术前即时血浆置换对慢性重型肝炎肝移植的价值  

The value of plasma exchange immediately before liver transplantation for patients with chronic severe hepatitis

作　　者：郭庆良[1] 卢实春[1] 王孟龙[1] 赖威[1] 张振[1] 韩大康[2] 代丽丽[3] 李宁[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝胆外科暨肝移植中心,100069 [2]首都医科大学附属北京佑安医院人工肝治疗中心,100069 [3]首都医科大学附属北京佑安医院性病艾滋病防治中心,100069

出　　处：《北京医学》2010年第3期200-203,共4页Beijing Medical Journal

基　　金：国家自然科学基金(30671977);首都医学发展基金(2005-2034)

摘　　要：目的评价术前血浆置换对慢性重型肝炎肝移植手术过程及预后的影响。方法回顾性分析我中心2004年8月至2008年10月连续82例慢性重型肝炎肝移植患者的临床资料,其中56例于肝移植术前2～3h行血浆置换治疗。结果慢性重型肝炎患者血浆置换后,肝功能、凝血功能显著改善(P<0.01)。血浆置换组术中出血量少,输血量也少(P<0.01);术后脱呼吸机早(P<0.05),胃肠功能及意识恢复快,有显著性差异(P<0.01)。两组患者术后近期并发症率、1个月生存率无显著性差异。结论肝移植术前血浆置换能改善慢性重型肝炎患者的术前状况,虽不能降低术后并发症发生率及提高术后生存率,但有利于慢性重型肝炎患者肝移植手术的顺利进行和术后早期恢复。Objective To observe and investigate the effect of plasma exchange （PE） before liver transplantation on the operation and prognosis of chronic severe hepatitis.Methods Of 82 consecutive cases with chronic severe hepatitis underwent liver transplantation during June 2004 to October 2008 were analyzed retrospectively.Among 82 cases,56 patients were treated with plasmapheresis 2-3 hours before operation.Results After plasma exchange,the liver function and coagulation status were improved remarkably than before the operation.The volume of blood loss and blood infusion was remarkably lower in the PP group than in the control group （P 〈0.01）.Consciousness and digestive system recovered earlier in the plasmapheresis group than in the control group （P 〈0.01）.There were no significant differences of short-term complications and 1-month survival rate between the two groups.Conclusions Plasma exchange immediately before liver transplantation can improve general conditions of the patients with chronic severe hepatitis.Plasma exchange can not reduce the short-term complications and improve the survival rate among chronic severe hepatitis patients who underwent liver transplantation.However,the application of plasma exchange immediately before liver transplantation is helpful for the operative procedure and the postoperative recovery.

关 键 词：血浆置换 慢性重型肝炎 肝移植 

分 类 号：R575.1[医药卫生—消化系统] R657.3[医药卫生—内科学]