目的 评价分子吸附再循环系统(molecular adsorbent recirculating system,MARS)对急性重度肝炎型毒蕈中毒的治疗疗效.方法 回顾性分析2007年1月-2015年12月解放军307医院重症监护室(emergency intensive care unit,EICU)收治的33例急性重度肝炎型毒蕈中毒患者临床病例资料.根据治疗方法不同分为血浆置换治疗组即PE组(基础治疗联合血浆置换治疗)及分子吸附再循环系统治疗组即MARS组(基础治疗联合MARS治疗),比较两组患者谷丙转氨酶、总胆红素、直接胆红素、凝血酶原时间、国际标准化比值、血小板等的变化趋势及肝性脑病发生情况及死亡率.结果 MARS组患者ALT、TBIL、DBIL、PLT恢复程度明显优于PE组,PE组患者呈酶-胆分离现象,PT、INR则无明显差异.PE组发生肝性脑病11人(39.3％),死亡9例,肝性脑病的病死率为81.8％,而MARS组发生肝性脑病2人(40.0％),死亡1例,肝性脑病的病死率为50％.结论 MARS单独或联合PE治疗重度肝炎型毒蕈中毒患者的疗效优于单独PE及常规药物治疗,并可降低肝性脑病者的病死率.%Objective To investigate the efficacy of molecular absorbent recirculating system (MARS) on mushroom poisoning patients with severe toxic hepatitis.Method Retrospective analyze the clinical data of 33 patients of mushroom poisoning with severe toxic hepatitis in 307 hospital of PLA from Jan.2007 to Dec.2015.The patients were divided into two groups according to their therapeutic methods:plasma exchange group (PE group) and molecular adsorbent recirculating system group (MARS group).The change trend of glutamic-pyruvic transaminase (ALT),total bilirubin (TBIL),direct bilirubin (DBIL),prothrombin time (PT),international normalized ratio (INR) and thrombocyte (PLT) were compared.The occurrence of hepatic encephalopathy and mortality were also compared.Results The recovery of ALT,TBIL,DBIL and PLT in MARS group patients Was significantly superior to PE group patients,while there were no significantly difference in PT and INR between two groups.The "bile-enzyme separation phenomenon" was present in PE group.11 patients (39.3％) occurred hepatic encephalopathy in PE group compared to 2 patients (40.0％) in MARS group,the mortalities caused by hepatic encephalopathy in two groups were 81.8％ and 50％.Conclusion The efficacy of MARS is superior to PE in therapy of mushroom poisoning with severe toxic hepatitis,the morbidity of hepatic encephalopathy reduced.
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