血浆透析滤过治疗时间对肝衰竭治疗效果的影响  

Influence of duration of plasma diafiltration on therapeutic outcome of liver failure

作　　者：杨仙珊[1] 周莉[1] 李璐[1] 李爽[1] 孔明[1] 李珊珊[1] 邹怀宾[1] 徐曼曼[1] 陈煜[1] 段钟平[1] YANG Xianshan;ZHOU Li;LI Lu(Artificial Liver Treatment ＆ Training Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院人工肝中心,北京100069

出　　处：《临床肝胆病杂志》2018年第5期1052-1054,共3页Journal of Clinical Hepatology

基　　金：国家科技重大专项(2017ZX10203201-005,2017ZX10201201,2017ZX10302201-004-002,2017ZX10202203-006-001);2016年度院内中青年人才孵育项目(YNKT20160028,YNKT20160017)

摘　　要：目的探讨血浆透析滤过(PDF)治疗时间的长短对肝衰竭患者肝功能的影响以及对治疗后肝功能反弹的影响。方法选择2015年1月-2016年12月首都医科大学附属北京佑安医院收治的肝衰竭患者101例,按照治疗时间分为2组,治疗4 h组77例,治疗6 h组24例,均在内科治疗的基础上行人工肝治疗。观察2组治疗前后ALT、AST、TBil、DBil下降幅度及治疗后24 h、治疗后72 h的ALT、AST、TBil、DBil反弹幅度。计量资料2组间比较采用t检验,计数资料组间比较采用χ2检验。结果 2组患者治疗过程中血流动力学稳定,无不良事件发生,部分患者诉平卧时间长,感觉乏力,4 h组5例不耐受,不耐受率6.5%,6 h组10例,不耐受率41.7%,显著高于4 h组(χ2=17.90,P<0.01)。PDF治疗后,2组ALT、AST、TBil、DBil下降幅度差异均无统计学意义(t值分别为2.53、-4.48、-1.52、-0.47,P值均>0.05)。2组治疗后24 h ALT、AST、TBil、DBil反弹幅度差异均无统计学意义(t值分别为-0.236、-1.251、-1.251、0.943,P值均>0.05)。2组治疗后72 h ALT、AST、TBil、DBil反弹幅度差异均无统计学意义(t值分别为-0.7000、0.596、-1.530、1.837,P值均>0.05)。结论 PDF治疗不同时间效果相似,安全性相仿,因此常规可采用4 h治疗时间以增加患者耐受性。Objective To investigate the influence of different durations of plasma diafiltration （PDF） on liver function in patients with liver failure and rebound of liver function after treatment.Methods A total of 101 patients with liver failure who were admitted to Beijing YouAn Hospital,Capital Medical University,from January 2015 to December 2016 were enrolled,and according to the duration of treatment,these patients were divided into 4-hour group with 77 patients and 6-hour group with 24 patients.All patients were given artificial extracorporeal liver support therapy in addition to the medical treatment.The two groups were observed in terms of the reductions in alanine aminotransferase （ALT）,aspartate aminotransferase （AST）,total bilirubin （TBil）,and direct bilirubin （DBil） after treatment and the rebound of ALT,AST,TBil,and DBil at 24 and 72 hours after treatment.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results All patients had stable hemodynamics during treatment and no patient experienced adverse events.Some patients complained of staying in bed for a long time and feeling weak.The 6-hour group had a significantly higher intolerance rate than the 4-hour group [41.7% （10/24） vs 6.5% （5/77）,χ2 =17.90,P 〈0.01].There were no significant differences in the reductions in ALT,AST,TBil,and DBil after PDF treatment between the two groups （t =2.53,-4.48,-1.52,and-0.47,all P 〉 0.05）.There were also no significant differences between the two groups in the degrees of rebound of ALT,AST,TBil,and DBil at 24 and 72 hours after treatment （24 hours：t =-0.236,-1.251,-1.251,and 0.943,all P 〉 0.05;72 hours：t =-0.700,0.596,-1.530,and 1.837,all P 〉 0.05）.Conclusion PDF treatment with different durations has similar effect and safety.Therefore,4-hour PDF can be applied in clinical practice to improve patients＇ tolerance.

关 键 词：肝功能衰竭 血液透析滤过 肝 人工 

分 类 号：R575.3[医药卫生—消化系统]