人工肝血液净化技术临床应用专家共识(2022年版)

中华医学会肝病学分会重型肝病与人工肝学组

doi:10.3969/j.issn.1001-5256.2022.04.007

人工肝血液净化技术临床应用专家共识(2022年版)

DOI: 10.3969/j.issn.1001-5256.2022.04.007

中华医学会肝病学分会重型肝病与人工肝学组

利益冲突声明： 所有作者均声明不存在利益冲突。

韩涛，hantaomd@126.com；陈煜，chybeyond1071@ccmu.edu.cn；段钟平，duan@ccmu.edu.cn

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出版历程
- 收稿日期: 2022-02-14
- 录用日期: 2022-03-16
- 出版日期: 2022-04-20

Expert consensus on clinical application of artificial liver and blood purification (2022 edition)

Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association

摘要

- 肝, 人工 /
- 血液净化 /
- 肝功能衰竭 /
- 共识
- 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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