5%白蛋白用于人工肝选择性血浆置换治疗的有效性和安全性评价  

Evaluation of effectiveness and safety of application of 5% albumin on artificial liver selective plasma exchange treatment

作　　者：张行芬[1] 邓勤智 庞中强[1] 廖庆华[1] 周文红[1] 

机构地区：[1]宁波市第二医院肝病科,浙江宁波315010

出　　处：《中国现代医生》2016年第13期27-30,35,共5页China Modern Doctor

基　　金：浙江省宁波市自然科学基金(2013A610238);浙江省区域专病中心项目(浙卫发〔2014〕98号)

摘　　要：目的以单纯性血浆置换为对照,评价5%白蛋白部分替代血浆用于人工肝选择性血浆置换治疗肝衰竭的有效性和安全性。方法根据不同的血浆供应条件,治疗组33例肝衰竭患者用5%白蛋白500 m L部分替代血浆进行选择性血浆置换治疗,对照组40例肝衰竭患者进行单纯性血浆置换治疗,上述患者均在接受标准内科治疗的基础上接受人工肝治疗,比较两组患者治疗前后肝功能、凝血功能等指标及症状体征的变化,比较两组疗效,记录治疗过程中发生的不良反应事件。结果治疗后两组患者的症状体征均明显改善,部分生化指标包括血转氨酶、胆红素、胆汁酸等较治疗前显著下降,胆碱酯酶较治疗前显著升高。治疗组、对照组在降转氨酶、球蛋白、降胆红素、降胆汁酸、升胆碱酯酶及改善凝血酶原时间的影响方面疗效类似,差异无显著性(P>0.05);临床好转率亦相当(P>0.05)。但两者不良反应事件的发生率有显著差异,治疗组明显低于对照组(P<0.01)。结论 5%白蛋白部分替代血浆用于人工肝选择性血浆置换是治疗肝衰竭患者的一种有效且可行的方法,节约了血浆用量,有较好的安全性。Objective To evaluate the effectiveness and safety of the application of 5% albumin partially substituted plasma to the artificial liver selective plasma exchange treatment of liver failure, with simple plasma exchange as control. Methods According to different plasma supply conditions, 33 patients with liver failure of the treatment group received selective plasma exchange treatment by using 500 mL of 5% albumin partially substituted plasma and 40 patients with liver failure of the control group received simple plasma treatment. All the patients were given artificial liver treatment on the basis of standard internal medicine treatment. The indicators, symptoms and signs such as liver function and coagulation function, and the efficacy of the two groups before and after treatment were compared. The adverse events that occurred during the treatment process were recorded. Results After treatment, the symptoms and signs of two groups improved obviously. Part biochemical indices including transaminase, bilirubin and bile acid reduced significantly, cholinesterase increased significantly. The treatment group and the control group were similar in reducing transaminase, globulin, bilirubin and bile acid, elevating cholinesterase and improving prothrombin time, without signif- icant differences （P〉0.05）, as well as in the clinical improvement rate （P〉0.05）. The two groups were significantly different in the incidence of adverse events, the treatment group was significantly lower than the control group（P〈0.01）. Conclusion The application of 5% albumin partially substituted plasma to the artificial liver selective plasma exchange treatment of liver failure is an effective and feasible method, which saves plasma usage and has preferable safety.

关 键 词：白蛋白 血浆 选择性血浆置换 肝衰竭 人工肝 

分 类 号：R575.3[医药卫生—消化系统]