The molecular adsorbent recirculating system (MARS) is a new type of artificial liver support system imported from Germany. The system has the function of selective adsorption and removal of albumin-bound toxin, and the adsorption rate is high, the adverse effects are few, and the instrument operation safety performance is reliable.
I. Working principle of MARS
MARS is a non-biological artificial liver support system consisting of three circulatory systems, namely: blood circulation, albumin circulation and dialysis circulation.The principle of MARS treatment is mainly to support the replacement of some of the detoxification functions of the liver.The most critical technology that makes MARS artificial liver system different from other artificial liver support systems is the MARSFLUX dialysis membrane (simulated hepatocyte membrane), which works very similar to the detoxification of hepatocytes.
II. Equipment of MARS
The therapeutic equipment of MARS consists of three parts: MARS mainframe, dialysis machine and dialyzer and pipeline system.
III. Indications and contraindications of MARS
(i) Advantages of MARS
MARS therapy has the following advantages
1. Efficient simulation of the biological detoxification process of liver cells, which can effectively remove protein-bound toxins and water-soluble toxins.
2. It also has artificial kidney function, regulates water, electrolyte and acid-base balance imbalance, and maintains the stability of internal environment.
3.Better biocompatibility, high selectivity, and cell-free operation.
4.The treatment is relatively safe and reliable, with few adverse reactions and low medical risk.
(II) Indications
1, chronic acute liver insufficiency and liver failure, acute severe liver impairment, liver insufficiency, liver failure occurring on the basis of chronic liver disease due to various causes (viral infection, alcoholic liver disease, autoimmune liver disease, metabolic disorders), and complications of the above disorders: 1) progressive jaundice, cholestasis; hepatic encephalopathy; renal insufficiency (hepatorenal syndrome); spontaneous bacterial peritonitis; refractory ascites; multi-organ failure.
2. Acute/fulminant liver failure Acute/fulminant liver failure from various causes (viral infection, toxic hepatitis due to poisoning by drugs, poisonous mushrooms, halothane, etc., acute fatty liver in pregnancy, surgical trauma, etc.) and complications of the above disorders: 1) hepatic encephalopathy; 2) renal insufficiency (hepatorenal syndrome); 3) spontaneous bacterial peritonitis.
3. primary transplanted liver non-function
4. Others such as intractable pruritus due to cholestasis.
(C) Contraindications
1. Patients with severe active bleeding and DIC with uncontrolled bleeding and DIC.
2.Patients with shock and circulatory failure.
3.Patients with non-stable stage of cardiac or cerebral infarction.
4.Cases considered by clinicians as unsuitable for treatment, or those who cannot tolerate treatment.
(IV) Application of MARS in other diseases
MARS can be applied not only in the treatment of various liver diseases and liver failure and their complications, but also play an important role in the treatment of other serious systemic diseases to save lives, restore organ function and/or relieve symptoms.
1. Intractable pruritus due to cholestasis
2. Hypoxic liver damage due to cardiogenic shock
3. Multi-organ failure
4. Fulminant hepatomegaly crisis
5. Mushroom poisoning
6. Progressive malignancy
In conclusion, based on the special mechanism of action of MARS, it has been widely used in the rescue of various clinical emergencies and critical illnesses, and the clinical indications are gradually expanding.