| 摘要: |
| 目的 分析ICU综合替代治疗在抢救妊娠期急性脂肪肝(AFLP)合并多脏器功能障碍综合征(MODS)患者的疗效,提高对此病的救治能力。方法 回顾性分析1例重症AFLP合并MODS患者的病史,病情变化,诊治经过,治疗效果及预后,并结合相关文献分析讨论。结果 患者入院3小时出现胎死宫内、肝肾功能衰竭,立即行剖宫产术,术后发生难治性产后出血；因病情危重被转入ICU,第一时间启动MDT共同探讨治疗方案。随后患者相继出现严重的DIC、呼吸衰竭、重症感染以及胃肠道衰竭等多种问题；通过给予输注全血等血液制品,应用rFⅦa等止血,补充白蛋白,行CRRT,机械通气,抗感染,双套管引流,启动肠内肠外营养等综合治疗,患者病情有所好转。结论 AFLP发病急、进展快、病死率高,需要多种替代治疗同时进行,新鲜全血、rFⅦa、CRRT的应用大大提高了AFLP患者的抢救成功率,明显改善预后。 |
| 关键词: 妊娠期急性脂肪肝(AFLP)，多脏器功能障碍综合征(MODS)，连续肾脏替代治疗(CRRT)，新鲜全血，重组活化人凝血因子Ⅶa（rFⅦa） |
| DOI： |
| 分类号:R714. 2；R575. 5 |
| 基金项目: |
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| Experience of ICU comprehensive replacement support therapy in patients with AFLP complicated with MODS |
|
Song sanbing1,2,3
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1.Taixing People'2.'3.s Hospital
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| Abstract: |
| Objective: Analysis of the effect of ICU comprehensive replacement therapy in patients with severe AFLP complicated with MODS,toSenhanceSthe cureSability of the disease.Methods: The clinical data of an AFLP case with MODS were retrospectively collected and analyzed in combination with literature review.Results: The patient suffered the intrauterine fetal death in 3 hours of admission,with liver and renal failure ,with cesarean section immediately,postoperative with intractable postpartum hemorrhage; Be transferred to ICU for the critical condition, start the MDT mode to explore the treatment plan first time. Then the patient had severe DIC, respiratory failure,severe infection, gastrointestinal failure and other problems successively. Finally her condition has improved through applying the whole blood, rFⅦa,CRRT, mechanical ventilation, anti-infection, double tube drainage,enteral and parenteral nutrition,etc.Conclusion:AFLP isScharacterized by theSacute,SrapidSprogress,SandShighSmortality.Multiple alternative therapies are required,such as fresh whole blood, rFⅦa, CRRT,can greatly improve the rescue success rate in patients with AFLP, significantly improve the prognosis. |
| Key words: Acute fatty liver of pregnancy Multiple organ dysfunction syndrome Continuous renal replacement therapy fresh whole blood. Recombinant human coagulation factor Ⅶa. |
