人工肝血浆置换对慢性重型乙型肝炎患者的疗效与安全性  

The therapeutic effect and safety of plasma exchange in chronic severe hepatitis B

作　　者：高蕾[1] 汪茂荣[1] 隋云华[1] 何长伦[1] 季付红[1] 胡玲[1] 

机构地区：[1]解放军第81医院肝病研究所,江苏南京210002

出　　处：《生物医学工程与临床》2009年第5期399-402,共4页Biomedical Engineering and Clinical Medicine

基　　金：江苏省应用基础研究项目(BJ200037)

摘　　要：目的评价慢性重型乙型肝炎患者人工肝血浆置换疗法效果与安全性。方法113例慢性重型乙型肝炎患者,其中男性95例,女性18例;年龄19～75岁,平均年龄41.3岁。进行血浆置换共235例次,每次置换同型血浆3000ml,比较治疗前、后肝功能和脂代谢等生物化学指标及电解质状况。随机抽取30份置换用血浆同时作相应检测。观察治疗中出现的并发症并加以治疗。结果与治疗前比较,患者治疗后血清总胆红素、直接胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶明显降低(P<0.01),胆碱酯酶、胆固醇增高(P<0.05),高密度脂蛋白、载脂蛋白A1、血糖、血氨显著增高(P<0.01),钙离子和总钙浓度明显降低(P<0.01)。与正常参考值比较,置换用血浆中糖、氨含量明显增高,钾、钠、氯浓度偏低或降低,钙离子和总钙浓度极低。治疗过程中,患者全身不适、肌肉抽搐19例次(8.1%),穿刺部位淤斑和出血42例次(17.9%),恶心、呕吐5例次(2.1%),过敏反应48例次(20.4%),一过性低血压6例次(2.6%),分别经补充钙剂或凝血因子、给予甲氧氯普胺或地塞米松、调整进出体内血液流速等加以防治。结论人工肝血浆置换疗法可改善慢性重型乙型肝炎患者肝功能和脂代谢等状态,妥善预防与处理治疗中并发症是确保该疗法安全性所必需的。Objective To evaluate the therapeutic effect and safety of plasma exchange in patients with chronic severe hepatitis B.Methods A total of 113 cases with chronic severe hepatitis B,male 95,female 18,aged 19-75 years,mean age 41.3 years,were enrolled in total 235 times of treatment and 3 000 ml frozen plasma with same blood group was used for each time.The biochemical indexes of liver function and lipid metabolism,as well as electrolytes in the blood were examined before and after treatment.The same detection was also performed randomly in selected 30 samples of the exchanging plasma in treatment.The complications induced by the therapy were observed.Results After treatment,the serum total bilirubin,direct bilirubin,alanine aminotransferase and aspartate aminotransferase were reduced obviously（P 〈 0.01）,as well as increased cholinesterase and cholesterol（P 〈 0.05）and distinctly raised high density lipoprotein,apolipoprotein A1,glucose and ammonia（P 〈 0.01）,and remarkably decreased the ionized calcium and total calcium（P 〈 0.01）.Compared with the normal value,glucose and ammonia in the exchanging plasma were increased greatly,while reduced potassium,natrium,chloride,and obviously decreased the ionized calcium and total calcium.During treatments in the patients about 8.1 %（19/235）times of treatment had malaise and muscle twitch;in 17.9 %（42/235）,ecchymosis and hemorrhage on the puncture sites;in 2.1 %（5/235）,vomit and nausea;in 20.4 %（48/235）,allergic reaction and in 2.6 %（6/235）,temporary hypotension were found.Such complications could be prevented or treated by supplementing calcium agents or coagulative factors and metoclopramide or anti-allergy drugs for adjusting the rate of blood flow-in or-out of the body.Conclusion The plasma exchange can improve the biochemical indexes in the blood of patients with chronic severe hepatitis B.Prevention and finding the complications in time is essential to keep the safety of the treatment.

关 键 词：人工肝 血浆置换 慢性重型乙型肝炎 并发症 

分 类 号：R512.62[医药卫生—内科学]