摘要
目的比较血浆置换联合胆红素吸附与单纯血浆置换治疗慢加急性肝衰竭的疗效及安全性。探讨既节省血浆用量,又有效安全的治疗方法。方法选择2016年期间我科收治的慢加急性肝衰竭患者62例。按照治疗方案不同分为:A组(血浆置换联合胆红素吸附)30例,(其中男26例,女4例,平均年龄(45±12)岁;B组(单纯血浆置换)32例,(其中男28例,女4例,平均年龄(42±13)岁)。所有患者均在常规内科护肝退黄及支持治疗的基础上给予人工肝治疗。血浆置换联合胆红素吸附治疗的血浆用量为1500ml/次,单纯血浆置换治疗的血浆用量为3000ml/次。分析比较两组患者治疗后其肝功能、凝血酶原时间及临床症状等改善的情况,同时观察不同治疗方法对患者电解质、血常规的影响,重点观察并比较两种不同的治疗方法在治疗过程中不良反应,尤其是严重不良反应发生的情况以及对患者病情的影响。结果血浆置换联合胆红素吸附治疗慢加急性肝衰竭,可明显改善患者ALT、TBIL、DBIL、凝血酶原时间及临床症状等(P<0.05),与单纯血浆置换治疗对上述指标改善相比较无明显差异。血浆置换联合胆红素吸附治疗后对患者血电解质、白细胞、红细胞及血小板的影响较小,与单纯血浆置换治疗后对上述指标的影响相比较无显著差异(P>0.05)。在治疗过程中过敏反应发生及严重程度上,血浆置换联合胆红素吸附治疗过程中过敏反应的发生以及严重程度均明显较单纯血浆置换治疗更低(P<0.05)。此外,血浆置换联合胆红素吸附血浆用量仅需:1500ml/次,明显少于单纯血浆置换血浆用量:3000ml/次。大大减少了血浆的用量,较好地解决了目前血浆供应短缺的难题。结论血浆置换联合胆红素吸附是目前临床上治疗慢加急性肝衰竭的一个即节省血浆,又有效且安全的、值得推广的治疗方法。
Objective To compare the efficacy and safety of plasma exchange combined with bilirubin adsorption（PE＋PBA）and plasma exchange（PE） alone in the treatment of Acute on chronic liver failure. In order to explore the method with effective and safety as well as saving plasma dosage. Methods Sixty-two cases of Acute on Chronic liver failure were selected and divided into two groups：Group A（PE ＋PBA）：30 cases,including male：26 cases;female：4 cases. which average age is 45 ±12 years of age.Group B（PE）：32 cases,including male：28 cases;female：4 cases. which average age is 42±13 years of age. All patients were treated with artificial liver treatment on the basis of routine internal medicine,liver protection and supportive treatment. The dosage of plasma exchange combined with bilirubin adsorption treatment was 1500 ml/times;and the plasma dosage of pure plasma exchange treatment was 3000 ml/times. The liver function,prothrombin time and clinical symptoms of the two groups were analyzed and compared before and after treatment. Meanwhile,the influence of different treatment methods on the electrolyte and blood routine of the patients was observed. At the same time,the adverse reactions were observed and compared,especially the serious adverse reactions and the effect on the patient＇s condition during the treatment of two different therapies. Results Plasma exchange combined with bilirubin adsorption therapy can significantly improve the ALT,TBIL,DBIL,prothrombin time and clinical symptoms of patients with Acute on chronic liver failure（P〈0.05）,and the effects on blood electrolytes,WBC,RBC and platelets were less,which was the same as that of Plasma exchange treatment（P〉0.05）. The occurrence and severity of anaphylaxis,the occurrence and severity of anaphylaxis in plasma exchange combined with bilirubin adsorption treatment were significantly lower than that of pure plasma exchange therapy（P〈0.05）. In addition,the amount of plasma in plasma exchange with bilirubin adsorptio
作者
刘晓妍
高莉
张伦理
LIU Xiaoyan;GAO L i;ZHANG Lunli(Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China)
出处
《江西医药》
CAS
2018年第4期287-289,321,共4页
Jiangxi Medical Journal
基金
江西省卫生和计划生育委员会课题
编号20171060
关键词
血浆置换术
胆红素吸附
慢加急性肝衰竭
Plasma exchange
Bilirubin adsorption
Acute on chronic liver failure
