嚴重肝衰竭使用分子吸附再循環系統的臨床處置與護理

Clinical Management and Nursing Care for Using Molecular Adsorbent Recirculating System in Severe Liver Failure

嚴重肝衰竭是進展快速、預後極差且死亡率偏高的疾病，臨床症狀為疲倦、黃疸、出血、肝性腦病變、食道靜脈曲張、肝腎症候群及腦水腫或多重器官衰竭，主要治療方式為支持療法，但無法根治，唯有進行肝臟移植，但由於國內器官短缺，患者因長期等不到器捐併發合併症而死亡。近年，體外肝臟支持系統—分子吸附再循環系統（Molecular Adsorbent Recirculating System, MARS）被發展來治療嚴重肝衰竭，它可有效移除患者體內毒素，穩定生命徵象，以爭取時間等待移植。

Severe liver failure is a disease with rapid progression, poor prognosis, and high mortality. The symptoms and signs of severe liver failure include fatigue, jaundice, bleeding, hepatic encephalopathy, esophageal varices, hepatorenal syndrome, brain edema and multiple organ failure. Most patients are managed by supportive treatments which cannot cure the condition. Liver transplantation is the only curative treatment for severe liver failure, but many patients die before transplantation due to lack of donated organsin Taiwan. The extracorporeal liver support system, Molecular Adsorbent Recirculating System (MARS), was developed to treat severe liver failure in recent years. It can effectively remove toxins out of patient’s body and stabilize hemodynamics to gain time for patients in waiting for liver transplantation.