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Acute liver failure

机译:急性肝衰竭

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Worldwide, viral hepatitis is the leading cause of acute liver failure, whereas acetaminophen hepatotoxicity is the most commonly identified cause in Western countries. Restricting the quantity of acetaminophen tablets dispensed has been shown to reduce morbidity and mortality in countries with a high incidence of acetaminophen overdose. Troglitazone and bromfenac are two recently approved medications that were withdrawn from the market due to an unacceptably high incidence of severe hepatotoxicity. In addition, trovafloxacin, nefa-zodone, and ritonavir were reported to be associated with severe hepatitis and acute liver failure. Moderate hypothermia is a simple and potentially effective means of reducing intracra-nial pressure in patients with acute liver failure and cerebral edema. However, controlled clinical trials are needed to determine proper patient selection and optimize treatment. Extracorporeal bioartificial liver support devices remain an exciting but as yet unproven means of supporting acute liver failure patients with advanced encephalopathy. Living donor liver transplantation has recently been reported for adults and children with acute liver failure. However, ethical concerns regarding donor safety and the ability to obtain informed consent without coercion have been raised. Lastly, advances in the identification and isolation of pluripotent liver stem cells in human bone marrow provides hope for a simple and effective meates of enhancing native liver regeneration.
机译:在世界范围内,病毒性肝炎是急性肝衰竭的主要原因,而对乙酰氨基酚肝毒性是西方国家最常见的病因。在对乙酰氨基酚用药过量的高发国家,限制对乙酰氨基酚片的分配已显示可降低发病率和死亡率。曲格列酮和溴芬酸是最近批准的两种药物,由于严重的肝毒性发生率高得令人无法接受,因此已撤出市场。此外,据报道曲伐沙星,奈法唑酮和利托那韦与严重肝炎和急性肝衰竭有关。适度的体温过低是减轻急性肝衰竭和脑水肿患者颅内压的一种简单有效的方法。但是,需要进行受控的临床试验以确定合适的患者选择并优化治疗。体外生物人工肝支持装置仍然是令人兴奋的,但尚未得到证实,它可以支持患有晚期脑病的急性肝衰竭患者。最近有报道说,成年和急性肝衰竭的儿童进行活体供肝移植。但是,已经提出了有关捐助者安全和在没有胁迫的情况下获得知情同意的能力的道德问题。最后,人类骨髓中多能肝干细胞的鉴定和分离的进展为增强天然肝再生的简单有效途径提供了希望。

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