人工肝血浆置换治疗肝衰竭的临床观察

张琳; 赵守松

doi:10.3969/j.issn.1001-5256.2014.10.010

人工肝血浆置换治疗肝衰竭的临床观察

DOI: 10.3969/j.issn.1001-5256.2014.10.010

张琳,
赵守松

蚌埠医学院第一附属医院感染性疾病科

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中图分类号: R575.3
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出版历程
- 收稿日期: 2014-01-08
- 出版日期: 2014-10-20

Clinical efficacy of plasma exchange therapy in treatment of liver failure

Department of Infections Diseases, The First Affiliated Hospital, Bengbu Medical College

摘要

摘要:
目的观察血浆置换术(PE)治疗肝衰竭的疗效。方法回顾性分析2012年1月至2013年6月收治的肝衰竭患者的临床资料,PE组33例肝衰竭患者在内科综合治疗基础上加用血浆置换治疗,对照组30例肝衰竭患者予内科综合治疗,观察两组患者治疗2周后临床症状、并发症发生情况、肝功能生化指标的变化等,随访治疗后3个月内病情转归情况并分析影响疗效的因素。实验检测数据用均数±标准差(x±s)表示,计量资料用t检验进行比较,计数资料采用χ2检验或Fisher确切概率法。结果予血浆置换治疗后,患者乏力、纳差、腹胀等临床症状明显改善,血清中ALT、TBil水平较治疗前降低[(390.48±536.52)U/L vs(81.03±47.58)U/L;(479.27±130.01)μmol/L vs(244.64±151.05)μmol/L,P值均<0.01],Alb、胆固醇(CHO)、凝血酶原活动度(PTA)水平较治疗前升高[(33.06±5.42)g/L vs(35.24±3.68)g/L;(2.50±1.24)mmol/L vs(3.59±0.86)mmol/L;(34.16±5.33)%vs(73.9...
- 肝功能衰竭 /
- 肝,人工 /
- 血浆置换
Abstract:
Objective To investigate the clinical efficacy of plasma exchange ( PE) in the treatment of liver failure. Methods A retrospective analysis was performed on the clinical data of patients with liver failure who were treated from January 2012 to June 2013 in our hospital. Thirty-three patients in PE group received PE in addition to medical comprehensive treatment, and 30 patients in control group were treated with medical comprehensive treatment. Clinical symptoms, complications, and the changes in biochemical markers of liver function were observed after 2 weeks of treatment, post-treatment outcomes were evaluated by 3-month followed-up, and the influential factors for efficacy were analyzed. Experimental data were expressed as mean ± standard deviation, continuous data were compared by t test, and categorical data were analyzed by chi-square test or Fisher's exact test. Results Symptoms such as fatigue, poor appetite, and abdominal distension were significantly relieved after PE. Post-treatment serum alanine aminotransferase ( ALT) and total bilirubin ( TBil) levels were significantly lower compared with pre-treatment levels ( 390. 48 ± 536. 52 U /L vs 81. 03 ± 47. 58 U /L and 479. 27 ± 130. 01 μmol /L vs244. 64 ± 151. 05 μmol /L, P < 0. 005) , whereas post-treatment levels of albumin ( Alb) and cholesterol ( CHO) and prothrombin activity ( PTA) were significantly higher than those measured before the treatment ( 33.06 ±5.42 g/L vs 35.24 ±3.68 g/L, 2.50 ±1.24 mmol/L vs 3. 59 ± 0. 86 mmol /L, and 34. 16% ± 5. 33% vs 73. 98% ± 27. 23%, P < 0. 005) . No significant differences were identified between pre-and post-treatment levels of ALT, TBil, Alb, CHO, and PTA ( P > 0. 05) . Patients in PE group had a significantly higher improvement rate ( χ2= 8. 276, P < 0. 005) and a significantly lower mortality rate ( χ2= 13. 258, P < 0. 005) compared with the control group. The efficacy of PE was found to be correlated with pre-treatment TBil level, complications, bilirubin enzyme separation, and age ≥40 years ( P <0.05) . TBil and bilirubin enzyme separation were independent risk factors affecting the efficacy of PE ( P <0.05, OR =1.01 and8. 75) . Adverse reactions occurred in 8 cases during PE treatment, and disappeared after symptomatic treatment. Conclusion PE is a safe and effective treatment for liver failure, and holds promise for clinical application. TBil level and bilirubin enzyme separation are independent risk factors affecting the efficacy of PE.
- liver failure /
- liver, artifical /
- plasma exchange

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参考文献(11)

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