儿童急性肝衰竭
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摘要
儿童急性肝衰竭是一种以肝性脑病、黄疸、凝血障碍和腹水为主要表现的临床综合征,常导致多器官功能障碍,病死率较高,是重症医学面临的救治难题。由于儿童这个群体的特殊性,儿童急性肝衰竭和成人相比在定义、病因以及诊治过程中均有其独特性。近年来随着医学技术的发展,尤其是重症医学的发展使得急性肝衰竭的预后有所改善。儿童肝移植的发展也为儿童急性肝衰竭的治疗提供了更多的机会。
Paediatric acute liver failure is a clinical syndrome mainly manifested by hepatic encephalopathy, jaundice,coagulopathy and ascites. It often leads to multiple organ dysfunction and has a high mortality rate. It is regarded as a challenge in the treatment of critical care medicine. Due to the particularity of children group, acute liver failure in children has its own characteristics in definition, etiology, diagnosis and treatment compared with those in adults. In recent years, the development of medical technology,especially the development of critical care medicine, has improved the prognosis of acute liver failure. The development of paediatric liver transplantation also provides more opportunities for the treatment of paediatric acute liver failure.
Paediatric acute liver failure is a clinical syndrome mainly manifested by hepatic encephalopathy, jaundice,coagulopathy and ascites. It often leads to multiple organ dysfunction and has a high mortality rate. It is regarded as a challenge in the treatment of critical care medicine. Due to the particularity of children group, acute liver failure in children has its own characteristics in definition, etiology, diagnosis and treatment compared with those in adults. In recent years, the development of medical technology,especially the development of critical care medicine, has improved the prognosis of acute liver failure. The development of paediatric liver transplantation also provides more opportunities for the treatment of paediatric acute liver failure.
引文
[1] Newland CD. Acute liver failure[J]. Pediatr Ann, 2016, 45(12):e433-e438.
[2]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版)[J].临床肝胆病杂志,2019,35(1):38-44.
[3]王建设,傅海燕.儿童急性肝衰竭若干研究进展——记第九次全国儿科肝病学术会议[J].中华临床感染病杂志,2009,2(3):190-192.
[4] European Association for the Study of the Liver. EASL clinical practical guidelines on the management of acute(fulminant)liver failure[J]. J Hepatol, 2017, 66(5):1047-1081.
[5] Dhawan A. Acute liver failure in children and adolescents[J]. Clin Res Hepatol Gastroenterol, 2012, 36(3):278-283.
[6]付海燕,王晓明,王亚利,等.儿童急性肝衰竭病因及生化指标分析[J].临床儿科杂志,2015,33(10):841-845.
[7] Squires RH Jr, Shneider BL, Bucuvalas J, et al. Acute liver failure in children:the first 348 patients in the pediatric acute liver failure study group[J]. J Pediatr, 2006, 148(5):652-658.
[8] Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease:2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60(2):715-735.
[9]邹正升,刘志国,陈菊梅,等.凝血因子V在重型肝炎患者中的检测及其临床意义[J].中华实验和临床病毒学杂志,2003,17(3):274-276.
[10] Lawrence SF, Paul M. Handbook of liver disease[M]. 4th ed. Amsterdam:Elsevier, 2018:342.
[11] Bernal W, Hyyrylainen A, Gera A, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients[J]. J Hepatol, 2013, 59(1):74-80.
[12] Lutfi R, Abulebda K, Nitu ME, et al. Intensive care management of pediatric acute liver failure[J]. J Pediatr Gastroenterol Nutr, 2017, 65(5):660-670.
[13] Devictor D, Tissieres P, Afanetti M, et al. Acute liver failure in children[J]. Clin Res Hepatol Gastroenterol, 2011, 35(6-7):430-437.
[14]中华医学会儿科学分会,中华医学会急诊医学分会,中国医师协会重症医学医师分会.儿童重症监护治疗病房镇痛和镇静治疗专家共识2013版[J].中华儿科杂志,2014,52(3):189-192.
[15] Stravitz RT, Kramer AH, Davern T, et al. Intensive care of patients with acute liver failure:recommendations of the U.S. Acute Liver Failure Study Group[J]. Crit Care Med, 2007, 35(11):2498-2508.
