通信作者:,wangxianbo638@163.com(ORCID:0000-0002-3593-5741)
關鍵詞:慢加急性肝功能衰竭;中西醫結合療法;多學科診療
基金項目:國家自然科學基金(82474419,82474426);北京市衛生健康委員會-研究型病房卓越臨床研究計劃(BRWEP2024W102170107);北京市醫院管理中心創新夢工場經費資助(202335)
Characteristics and advantages of integrated traditional Chinese and Western medicine therapy in whole-course management of acute-on-chronic liver failure
GAO Fangyuan,FENG Ying,WANG Xianbo
Center of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 1Ooo15,China
Corresponding author:WANG Xianbo,wangxianbo638@163.com(ORCID: 0000-0002-3593-5741)
Abstract:Acute-on-chronic liverfailure(ACLF)isacomplexclinical syndrome characterized byacute deteriorationof liver functioncaused bydiferent factorson the basisof chronic liverdisease,accompanied by liver failureand/or extrahepatic organ failure,and itoften hasa high short-term mortalityrate.With the increasing evidenceof evidence-based medicine, multipleguidelinesandconsensus statements havebeenreleased,suchas Guidelines forclinicaldiagnosisandtreatmentof acute-on-chronic liver failure intraditional Chinese medicine,Expertconsensus on thediagnosisand treatmentofacute-onchronicliverfailurewithintegratedtraditionalChineseandWesternmedicine,andGuidelines fortheintegrated traditional Chineseand Westernmedicinediagnosisandtreatmentofacute-on-chronic liverfailure,and integrated traditional Chinese and Western medicine therapies for ACLF have been constantly standardizedand perfected.This article explores the characteristicsandadvantagesof integrated traditional Chinese andWestern medicine therapyin the whole-course management of ACLF from theaspectsof early warning and prevention,treatment in theacute stage,managementof complications,andrehabilitationcare,inorder to enhancetheunderstandingof traditional Chinese and Western medicine treatment strategies among clinicians.
KeyWords:Acute-On-ChonicLiverFilure;IntegratedChineseTraditionalandWesteMedicineTherapy;Multi-DisciplinaryTeam
Research funding:NationalNaturalScienceFoundationofChina(82474419,82474426);BeijingMunicipal HealthCommisionExcelent Clinical ResearchProgram for Research Wards(BRWEP2024W102170107);Beijing HospitalsAuthority Innovation Studio of Young Staff Funding Support (202335)
慢加急性肝衰竭(ACLF)具有發病急驟、進展迅速、并發癥多、病死率高等特點,中西醫結合作為我國獨特的醫療模式,在ACLF這類復雜危重癥的全病程管理中展現出顯著特色與優勢。本文將系統闡述中西醫協同在ACLF不同病程階段的整合干預策略,為構建ACLF多學科協作診療體系提供新的思路
1ACLF的早期預警
ACLF發病迅速、病情兇險、并發癥多、預后差。若能對ACLF早期預警,并給予積極干預,則有機會控制疾病的發生和發展,對降低ACLF的發病率和病死率具有重要臨床意義。
1.1ACLF早期中醫癥候群余思邈等1對多中心、大樣本HBV相關ACLF(HBV-ACLF)患者不同分型及分期的證素、證型分布規律開展因子分析和聚類分析研究,結果顯示,肝衰竭早期患者病性證素分布以熱( 39.4% ,359/912)濕 (27.5%,251/912) 多見,證型主要以肝膽濕熱證1 74.6% ,461/618)為主;主要癥候群包括身目發黃,口渴喜涼飲、口中黏膩、口苦、口臭,腹脹、惡心嘔吐,急躁易怒、脅肋脹痛,小便黃或短少,大便穢臭或黏滯不爽或秘結,苔厚或膩,脈滑或弦。正如《金匱要略方論·黃疸病脈證并治》所云:“黃家所得,從濕得之”,《諸病源候論》謂之:“熱毒所加,故卒然發黃”,濕熱毒邪是HBV-ACLF發病的首要病因。若肝損傷患者出現上述癥候表現,應警惕ACLF的發生。
1.2預警ACLF發生風險的常用評分系統和工具近10年,我國研究團隊陸續開發了多項ACLF早期預警系統,包括基于臨床病歷數據和新型生物標志物的預測模型。……