人工肝血浆置换治疗不同临床分期肝衰竭37例疗效观察  

Clinical observation of artificial liver plasma exchange on 37 patients with liver failure at different clinical stages

作　　者：寇国先[1] 张欢[1] 滕小华[1] 谢俊华[1] 

机构地区：[1]绵阳市中心医院感染科,四川绵阳621000

出　　处：《生物医学工程与临床》2015年第4期374-377,共4页Biomedical Engineering and Clinical Medicine

摘　　要：目的：观察在常规内科治疗的基础上使用人工肝血浆置换治疗不同临床分期肝衰竭的临床疗效。方法选择肝衰竭患者37例，其中男性28例，女性9例；年龄25～65岁，平均年龄39.5岁。早期19例，中期11例，晚期7例。急性肝衰竭8例，亚急性肝衰竭13例，慢性肝衰竭16例。在常规内科治疗的基础上，使用人工肝血浆置换方法对37例患者进行治疗，观察治疗前、治疗后24 h、治疗后72 h临床症状、生物化学指标[凝血酶原时间活动度（PTA）、血清转氨酶、黄疸指标等]，从而判断临床疗效；并观察临床中出现的不良反应。结果常规内科治疗联合人工肝血浆置换治疗前后患者临床症状得到不同程度的改善。急性肝衰竭有效率为37.50%，亚急性肝衰竭为69.23%，慢性肝衰竭为68.75%。早中晚期肝衰竭患者的有效率分别为84.21%、63.64%、28.57%。治疗后24 h患者的丙氨酸氨基转移酶（ALT）、天冬氨酸转氨酶（AST）、血清总胆红素（TBiL）、直接胆红素（DBiL）、间接胆红素（IBiL）有下降，PTA明显上升，差异有统计学意义（P〈0.05）。治疗后72 h再次复查以上指标较治疗后24 h的ALT、AST、TBiL、DBiL、IBiL有所上升，但较治疗前仍有所下降。未发生严重并发症。结论人工肝血浆置换是一种有效的治疗肝衰竭的方法，安全性好，明显提高了救治的有效率，降低了死亡率。Objective To observe the efficiency of artificial liver plasma exchange on liver failure of conventional internal medicine at different clinical stages. Methods A total of 37 cases with liver failure were enrolled, which included 28 males and 9 females, aged 25-65 years old with mean age of 39.5 years old. The amount of these cases in early phase, metaphase or late phase were 19, 11 and 7 respectively. Eight of them were acute liver failure, 13 of sub-acute liver failure and 16 of chronic liver failure. Based on conventional internal medicine, the artificial liver plasma exchange was performed. The clinical symptoms of pre-treatment, 24-hour, 72-hour at post- treatment, the biochemical indexes of prothrombin time activity （PTA）, serum amino-transferase and jaundice index were evaluated, and the adverse reactions was observed. Results The clinical symptoms of patients were improved in different degrees before and after conventional internal medicine combined with artificial liver plasma exchange treatment. The efficiency rate of acute liver failure, sub-acute liver failure and chronic liver failure were 37.50%, 69.23%and 68.75%respectively. The efficiency rate of patients with early phase, metaphase and late phase was 84.21 %, 63.64 % and 28.57 %, respectively. After treatment 24-hour, the index of alanine aminotransferase （ALT）, aspertate aminotransferase（AST）, total bilirubin （TBiL）, direct bilirubin（DBiL） and indirect bilirubin（IBiL） decreased, and PTA increased significantly. The difference was statically significant （P〈0.05）. Compared with the ALT, AST, TBiL, DBiL and IBiL after treatment 24-hour, the ALT, AST, TBiL, DBiL and IBiL after 72-hour increased, but compared the index before treatment, the indexes after 72-hour declined. The serious complication of patients was no occurred. Conclusion It is demonstrated that the artificial liver plasma exchange is an effective treatment for liver failure with good safety, which could increase cure rate and reduce mortality rate.

关 键 词：人工肝 血浆置换 肝衰竭 

分 类 号：R657.3[医药卫生—外科学] R318.14[医药卫生—临床医学]