CRRT联合PE治疗晚期重症肝炎合并肝肾综合征的疗效观察  

Efficacy of CRRT combined with PE in treatment of advanced severe hepatitis complicated with hepatorenal syndrome

作　　者：高海丽[1] 王新伟[1] 梁海军[1] 杨道坤[1] 乔汉臣[1] 

机构地区：[1]新乡医学院第一附属医院感染疾病科,河南卫辉453100

出　　处：《中华医院感染学杂志》2014年第5期1191-1193,共3页Chinese Journal of Nosocomiology

基　　金：河南省教育厅科研基金项目(200733001)

摘　　要：目的观察连续性肾脏替代疗法(CRRT)与血浆置换(PE)联合治疗晚期重症肝炎患者合并肝肾综合征(HRS)的疗效。方法选择医院收治的60例晚期重症肝炎合并肝肾综合征患者随机分为观察组和对照组各30例,对照组行常规治疗,观察组除常规治疗外给予CRRT与PE联合治疗;数据采用SPSS13.0统计软件进行统计分析。结果治疗前两组尿素氮(BUN)、肌酐(Cr)、总胆红素(TBIL)、血氮(NH3)、血清白蛋白(ALB)、胆碱酯酶(CHE)、血钠(Na+)、血钾(K+)比较,差异无统计学意义;治疗后血清K+、BUN、Cr、NH3、TBIL观察组分别为(3.78±0.43)mmol/L、(8.90±2.47)mmol/L、(145.86±65.11)μmol/L、(104.34±35.57)μmol/L、(387.43±97.90)μmol/L,明显低于对照组的(4.65±0.56)mmol/L、(12.21±3.21)mmol/L、(224.55±91.32)μmol/L、(145.32±41.45)μmol/L、(494.12±132.65)μmol/L(P<0.01);而血Na+、ALB、CHE观察组分别为(131.34±7.11)mmol/L、(32.79±3.54)g/L、(445.76±123.56)U/L,明显高于对照组的(125.73±7.44)mmol/L、(29.53±3.76)g/L、(343.78±90.77)U/L(P<0.05);观察组死亡9例;对照组死亡20例;两组患者比较,差异有统计学意义(P<0.05)。结论 CRRT联合PE治疗晚期重症肝炎合并肝肾综合征的疗效较好,存活率高。OBJECTIVE To observe the clinical efficacy of continuous renal replacement therapy （CRRT） combined with plasma exchange （PE） in treatment of advanced severe hepatitis complicated with hepatorenal syndrome （HRS）. METHODS Totally 60 cases of advanced severe hepatitis patients complicated with HRS were recruited from the hospital and randomly divided into the observation group and the control group, with 30 cases in each, then the control group was treated with the conventional therapy, the observation group was given additional CRRT combined with PE on the basis of the conventional therapy; the data were statistically analyzed with SPSS13. 0 software. RESULTS Compared with the urea nitrogen （BUN） ,creatinine （SCr） ,total bilirubin （TBlL） .riitrogen （NH3） ,serum albumin （ABL） , cholinesterase （CHE）,Na＋ ,or K＋ before the treatrnent v the difference between the two groups was not statistically significant; after the treatment, the levels of serum K＋ , BUN, Cr , NH3, and TBlL of the observation group were respectively （3. 78 ± 0. 43） mmol/L, （8. 90 ± 2. 47） mmol/L,045. 86±65.11）μmol/L, 004. 34±35. 57） μmol/L, and （387. 43±97. 90）μmol/L, significantly lower than （4. 65±0. 56）mmol/L, （12. 21±3. 21）mmol/L,（224. 55±91. 32）μmol/L, （145. 32±41. 45）μmol/L, and （494. 12±132. 65）μmol/L of the control group （P〈0. 01）; While the levels of blood Na＋, ALB, and CHE of the observation group were respectively（31. 34±7.11）mmol/L, （32. 79±3. 54）g/L, and（445. 76±123. 56）U/L, significantly higher than （125. 73±7. 44）mmol/L,（29. 53±3. 76）g/L, and （343. 78±90. 77）U/L of the control groups（P〈0.05）. Totally 9 cases died in the observation group, 20 cases in the control groups, with statistical difference between the two groups （P 〈 0. 05）. CONCLUSION The CRRT combined with PE can achieve good effect on treatment of advanced severe hepatitis complicated with HRS, with the higher survival rate.

关 键 词：肾脏替代疗法 血浆置换 肝肾综合征 重症肝炎 

分 类 号：R512.6[医药卫生—内科学]