选择不同规格的血浆成分分离器 DFPP 选择性清除大分子致病物质,外源性血浆需求量少 丢失一部分凝血因子,操作相对复杂 根据患者具体情况选择不同的置换液,设置合适的弃浆泵与分浆泵速度比值 不含外源性血浆补充的模式 HP/PP 吸附范围广,不依赖血浆 不能补充血浆成分,会丢失部分白蛋白和凝血因子 肝衰竭患者不推荐行HP,可行PP;HP适用于各种中毒的治疗 DPMAS 清除毒素范围广(包括炎性介质),不依赖血浆,可做强化治疗 不能补充血浆成分,会丢失部分白蛋白和凝血因子 凝血功能差的患者建议与含外源性血浆补充的模式联合应用 HF/HD/HDF 清除中、小分子物质效率较高,调节水、电解质及酸碱平衡 不能补充血浆成分,对大分子毒素、蛋白结合毒素等清除效率低 适用于合并水/电解质/酸碱平衡紊乱、肾功能不全、脑水肿、肝性脑病、SIRS患者 CPFA 同时清除蛋白结合毒素和水溶性毒素,调节水、电解质及酸碱平衡 不能补充血浆成分,对设备要求高,操作复杂 根据患者具体情况选择不同的吸附器 MARS 同时清除蛋白结合毒素和水溶性毒素,调节水、电解质及酸碱平衡 不能补充血浆成分,对设备要求高,耗材价格较高 治疗时间较长,需与患者充分沟通,提高依从性 -
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