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

廖盈謹(Ying-Chin Liao) ； 蘇淑芬(Shu-Fen Su)

《台灣專科護理師學刊》 3卷1期 (2017/02) Pp. 78-83

摘要

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。嚴重肝衰竭患者有意識改變、血流灌注不穩定、凝血功能障礙、全身性感染及焦慮、無望感或身體心像受損等負面情緒問題，因此醫護人員需密切觀察病人之生理和心理問題，提供持續性的全人照護，以協助患者恢復健康度過整個病程。本文提供MARS相關照護知識有助於醫護人員照顧此類患者之依據，並建議可進一步深入研究探討MARS成效。

關鍵字

嚴重肝衰竭 ； 分子吸附再循環系統 ； 護理

並列摘要

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. Severe liver failure patients may have problems of disturbance of consciousness, hemodynamics unstable, coagulopathy, systemic infection, anxiety, hopelessness and body image disturbance. Thus, the medical staff needs closely to observe the physiological and psychological problems of the patients, and to provide continuous and holistic care to patients in recovering health status. This article provides knowledge related to MARS which can help medical staff in taking care of liver failure patients. We suggest that the effectiveness of MARS could be investigated in the further study.

並列關鍵字

Severe liver failure ； Nursing ； Molecular Adsorbent Recirculating System (MARS)

參考文獻

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