晚期重症肝炎患者合并肝肾综合征治疗效果的研究  

Therapeutic effect of late severe hepatitis patients complicated with hepatorenal syndrome

作　　者：高海丽[1] 梁海军[1] 王新伟[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6期1455-1457,共3页Chinese Journal of Nosocomiology

基　　金：河南省教育厅科研基金资助项目(200733001)

摘　　要：目的比较连续性肾脏替代(CRRT)治疗与血浆置换(PE)治疗对晚期重症肝炎合并肝肾综合征患者治疗效果,为其临床治疗提供参考依据。方法选取2007年1月-2012年12月124例晚期重症肝炎合并肝肾综合征患者为观察对象,根据治疗方法不同分别为CRRT组和PE组,各62例,比较两组患者治疗前后机体有毒物质的清除情况和治疗并发症情况。结果 CRRT组患者治疗后总胆红素、胆汁酸、谷丙转氨酶低于治疗前,但比较差异无统计学意义,中分子物质、尿素氮、肌酐、血氨、血钾浓度明显低于治疗前,比较差异有统计学意义(P<0.05);PE组患者治疗后总胆红素、胆汁酸、谷丙转氨酶明显低于治疗前,比较差异有统计学意义;CRRT组治疗后总胆红素、胆汁酸、谷丙转氨酶高于PE组治疗后,比较差异有统计学意义(P<0.05);CRRT组治疗后中分子物质、尿素氮、肌酐、血氨、血钾浓度低于PE组,比较差异有统计学意义(P<0.05);并发症发生率CRRT组为16.13%,PE组为19.35%,两组比较差异无统计学意义。结论 PE在对大分子物质的清除效果优于CRRT治疗,而CRRT治疗在对中小分子量物质的清除效果优于PE;二者联合应用可对患者体内不同分子量的毒性物质进行有效清除,有利于提高治疗效果。OBJECTIVE To compare the effects of continuous renal replacement therapy （CRRT） and plasma exchange （PE） on treatment of late severe hepatitis complicated with hepatorenal syndrome so as to provide guidance for clinical treatment. METHODS A total of 124 cases of late severe hepatitis patients complicated with hepatorenal syndrome, who were treated in the hospital from Jan 2007 to Dec 2012, were enrolled in the study and divided into the CRRT group and the PE group, with 62 cases in each, the removal of toxic substance and the incidence of complications were observed and compared between the two groups. RESULTS In the CRRT group, the levels of the total bilirubin, bile acid, and alanine aminotransferase were lower after the treatment than before the treatment, the differences were not statistically significant; the concentrations of the molecular substances, urea nitrogen, creatinine, ammonia, and potassium were significantly lower after the treatment than before the treatment, with statistical significance（P〈0.05）. In the PE group, the levels of the total bilirubin, bile acid, and alanine aminotransferase were significantly lower after the treatment than before the treatment, with statistical significance. After the treatment, the levels of the total bilirubin, bile acid, and alanine aminotransferase of the CRRT group were higher than those of the PE group, with statistical significance （P〈0. 05）; the concentrations of the molecular substances, urea nitrogen, creatinine, ammonia, and potassium of the CRRT group were lower than those of the PE group , with statistical significance （P〈0.05）. The incidence of complications was 16.13% in the CRRT group, 19. 35% in the PE group, the difference between the two groups was not statistically significant. CONCLUSION PE is superior to CRRT on effect of removal of maeromolecular substances, while CRRT can achieve better effect on removal of medium and small molecular substances; the combination of the two can effectively remove the toxic substances

关 键 词：重症肝炎 肝肾综合征 连续性肾脏替代治疗 血浆置换治疗 

分 类 号：R512.6[医药卫生—内科学]