血浆置换治疗肝功能衰竭临床研究  

Clinical study of plasma exchange in the treatment of liver failure

作　　者：周福元[1] 杨淑玲[1] 陈金军[1] 刘定立[1] 文维群[1] 姜荣龙[1] 陈永鹏[1] 彭颉[1] 冯筱榕[1] 朱幼芙[1] 郭亚兵[1] 侯金林[1] 

机构地区：[1]南方医科大学南方医院感染内科,广州市510515

出　　处：《临床合理用药杂志》2011年第14期31-32,共2页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察血浆置换治疗肝功能衰竭的疗效。方法 148例患者在内科综合治疗的基础上给予血浆置换治疗,观察临床疗效和并发症发生情况,监测治疗前后肝功能生化指标的变化情况。结果 148例患者经血浆置换治疗后临床症状有不同程度缓解,有效率为62.2%(92/148);临床症状无好转48例;死亡8例。治疗后TBil、谷丙转氨酶、谷草转氨酶、PT均低于治疗前,白蛋白和PTA均高于治疗前,差异均有统计学意义(P<0.05和P<0.01)。早期患者临床好转率为85.7%均高于中期的59.5%和晚期的38.0%,差异有统计学意义(P<0.05)。连续3次以上(包含3次)血浆置换的患者TBil下降幅度为65.93%高于连续3次以下的43.49%,差异有统计学意义(P<0.01)。148例患者共进行血浆置换治疗436次,出现不良反应58次(13.30%)。结论血浆置换治疗肝功能衰竭疗效明显,连续多次治疗对降低TBil效果更好,治疗早、中期肝功能衰竭最为适宜。Objective To observe the clinical efficacy of plasma exchange in the treatment of liver failure.Methods 148 patients were treated with plasma exchange on the basis of conventional therapy.The clinical efficacy,incidence situation of complications and change of biologic liver function markers.Results After treatment,the clinical symptoms were alleviated of varied degree,and the effective rate was 62.2%（92/148）;48 cases were without alleviation;8 cases were died.The Tbil,ALT,AST,PT after treatment were respectively lower than those before treatment,while ALB and PTA were higher than those before treatment,and the differences were statistically significant（P0.05,P0.01）.The improvement rate of patients in early stage was 85.7% higher than 59.5% in middle stage and 38.0% in late stage,and the differences were statistically significant（P0.05）.The descender of TBil of patients received continuous equal to or more than 3 times plasma exchange treatment was 65.93% higher than 43.49% of that received less than 3 times,and the difference was statistically significant（P0.01）.436 times of plasma exchange treatments were done in all 148 cases,and that with adverse reaction was 58 times（13.30%）.Conclusion Plasma exchange is effective in treating liver failure.It is more effective to reduce TBil level after treating with several times of plasma exchange.It is more suitable to treat liver failure with plasma exchange in early and middle stage.

关 键 词：人工肝支持系统 血浆置换 肝功能衰竭 

分 类 号：R575.3[医药卫生—消化系统]