摘要
目的研究小剂量血浆置换序贯血浆灌流对慢加急性肝衰竭(ACLF)患者的临床疗效。方法病例来源于泸州医学院附属医院感染科住院ACLF患者,包括血浆置换治疗组(A组,n=114)和小剂量血浆置换序贯血浆灌流治疗组(B组,n=144)。A组采用单纯血浆置换治疗,血浆用量2 400mL;B组采用血浆置换序贯血浆灌流,血浆用量1 400mL。观察两组患者肝、肾功能,凝血功能及电解质指标变化;比较临床疗效及不良反应差异。结果两组患者治疗后丙氨酸转氨酶(ALT)、总胆红素(TBIL)和凝血酶原时间的国际标准化比值(INR)均较治疗前有显著下降(P<0.05);清蛋白(ALB)、凝血酶原活动度(PTA)均较治疗前有显著改善(P<0.05);血清肌酐(CRE)、钾离子和钠离子在治疗前后无显著性变化。两组患者各指标治疗前后变化程度差异无统计学意义。B组患者总有效率为66.66%,24周病死率为47.22%;与A组患者比较差异无统计学意义。B组不良反应总发生率(23.75%)较A组显著降低(35.26%),差异有统计学意义(P=0.011)。结论血浆置换序贯血浆灌流治疗对于ACLF患者具有良好的临床疗效,不良反应较少,且可以明显减少血浆用量。
Objective To investigate the clinical efficacy of sequential plasma perfusion of low dose plasma exchange in the pa-tients with acute on chronic liver failure （ACLF）.Methods The patients with HBV related ACLF in the infection department of the Affiliated Hospital of Luzhou Medical College were divided into the plasma exchange therapy group （group A,n=114）and the low dose plasma exchange sequential plasma perfusion therapy group （group B,n=144）.The group A was treated only by plasma exchange of fresh frozen plasma 2 400 mL;while the group B adopted the sequential plasma perfusion of plasma exchange,with fresh frozen plasma dosage of 1 400 mL.The changes of the liver and renal function,coagulation function and electrolyte indicators were observed in the two groups.The differences in the clinical effects and adverse reactions were compared between the two groups.Results The serum levels of ALT,TBIL and INR after treatment in the two groups were significant decreased than before treatment（P〈0.05）;ALB and PTA were significantly improved compared with before treatment（P〈0.05）;there were no signif-icant differences in serum levels of CRE,K＋ and Na＋ between before and after treatment.The changes of various indexes before and after treatment had no statistical differences between the two groups.The total effective rate and the mortality at 24 weeks in the group B was 66.66% and 47.22% respectively,which had no statistical differences compared with the group A.The total oc-currence rate of adverse reactions in the group B was 23.75%,which was significant lower than 35.26% in the group A with statis-tical difference （P=0.011）.Conclusion Sequential plasma perfusion of plasma exchange has better clinical effect and few adverse reactions for treating the patients with ACLF,which can reduce the plasma dosage significantly.
出处
《重庆医学》
CAS
CSCD
北大核心
2014年第25期3281-3283,共3页
Chongqing medicine
基金
重庆市卫生局基金资助项目(2010-2-025)
关键词
血浆置换
灌流
慢加急性肝衰竭
治疗结果
plasma exchange
perfusion
acute on chronic liver failure
treatment outcome
