持续缓慢血浆置换透析治疗重型肝炎的疗效及安全性评估  

Evaluation of the efficacy and safety of continuous slow plasma exchange dialysis in the treatment of severe hepatitis

作　　者：熊墨龙[1] 欧阳兵[1] 熊云逢 谢能文[1] 

机构地区：[1]南昌市第九医院肝病科,江西南昌330002

出　　处：《中国现代医生》2017年第29期19-22,共4页China Modern Doctor

基　　金：江西省科技计划项目(2013ZBBG70002)

摘　　要：目的评估重型肝炎患者持续缓慢血浆置换透析的疗效及安全性。方法选取2016年3月~2017年2月期间本院住院的重型肝炎患者200例,均予持续缓慢血浆置换透析治疗,治疗405例次。收集治疗前后患者肝功能(ALT、AST、TBIL、CHE、ALB),凝血功能(PTA、INR),血常规(WBC、HGB、PLT),电解质(K^+、Na^+、Cl^-、Ca^(2+)),肾功能(BUN、Cr)。记录治疗前后患者症状的变化(乏力、纳差、腹胀、精神状况等),以及观察记录患者治疗过程中的并发症。计量资料组间比较采用t检验,非正态分布用wilcoxon秩和检验。结果持续缓慢血浆置换透析治疗后,患者精神、食欲、乏力感及消化道等临床症状有不同程度改善。ALT、AST、TBIL均显著下降,CHE、ALB显著升高,显示肝功能明显改善。PTA上升,INR下降,凝血功能显著改善。患者的K^+、Na^+、Cl^-、Ca^(2+)明显改善,持续缓慢血浆置换透析治疗能调节电解质。患者发生并发症69例次,经一般对症处理后,不良反应均恢复正常,对人工肝治疗没有影响。结论持续缓慢血浆置换透析治疗重型肝炎的黄疸下降显著,调节电解质、肾功能,既能去除与蛋白质结合的毒素,又能清除水溶性毒素,对重型肝炎患者安全有效。Objective To evaluate the efficacy and safety of continuous slow plasma exchange dialysis in the patients with severe hepatitis. Methods From March 2016 to February 2017, 200 patients with severe hepatitis who were hospitalized our Hospital were given continuous slow plasma exchange dialysis, with a total of 405 cases for the treatment.Liver function（ALT, AST, TBIL, CHE, ALB）, coagulation function（PTA, INR）, blood routine（WBC, HGB, PLT）, electrolyte（K~＋, Na~＋, Cl^-, Ca^（2＋））, renal function（BUN, Cr） were collected before and after treatment. Changes in the symptoms before and after treatment were recorded（fatigue, anorexia, bloating, mental condition, etc.）. The complications involved in the treatment were observed and recorded. The t-test was used for the comparison of statistical data between groups.For non-normal distribution, wilcoxon rank sum test was used. Results After continued slow plasma exchange dialysis,patients＇ spirit, appetite, fatigue, digestive tract and other clinical symptoms have improved to varying degrees. ALT,AST, and TBIL were significantly decreased, CHE and ALB were significantly increased, showing significant improvement in liver function. PTA was increased, and INR was reduced. Coagulation function was significantly improved. Patients＇ K~＋, Na~＋, Cl^- and Ca^（2＋） were significantly improved. Continuous slow plasma exchange dialysis can regulate the electrolyte. Patients had 69 times of complications. After the general symptomatic treatment, the adverse reactions were restored to normal, showing no effect on artificial liver treatment. Conclusion Due to the continuous slow plasma exchange dialysis in the treatment of severe hepatitis,jaundice is decreased significantly. Regulation of electrolytes and renal function can not only remove the binding toxins to protein, but also remove water-soluble toxins, which is safe and effective for the patients with severe hepatitis.

关 键 词：重型肝炎 持续缓慢血浆置换透析 疗效 安全性 

分 类 号：R512.6[医药卫生—内科学]