肝支持系统和肝衰竭患者无移植生存:一个基于证据的病例报告

Aravinda Pravita, Kresna Adhiatma, Juferdy Kurniawan
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引用次数: 0

摘要

背景:急性肝衰竭(ALF)和急性中慢性肝衰竭(ACLF)患者的死亡率仍然很高。目前,肝支持系统是桥接肝移植的一种替代治疗方法。然而,与标准药物治疗(SMT)相比,其降低死亡率的有效性仍存在争议。我们的研究旨在回顾肝支持系统与标准药物治疗(SMT)在非肝移植急性肝衰竭患者中的疗效。方法:采用PubMed/MEDLINE、EBSCO-CINAHL、ProQuest、Cochrane等数据库进行系统文献检索。对所选文章进行重复检查,并按摘要和标题进行筛选。然后,我们基于牛津大学循证医学中心(CEBM)的关键评价工具对文章进行评价。结果:经过深入研究,提取了一项随机对照试验的系统评价和荟萃分析研究。Alhamshi等研究表明,体外肝支持作为主要结局显著降低了ALF和ACLF患者的死亡率。其他不良事件的主要发现包括肝性脑病、血小板减少、出血和感染尚不清楚。结论:使用肝支持系统在降低无移植肝衰竭患者的死亡率方面优于标准药物治疗,但最佳模式推荐尚无定论。
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Liver Support System and Transplant-Free Survival Patients with Liver Failure: An Evidence-Based Case Report
Background: The mortality rate in patients with acute liver failure (ALF) and acute on chronic liver failure (ACLF) is still very high. Currently, liver support systems are an alternative therapy in bridging liver transplantation. However, its effectiveness in reducing mortality is still controversial when compared to standard medical therapy (SMT). Our study aims to review the efficacy of liver support system compared to standard medical therapy (SMT) among acute liver failure patients without liver transplantation.Method: We conducted systematic literature searching using PubMed/MEDLINE, EBSCO-CINAHL, ProQuest, and Cochrane databases. Selected articles were examined for duplicates and were screened by abstract and title. Then, we appraised the articles based on the critical appraisal tools from Centre for Evidence-Based Medicine (CEBM) University of OxfordResults: One systematic review and meta-analysis of randomized control trials study was extracted after thorough research. Alhamshi et al showed that extracorporeal liver support has significantly reduced mortality in both ALF and ACLF patients as the primary outcome. Other main findings about adverse events including hepatic encephalopathy, thrombocytopenia, bleeding, and infection were still unclear.Conclusion: The use of liver support system demonstrated better outcome in reducing mortality to standard medical therapy in transplant free patients with liver failure, but best modality recommendation was inconclusive. 
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