急性肝功能衰竭诊治ppt课件

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1、急性肝功能衰竭1急性肝功能衰竭的定义Acuteliverfailure(ALF)isdefinedaslife-threateningliverinjuryintheabsenceofpreexistingliverdiseasewithcoagulopathy(prothrombintime>15secondsorinternationalnormalizedratio[INR]1.5)andhepaticencephalopathy(HE)thatdevelopswithin26weeksof

2、initialsymptomsTheterm‘‘fulminanthepaticfailure’’(FHF)isusedwhenHEdevelopswithin8weeksofjaundice2Etiologyofacuteliverfailure34肝性脑病的分期临床上按神经精神症状的轻重把肝性脑病分为四期：一期(前驱期):轻微的神经精神症状,可表现出欣快、反应迟钝、睡眠节律的变化。二期(昏迷前期):一期症状加重,可出现:行为异常、嗜睡、精神错乱.经常出现扑翼样震颤等.三期(昏睡期):有明显的精

3、神错乱、昏睡、肌张力↑等症状.四期(昏迷期):神志丧失,不能唤醒,没有扑翼样震颤等.5肝性脑病分期6肝性脑病发病机制氨中毒学说假性神经递质学说血浆氨基酸失衡学说GABA学说其他神经毒质在肝性脑病发病中的作用7氨中毒(ammoniaintoxication)学说血氨增高的原因：氨清除不足（主要）图　肝脏合成尿素的鸟氨酸循环OCT：鸟氨酸氨基甲酰转移酶CPS：氨基甲酰磷酸合成酶氨的清除：8proteinNH3NH3ureaNormalmetabolism9Liverfailure肝衰竭proteinN

4、H3NH3urea×BloodNH3↑10Liverfailure肝衰竭proteinNH3NH3urea×血NH3↑ShuntingCirculation门-体分流↑11CerebralEdemaandIntracranialHypertensionHepaticencephalopathyammoniainflammationalteredneurotransmissionpathwayscerebralhemodynamicdysautoregulation12CerebralEdemaan

5、dIntracranialHypertensionOthercommontriggersforICPelevation:volumeoverloadhyponatremiaseverehypercarbiasevereacidosisincreasedthoracicandabdominalcompartmentpressures13NeuromonitoringstrategiesInvasiveneuromonitoringstrategiesNoninvasiveneuromonitorin

6、gstrategiesserialheadcomputedtomography(CT)transcranialDopplerjugularbulboximetrypupillometry14AlgorithmforthediagnosticandtherapeuticmanagementofacuteliverfailurewithadvancedhepaticencephalopathyandintracranialhypertensionEmergingstrategiesforthetre

7、atmentofpatientswithacutehepaticfailure,CurrOpinCritCare2016,22:000–00015AlgorithmforthediagnosticandtherapeuticmanagementofacuteliverfailurewithadvancedhepaticencephalopathyandintracranialhypertensionEmergingstrategiesforthetreatmentofpatientswithac

8、utehepaticfailure,CurrOpinCritCare2016,22:000–00016AnnualUpdateinIntensiveCareandEmergencyMedicine201517IntensivecaresupportivestrategiesdirectedatcerebraledemainacuteliverfailureEmergingstrategiesforthetreatmentofpatientswithacutehepaticfailu