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Control study on the immediate effect and adverse reaction of different types of artificial liver treatment of liver failure
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摘要: 目的通过前瞻性、大样本的对照研究,探讨不同类型人工肝在重型肝病治疗中的临床意义。方法选择北京佑安医院的重型肝炎和慢性肝炎重度且凝血酶原活动度（PTA）<50%的患者469例,共进行不同种类人工肝治疗1257次,按照人工肝类型分为3组,血浆置换（PE）组,分子再循环系统（MARS）组,PE和血液滤过组合（PE+CVVH）组,并记录人工肝治疗前后患者症状、实验室指标及不良反应。结果各组人工肝治疗前后胆红素水平均有明显改善,PE组、PE+CVVH组清除胆红素及提高凝血酶原活动度（PTA）水平的能力优于MARS组;PE+CVVH和MARS组降低肌酐（Cr）作用强于PE组;PE组治疗后肝性脑病（HE）无改善,MARS组、PE+CVVH组治疗后HE明显缓解,其中MARS组有效率为51.5%（17/33）,PE+CVVH组有效率为54.3%（19/35）。结论 3组人工肝治疗方法对重型肝病治疗均有一定的效果,而PE、PE+CVVH治疗清除总胆红素（TBil）的作用优于MARS组;PE+CVVH和MARS治疗对Cr的清除优于PE。PE组发生过敏反应的比例高于PE+CVVH组及MARS组,PE+C...Abstract: Objective To investigate the therapeutic effects and side effects of different types of artificial liver treatments of liver failure by a prospective,large-sample comparative study.Methods 469 patients from Beijing Youan hospital with liver failure or severe hepatitis whose PTA less than 50% were treated by all kinds of artificial liver treatment for 1257 times.They were divided into three groups: plasma exchange(PE) group,molecular adsorbent recirculating system(MARS) group and plasma exchange plus continuous vein-vein hemofiltration(PE+CVVH) group.The clinical symptoms,laboratory tests and adverse reactions before and after the treatments were recorded.Results The total bilirubin level is significantly decreased after treatments in the three groups.The creatinine level in MARS group and PE+CVVH group also declined dramatically.The bilirubin reduction and prothrombin activity improving in PE group and PE+CVVH group are more remarkable than that in MARS group.The decline of creatinine in PE+CVVH group and in MARS group is more remarkable than that in PE group.In PE group,the stage of hepatic encephalopathy is not modified after treatment,while in MARS group and PE+CVVH group,hepatic encephalopathy is relieved.The effective percentage is 51.5%(17/33)in MARS group and 54.3%(19/35)in PE+CVVH group.The incidence rate of adverse reaction in PE group,MARS group and PE+CVVH group is 17.6%、13.4% and 27.3% respectively.Conclusion Three types of artificial liver treatments are all effective to treat liver failure.The decline of bilirubin in PE group and PE+CVVH group is more remarkable than that in MARS group.The decline of creatinine in MARS group and PE+CVVH group is more remarkable than that in PE group.The incidence rate of anaphylactic reaction in PE group is higher than that in PE+CVVH group and MARS group.The incidence rate of fall of blood pressure in PE+CVVH group is higher than that in PE group and MARS group.The result will be helpful for doctors to choose most suitable artificial liver treatment for patients.
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Key words:
- liver artifical /
- hepatitis
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