不同物理型人工肝治疗模式早期救治慢性重型肝炎疗效比较  

Comparisons of effects of different types of physical artificial liver support system applied in treatment of patients with early stage of chronic severe hepatitis

作　　者：胡肖兵[1] 高洪波[1] 廖明儿[1] 何敏茹[1] 

机构地区：[1]广州市第八人民医院重症肝病科,广东广州510060

出　　处：《中国中西医结合急救杂志》2008年第2期117-119,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的比较不同物理型人工肝支持治疗模式在慢性重型肝炎（慢重肝）早期救治中的疗效，探索早期救治慢重肝的人工肝治疗有效模式。方法120例慢重肝患者均符合重型乙型病毒性肝炎早期的诊断，按随机原则分为4组，每组30例。治疗1组，进行血浆置换，每次置换血浆3000ml；治疗2组，每次置换血浆2000ml后进行血浆吸附2h；治疗3组，每次进行血浆吸附3h；治疗4组，采用分子吸附再循环（MARS）治疗，每次治疗4h，均每周2次，每次间隔2～3d，连续治疗2周。比较治疗前后症状改善、黄疸消退与反弹、白蛋白与凝血酶原活动度的改变及不良反应的发生。结果血浆置换组症状改善27例，总胆红素（TBil）下降率为51．8％，反弹幅度为14．4％～46．7％，不良反应多；减量血浆置换联合中性大孔树脂血浆吸附组症状改善24例，TBil下降率为62．2％，反弹幅度为2．8％～28．5％，不良反应少；单纯中性大孔树脂血浆吸附治疗组症状改善16例，TBil下降率为38．8％，反弹幅度为2．8％～6．8％，不良反应少；MARS治疗组症状改善26例，TBil下降率为60．1％，反弹幅度为7．8％～27．4％，不良反应多，且费用昂贵，性价比不高。结论减量血浆置换联合中性大孔树脂血浆吸附治疗慢重肝（早期）具有退黄效果好，黄疸反弹小，不良反应少的特点，性价比较高，是慢重肝早期救治较为合理的方式。Objective To compare the different types of physical artificial liver support system （ALSS） applied in the treatment of patients with early stage of chronic severe hepatitis in order to evaluate the therapeutic effect and look for the most effective one. Methods One hundred and twenty patients of chronic severe hepatitis B in early stage were randomly divided into 4 groups （each n = 30）. The patients in group 1 were treated by 3 000 ml plasma exchange; in group 2, by 2 000 ml plasma exchange combined with plasma adsorption for 2 hours; in group 3, only by plasma adsorption for 3 hours and in group 4, by molecular adsorbent re-circulating system （MARS）. The observation time lasted for 2 weeks and the therapy twice a week, the interval between two times of treatment being 2 - 3 days. The improvement of symptoms, the fade away and rebound of ieterus, the changes of albumin and prothrombin activity （PTA）, side effects （anaphylaxis, hepatic encephalopathy, edema of conjunctiva, burp, fluid and electrolyte balance failure, changes of blood routine test and ammonia level, ete） were compared before and after the treatment. Results The symptoms of 27 cases in group 1 were improved, the rate of decrease of total bilirubin （TBil） of group 1 was 51.8% and the range of icterus rebound was 14.4% to 46.7% with comparatively more side effects. The symptoms of 24 cases of group 2 were improved, the rate of decrease of TBil in group 2 was 62.2% and the range of icterus rebound was 2.8% to 28.5% with comparatively less side effects. The symptoms of 16 cases of group 3 were improved, the rate of decrease of TBil in group 3 was 38. 8% and the range of icterus rebound was 2.8% to 6.8% with less side effects. The symptoms of 26 cases of group 4 were improved, the rate of decrease of TBil in group 4 was 60. 1% and the range of ieterus rebound was 7.8% to 27.4% with comparatively more side effects, moreover the cost was higher than that in the other groups. Conclusion The method of reduced plasma exchange combined

关 键 词：血浆置换 血浆吸附 分子吸附循环系统 肝炎 重型 慢性 

分 类 号：R575.1[医药卫生—消化系统]