血浆置换联合去甲肾上腺素治疗重型肝炎合并Ⅱ型肝肾综合征的临床疗效分析  

The study on plasma exchange combined with noradrenalin in the treatment of severe hepatitis with type Ⅱ hepatorenal syndrome

作　　者：唐文[1] 蒋明德[1] 徐辉[1] 秦建平[1] 沈才飞[1] 

机构地区：[1]军区总医院消化内科,成都610083

出　　处：《北京医学》2011年第9期713-716,共4页Beijing Medical Journal

摘　　要：目的探讨血浆置换联合去甲肾上腺素对重型肝炎合并Ⅱ型肝肾综合征(hepatorenal syndrome,HRS)的疗效。方法 67例重型肝炎合并Ⅱ型HRS患者分为3组,均给予内科综合治疗;A组(n=19)为对照组,B组(n=23)给予去甲肾上腺素持续静脉泵入,C组(n=25)采用血浆置换联合去甲肾上腺素治疗。观察各组肝肾功能、终末期肝病模型评分(MELD评分)、尿量以及住院病死率。结果 A、B、C3组治疗后总胆红素分别为(254.50±143.41)、(129.65±60.28)、(97.39±39.53)μmol/L;肌酐分别为(153.07±81.00)、(148.00±82.36)、(81.28±12.98)μmol/L;MELD评分分别为27.91±6.55、25.98±8.06、19.26±2.22;尿量分别为(678.42±309.16)、(819.57±66.90)、(1611.20±225.71)ml。C组治疗后肌酐、MELD评分以及尿量与A、B组治疗后比较均有显著性差异(P<0.05),C组治疗后总胆红素与A组治疗后比较有显著性差异(P<0.05)。C组治疗前后比较,各指标均有显著性差异(P<0.05)。3组住院病死率分别为68.4%、43.5%和28.0%,3组比较有显著性差异(掊2=7.157,P<0.05)。结论血浆置换联合去甲肾上腺素是治疗重型肝炎合并Ⅱ型HRS的有效方法。Objective To evaluate the effect of plasma exchange combined with noradrenalin in the treatment of severe hepatitis with type Ⅱ hepatorenal syndrome.Methods Sixty-seven patients with severe hepatitis and type II hepatorenal syndrome were included and were divided into the control group（group A）,plasma exchange group（group B） and plasma exchange combined with noradrenalin treatment group（group C）.The etiopathogenisis,liver function,renal function,the MELD score,urinary volume and mortality were analyzed.Results After treatment,the total bilirubin level of group A,B and C was（254.50±143.41）,（129.65±60.28）,（97.39±39.53）μmol/L,respectively.The creatinine level of group A,B and C was（153.07±81.00）,（148.00±82.36）,（81.28±12.98） μmol/L,respectively.The MELD score of group A,B and C was 27.91±6.55,25.98±8.06,19.26±2.22,respectively and the urinary volume of group A,B and C was（678.42±309.16）,（819.57±466.90）,（1611.20±225.71）ml,respectively.There were significant differences of all the above parameters between group A and C（P 0.05）.There were significant differences between group C and B in creatinine level,the MELD score and the urinary volume（P 0.05）.The differences in case mortality between group A,B and C（68.4% vs.43.5% vs.28.0%）,were significant（χ2=7.157,P 0.05）.Conclusion Plasma exchange combined with noradrenalin is effective in treating severe hepatitis with type II hepatorenal syndrome.

关 键 词：重型肝炎 肝肾综合征 血浆置换 去甲肾上腺素 

分 类 号：R575.1[医药卫生—消化系统] R692[医药卫生—内科学]