Проблема гипераммониемии после ортотопической трансплантации печени

Актуальность. В настоящее время не вызывает сомнений, что ортотопическая трансплантация печени (ОТП) увеличивает продолжительность жизни по сравнению со стандартными методами лечения при ее декомпенсированном циррозе. В последние годы диагностике и лечению гипераммониемии уделяют все больше внимания при различных заболеваниях печени, а также после ее трансплантации. При этом исследований с высоким уровнем доказательной базы, устанавливающих связь между уровнем аммиака и тяжестью состояния пациента в раннем периоде после трансплантации печени, недостаточно.

Цель. Обобщить современные данные о проблеме гипераммониемии после трансплантации печени, проанализировать механизмы развития и патогенетическую роль высоких концентраций аммиака в сыворотке крови в развитии осложнений после ОТП, а также способы контроля уровня аммиака.

Материал и методы. Проведен анализ данных зарубежных и отечественных экспериментальных и клинических исследований, посвященных вопросам патогенеза, диагностики, методов лечения гипераммониемии после ОТП. Поиск литературных данных проводили в международных базах данных (PubMed/MedLine, ResearchGate), а также в научной электронной библиотеке России (eLIBRARY.RU) за период 2019–2024 гг.

Заключение. В проанализированных публикациях заслуживают внимание вопросы, посвященные проблеме гипераммониемии после трансплантации печени. Несмотря на большие успехи в понимании патогенеза гипераммониемии и ее влияния на развитие печеночной энцефалопатии и других нарушений со стороны прочих органов и систем организма, остается много нерешенных вопросов как в диагностике, так и выборе наиболее эффективных методов лечения.

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