[16] Weerink MMS, Struys M, Hannivoort LN, et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J]. Clin Pharmacokinet, 2017, 56(8):893-913.
[17] Kulkarni S, Perez C, Pichardo C, et al. Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013[J]. Pediatr Transplant, 2015, 19(8):888-895.
[18] Moore JK, Love E, Craig DG, et al. Acute kidney injury in acute liver failure:a review[J]. Expert Rev Gastroenterol Hepatol, 2013, 7(8):701-712.
[19] Leventhal TM, Liu KD. What a nephrologist needs to know about acute liver failure[J]. Adv Chronic Kidney Dis, 2015, 22(5):376-381.
[20] Murphy N, Auzinger G, Bernel W, et al. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure[J]. Hepatology, 2004, 39(2):464-470.
[21] Vaquero J. Therapeutic hypothermia in the management of acute liver failure[J]. Neurochem Int, 2012, 60(7):723-735.
[22] Jain V, Dhawan A. Extracorporeal liver support systems in paediatric liver failure[J]. J Pediatr Gastroenterol Nutr, 2017, 64(6):855-863.
[23] Singer AL, Olthoff KM, Kim H, et al. Role of plasmapheresis in the management of acute hepatic failure in children[J]. Ann Surg, 2001, 234(3):418-424.
[24] Ide K, Muguruma T, Shinohara M, et al. Continuous veno-venous hemodiafiltration and plasma exchange in infantile acute liver failure[J]. Pediatr Crit Care Med, 2015, 16(8):e268-e274.
[25]崔云,张育才.非生物型人工肝/血液净化治疗儿童急性肝衰竭技术规范——上海交通大学附属儿童医院重症医学科诊疗技术规范[J].中国小儿急救医学,2016,23(8):510-515.
[26]中国医师协会儿科医师分会血液净化专业委员会.儿童血浆置换临床应用专家共识[J].中华实用儿科临床,2018,33(15):1128-1135.
[27] Mahadeb P, Gras J, Sokal E, et al. Liver transplantation in children with fulminant hepatic failure:the UCL experience[J]. Pediatr Transplant, 2009, 13(4):414-420.
[28]中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国儿童肝移植临床诊疗指南[J].中华移植杂志(电子版),2016,10(1):2-11.
[29] Sundaram V, Shneider BL, Dhawan A, et al. King’s College Hospital Criteria for non-acetaminophen induced acute liver failure in an international cohort of children[J]. J Pediatr, 2013, 162(2):319-323.
[30] Barshes NR, Lee TC, Udell IW, et al. The pediatric end-stage liver disease(PELD)model as a predictor of survival benefit and posttransplant survival in pediatric liver transplant recipients[J]. Liver Transpl, 2006, 12(3):475-480.
[31] Lu BR, Zhang S, Narkewicz MR, et al. Evaluation of the liver injury unit scoring system to predict survival in a multinational study of pediatric acute liver failure[J]. J Pediatr, 2013, 162(5):1010-1016.
[2]中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版)[J].临床肝胆病杂志,2019,35(1):38-44.
[3]王建设,傅海燕.儿童急性肝衰竭若干研究进展——记第九次全国儿科肝病学术会议[J].中华临床感染病杂志,2009,2(3):190-192.
[4] European Association for the Study of the Liver. EASL clinical practical guidelines on the management of acute(fulminant)liver failure[J]. J Hepatol, 2017, 66(5):1047-1081.
[5] Dhawan A. Acute liver failure in children and adolescents[J]. Clin Res Hepatol Gastroenterol, 2012, 36(3):278-283.
[6]付海燕,王晓明,王亚利,等.儿童急性肝衰竭病因及生化指标分析[J].临床儿科杂志,2015,33(10):841-845.
[7] Squires RH Jr, Shneider BL, Bucuvalas J, et al. Acute liver failure in children:the first 348 patients in the pediatric acute liver failure study group[J]. J Pediatr, 2006, 148(5):652-658.
[8] Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease:2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60(2):715-735.
[9]邹正升,刘志国,陈菊梅,等.凝血因子V在重型肝炎患者中的检测及其临床意义[J].中华实验和临床病毒学杂志,2003,17(3):274-276.
