血浆置换联合血液滤过技术在重症肝炎肝移植手术前的临床应用  

Plasma exchange combined with continuous veno-venous hemofiltration in the treatment of patients with severe hepatitis before liver transplantation

作　　者：张琳 文刚 章车明 张尧 彭松 

机构地区：[1]安徽医科大学第三附属医院ICU,合肥230061 [2]安徽医科大学第三附属医院普外科,合肥230061

出　　处：《中国血液净化》2007年第6期317-319,共3页Chinese Journal of Blood Purification

摘　　要：目的探讨非生物型人工肝技术血浆置换(PE)加持续性静脉静脉血液滤过(CVVH),对各种原因所致重症肝炎肝移植手术前的应用价值。方法应用(PE+CVVH)人工肝技术对安徽医科大学第三附属医院9例不同病因重症肝炎患者进行27例次治疗,比较治疗前后患者生化指标肝功能、凝血酶原时间、血氨及临床症状改善程度及观察治疗不良反应对临床疗效和安全性评价。结果患者在治疗后意识障碍、黄疸、乏力、恶心﹑呕吐﹑腹胀、纳差等症状明显改善,食欲增加,血清总胆红素﹑直接胆红素﹑血氨分别较治疗前下降了49.4%、58.1%、65.8%。血浆白蛋白﹑转氨酶﹑肾功能较前好转,凝血酶原时间由治疗前(35.18±9.26)%下降为(19.61±10.26)%出血倾向得到纠正。血白细胞、血小板及电解质水平无明显变化。未发生出血、休克、过敏等并发症,患者耐受好。结论(PE+CVVH)人工肝技术可显著改善各种原因引起的重症肝炎肝衰竭患者临床症状及生化指标,安全性好,无明显不良反应,近期疗效显著。可作为支持治疗和肝移植的术前过渡治疗手段。Objective To evaluate clinical significance, feasibility and safety of plasma exchange combined with continuous veno-venous hemofiltmtion （PE＋ CVVH） in the treatment of severe hepatitis before liver transplantation. Methods Nine patients with severe hepatitis of various causes were treated with PE＋ CVVH for 27 times. After comparisons of their liver functions, thrombinogen time, blood ammonia, clinical manifestations, untoward effects before and after （PE＋ CVVH）, the efficacy and safety of the treatment were evaluated. Results After the treatment, conscious disturbances, jaundice, lassitude, nausea, vomiting, anorexia and abdominal distention were improved significantly. Serum total bilirubin, conjugated bilirubin and blood ammonia decreased by 49.4%, 58.1% and 65.8%, respectively, as compared with those before the treatment. Serum albumin, transaminases, renal functions also improved. Thrombinogen time reduced from （35.18± 9.26）% before the treatment to （19.61 ± 10.26） % after the treatment, and bleeding tendency was corrected. There were no changes in WBC, platelet and serum electrolytes. No hemorrhages, shock and hypersensitivity were found, and the patients tolerated PE＋CVVH well. Conclusion PE＋ CVVH significantly improves clinical symptoms and biochemical abnormalities in patients with severe hepatitis of various causes. It changes short term prognosis of the patients with relatively safety and less side effects. PE＋ CVVH can be used as a supportive treatment and as a transitional measure before liver transplantation.

关 键 词：血浆置换 血液滤过 重症肝炎 肝移植 

分 类 号：R318.14[医药卫生—生物医学工程]