血浆置换联合血液滤过在中晚期妊娠重症肝病患者中的初步应用  

Application of plasmapheresis combined with hemofiltration in the treatment of severe liver disease in middle and late pregnancy

作　　者：魏绪霞[1] 吕海金[1] 安玉玲[1] 易小猛[1] 刘剑戎[1] 熊亮[1] 黎利娟[1] 周密[1] 陆平兰[1] 杨扬[1] 易慧敏[1] 

机构地区：[1]中山大学附属第三医院外科ICU,广州510630

出　　处：《中华医学杂志》2015年第44期3607-3610,共4页National Medical Journal of China

基　　金：广东省自然科学基金（S013010016785）;广州市科技计划基金（2011Y1-033-1）

摘　　要：目的探讨血浆置换联合血液滤过在中晚期妊娠重症肝病患者治疗中的作用及安全性。方法回顾性分析2009年3月至2013年11月在中山大学附属第三医院接受诊治的29例中晚期妊娠重症肝病患者的临床资料。根据治疗方案分为对照组与治疗组，对照组16例，年龄18～29岁，中位年龄24岁；治疗组13例，年龄21～28岁，中位年龄25岁。所有患者均签署由本院伦理委员会批准的患者知情同意书，符合医学伦理学规定。对照组患者给予以抗感染、护肝、利胆、补充人血白蛋白和丙种球蛋白、输注凝血物质等治疗。治疗组在上述治疗的基础上予以血浆置换联合血液滤过治疗。比较两组患者治疗前6h及治疗后1、3、5d的MELD评分、APACHEⅡ评分及外周静脉血总胆红素（TB）、白蛋白（ALB）、凝血酶原活动度（PTA）、空腹血糖（FPG）、血清肌酐（Scr）和动脉血乳酸（Lae）等临床指标差异。观察两组患者临床疗效和不良反应情况。两组患者检验指标比较采用t检验，患者临床有效率比较采用χ2检验。结果两组患者治疗前6h临床指标差异无统计学意义（P〉0．05）。患者治疗后1d的MELD评分、APACHEⅡ评分、TB、ALB、PTA、FPG、Scr、Lac治疗组为（25±6）分、（22±5）分、（197±69）μmol／L、（30±7）g／L、（55±24）％、（5．7±2．4）mmol／L、（111±42）μmol/L、（2．3±0．6）mmol／L；对照组为（33±8）分、（30±7）分、（299±113）μmol／L、（24±6）g/L、（33±11）％、（3．7±1．7）mmol／L、（165±82）μmol／L、（4．4±1．5）mmo]／L。治疗后3、5d的相应临床指标治疗组均较对照组明显改善（均P〈0．05）。治疗组有效率92％（12／13），明显高于对照组的56％（9／16）（χ2=4．215，P〈0．05）。Kaplan—Meier生存分析显示治疗组产后42d生存率显著优于对照组（P=0．045）。治疗组患者中1例血浆置换后出�Objective To investigate the application and security of plasmapheresis combined with hemofiltration in the treatment of severe liver disease in middle and late pregnancy. Methods Clinical data of 29 patients of middle and late pregnancy with severe liver disease from March 2009 to November 2013 in the Third Affiliated Hospital of Sun Yat-sen University was analyzed retrospectively. According to the therapeutic schedule, patients were divided into control group （n = 16, 18 -29 years old, median age of 24 years old） and treatment group （n = 13, 21 -28 years old, median age of 25 years old）. The informed consents of all patients were obtained and the ethical committee approval was received. The control group was given the treatment of resisting infection, protecting liver, reducing jaundice, supplying albumin and globulin, infusing blood coagulation and so on. The treatment group was given plasmapheresis and hemofihration on the basis of the above-mentioned treatment. The differences of major clinical indicatorssuch as MELD scores, APACHE Ⅱ scores, total bilirubin （TB）, albumin （ALB）, protbrombin time activity （PTA） , fasting blood glucose （ FPG）, serum creatinine （Scr） of peripheral venous blood and arterial lactic acid （Lac） in patients of two groups were observed 6 hours before and 1,3,5 days after the treatment. The major clinical indicators in patients of two groups were compared by t test and the clinical efficient were compared by X2 test. Results There were no statistical differences of the clinical indicators between the two groups 6 hours before the treatment （ all P 〉 0. 05 ）. The MELD scores, APACHE Ⅱ scores, TB, ALB, PTA, FPG, Scr, Lac were （25 ±6） scores, （22 ±5） scores, （197 ±69） μmol/L, （30 ±7） g/L, （55 ±24）%, （5.7±2.4） mmol/L, （111 ±42） μmol/L, （2.3 -＋0.6） mmol/L in treatment group 1 day after treatment, and were （33 ±8） scores, （30 ±7） scores, （299 ±113） μmol/L, （24 ±6） g/L, （33 ±11）% , �

关 键 词：血浆置换 妊娠 肝炎 脂肪肝 治疗结果 

分 类 号：R714.255[医药卫生—妇产科学]