[10] Lawrence SF, Paul M. Handbook of liver disease[M]. 4th ed. Amsterdam:Elsevier, 2018:342.
[11] Bernal W, Hyyrylainen A, Gera A, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients[J]. J Hepatol, 2013, 59(1):74-80.
[12] Lutfi R, Abulebda K, Nitu ME, et al. Intensive care management of pediatric acute liver failure[J]. J Pediatr Gastroenterol Nutr, 2017, 65(5):660-670.
[13] Devictor D, Tissieres P, Afanetti M, et al. Acute liver failure in children[J]. Clin Res Hepatol Gastroenterol, 2011, 35(6-7):430-437.
[14]中华医学会儿科学分会,中华医学会急诊医学分会,中国医师协会重症医学医师分会.儿童重症监护治疗病房镇痛和镇静治疗专家共识2013版[J].中华儿科杂志,2014,52(3):189-192.
[15] Stravitz RT, Kramer AH, Davern T, et al. Intensive care of patients with acute liver failure:recommendations of the U.S. Acute Liver Failure Study Group[J]. Crit Care Med, 2007, 35(11):2498-2508.
[16] Weerink MMS, Struys M, Hannivoort LN, et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J]. Clin Pharmacokinet, 2017, 56(8):893-913.
[17] Kulkarni S, Perez C, Pichardo C, et al. Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008 to 2013[J]. Pediatr Transplant, 2015, 19(8):888-895.
[18] Moore JK, Love E, Craig DG, et al. Acute kidney injury in acute liver failure:a review[J]. Expert Rev Gastroenterol Hepatol, 2013, 7(8):701-712.
[19] Leventhal TM, Liu KD. What a nephrologist needs to know about acute liver failure[J]. Adv Chronic Kidney Dis, 2015, 22(5):376-381.
[20] Murphy N, Auzinger G, Bernel W, et al. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure[J]. Hepatology, 2004, 39(2):464-470.
[21] Vaquero J. Therapeutic hypothermia in the management of acute liver failure[J]. Neurochem Int, 2012, 60(7):723-735.
[22] Jain V, Dhawan A. Extracorporeal liver support systems in paediatric liver failure[J]. J Pediatr Gastroenterol Nutr, 2017, 64(6):855-863.
[23] Singer AL, Olthoff KM, Kim H, et al. Role of plasmapheresis in the management of acute hepatic failure in children[J]. Ann Surg, 2001, 234(3):418-424.
[24] Ide K, Muguruma T, Shinohara M, et al. Continuous veno-venous hemodiafiltration and plasma exchange in infantile acute liver failure[J]. Pediatr Crit Care Med, 2015, 16(8):e268-e274.
[25]崔云,张育才.非生物型人工肝/血液净化治疗儿童急性肝衰竭技术规范——上海交通大学附属儿童医院重症医学科诊疗技术规范[J].中国小儿急救医学,2016,23(8):510-515.
[26]中国医师协会儿科医师分会血液净化专业委员会.儿童血浆置换临床应用专家共识[J].中华实用儿科临床,2018,33(15):1128-1135.
[27] Mahadeb P, Gras J, Sokal E, et al. Liver transplantation in children with fulminant hepatic failure:the UCL experience[J]. Pediatr Transplant, 2009, 13(4):414-420.
[28]中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国儿童肝移植临床诊疗指南[J].中华移植杂志(电子版),2016,10(1):2-11.
[29] Sundaram V, Shneider BL, Dhawan A, et al. King’s College Hospital Criteria for non-acetaminophen induced acute liver failure in an international cohort of children[J]. J Pediatr, 2013, 162(2):319-323.
[30] Barshes NR, Lee TC, Udell IW, et al. The pediatric end-stage liver disease(PELD)model as a predictor of survival benefit and posttransplant survival in pediatric liver transplant recipients[J]. Liver Transpl, 2006, 12(3):475-480.
[31] Lu BR, Zhang S, Narkewicz MR, et al. Evaluation of the liver injury unit scoring system to predict survival in a multinational study of pediatric acute liver failure[J]. J Pediatr, 2013, 162(5):1010-1016.