胆红素吸附联合低容量血浆置换治疗重型肝炎的疗效及安全性评估  

Evaluation of therapeutic effect and safety of bilirubin absorption combined with low volume plasma exchange in treating severe hepatitis

作　　者：熊墨龙[1] 熊云逢 欧阳兵[1] 谢能文[1] 张晓青[1] 吴慧玲 

机构地区：[1]江西省南昌市第九医院肝一科,330002

出　　处：《重庆医学》2018年第7期923-925,共3页Chongqing medicine

基　　金：江西省科技厅立项课题[赣科发计字(2013)226号]

摘　　要：目的评估重型肝炎患者胆红素吸附联合低容量血浆置换的疗效及安全性。方法选取2015年1月1日至2016年12月31日该院住院的重型肝炎患者45例,均给予胆红素吸附联合低容量血浆置换治疗,治疗61例次。收集治疗前后患者肝功能[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、胆碱酯酶(CHE)、清蛋白(ALB)],凝血功能[凝血酶原时间活动度(PTA)、国际标准化比值(INR)],血常规[白细胞(WBC)、血小板(PLT)、血红蛋白(HGB)],电解质[钾离子(K^+)、钠离子(Na^+)、氯离子(Cl^-)、钙离子(Ca^(2+))],肾功能[尿素氮(BUN)、肌酐(Cr)]。记录治疗前后患者症状的变化(乏力、食欲缺乏、腹胀等),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。结果胆红素吸附联合低容量血浆置换治疗后,患者临床症状有不同程度改善。ALT、AST、TBIL均下降(P<0.01),CHE升高(P<0.01),ALB下降(P<0.01);PTA上升(P<0.05),INR下降(P<0.01);WBC、HGB、PLT下降(P<0.05)。患者发生不良反应19例(31.1%),经一般对症处理后,上述不良反应均恢复正常,治疗耐受性良好,对人工肝治疗没有影响。结论胆红素吸附联合低容量血浆置换治疗重型肝炎可显著改善肝功能,安全有效。Objective To evaluate the therapeutic effect and safety of bilirubin absorption（BA）combined with low volume plasma exchange（PE）in the treatment of severe hepatitis.Methods Forty-five inpatients with severe hepatitis in this hospital from January 1,2015 to December 31,2016 were performed the prospective study.All cases were given the therapy of BA combined with low volume PE.The indicators of liver function（ALT,AST,TBIL,CHE,ALB）,coagulation function（PTA,INR）,blood routine（WBC,Hb,PLT）,electrolytes（K~＋,Na~＋,Cl^-,Ca^（2＋））and renal function（BUN,Cr）were collected before and after treatment.The changes of clinical symptoms and signs（weak,anorexia,abdominal distension,etc.）before and after treatment were recorded in all cases.The complications during the treatment process were also observed and recorded.The t-test was used for the inter-group comparison of the measurement data and the abnormal distribution adopted the Wilcoxon rank sum test.Results After the treatment of BA and low volume PE,the clinical symptoms of the patients were improved in different levels.The levels of ALT,AST and TBIL were decreased（P0.01）,the CHE level was increased（P0.01）,ALB level was decreased（P0.01）;PTA was increased（P0.05）,INR was decreased（P0.01）;WBC,HGB and PLT were decreased（P0.05）.Nineteen cases（31.1%）developed adverse reactions,which were recovered to normal after general symptomatic treatment.The treatment compliance was good without influence on artificial liver therapy.Conclusion BA combined low volume PE for treating severe hepatitis can significantly improve the liver function with safety and effectiveness.

关 键 词：血浆置换 重型肝炎 胆红素吸附 低容量血浆置换 疗效 安全性 

分 类 号：R511[医药卫生—内科学]