血浆置换治疗肝功能障碍合并MODS的临床观察  

Clinical Observation of Plasma Exchange for Treating Patients with Acute Liver Dysfunction

作　　者：卢勇[1] 唐绍辉[1] 秦伟毅[1] 钱洪津[1] 

机构地区：[1]广州军区广州总医院急诊科,广东广州510010

出　　处：《华南国防医学杂志》2010年第2期109-111,共3页Military Medical Journal of South China

摘　　要：目的探讨血浆置换(plasma exchange,PE)在多器官功能障碍综合征(multiple organ disfunction syndrome,MODS)治疗中的意义。方法将20例急性肝功能障碍患者随机分为两组:肝功能障碍合并MODS组10例,急性单纯肝功能障碍组(非病毒性肝炎)10例。在统一标准的内科综合治疗基础上,分别对两组患者进行了以PE为主的非生物性人工肝治疗。检测治疗前后总胆红素、直接胆红素、谷丙转氨酶的变化。结果肝功能障碍合并MODS组肝功能指标明显好转,总胆红素由(240.00±75.53)μmol/L降到(125.00±42.47)μmol/L,直接胆红素由(139.70±54.35)μmol/L降到(75.30±22.18)μmol/L,ALT由(111.10±29.76)U/L降到(72.90±17.80)U/L;病死率为80%。急性单纯肝功能障碍组肝功能指标明显好转。总胆红素由(207.90±72.68)μmol/L降到(87.60±45.26)μmol/L,直接胆红素由(102.30±55.37)μmol/L降到(45.20±25.85)μmol/L,ALT由(120.20±62.54)U/L降到(58.30±26.70)U/L;病死率为0。两组肝功能各指标治疗前后差值和病死率比较差异均有显著性(P<0.01)。结论对于肝功能障碍合并MODS患者,PE可以显著改善肝功能指标及病情严重程度,延长患者生存时间,但不能改善患者预后。Objective To explore the clinical implications of plasma exchange （PE） in treating patients with multiple organ dysfunction syndrome （MODS）. Methods Twenty patients were evenly and randomly divided into MODS with liver dysfunction group （group 1） and acute liver dysfunction induced by non-virus hepatitis group （group 2）. Besides integrative medicine treatment, all patients were treated with PE. Total bilirubin, direct bilirubin and alanine aminotrans- ferase （ALT） were determined before and after PE. Results Bilirubin, direct bilirubin and ALT contents were decreased from （240. 00±75.53） μmol/L, （139. 70 ± 54. 35）μmol/L and （111.10± 29. 76） U/L to （125.00 ± 42. 47） μmol/L, （75.30 ± 22. 18） μmol/L and （72. 90 ± 17. 80） U/L after PE in group 1 respectively （P〈0. 01）. The case-fatality rate was 80% in group 1. Bilirubin, direct bilirubin and ALT contents were decreased from （207. 90± 72.68） /μmol/L, （102. 30 ± 55.37） μmol/L and （120. 20 ± 62. 54） U/L to （87. 60 ± 45.26） μmol/L, （45.20± 25.85） μmol/L and （120. 20 ±62.54） U/L after PE in group 2 respectively （P〈0. 01）. Death occurred in 0% of group 2. The changes of bilirubin, direct bilirubin and ALT levels and the mortality were significantly different between two groups （P〈0. 01 ）. Conclusion PE is effective to treat acute liver dysfunction, can improve live function and prolong the survival time, but can not ameliorate the prognosis.

关 键 词：血浆置换 肝功能障碍 人工肝支持系统 多器官功能障碍综合征 

分 类 号：R575.3[医药卫生—消化系统]