血浆透析滤过模式在重型肝炎治疗中的血液净化配合应用  

The application of plasma dialysis filtration model applied in patients with critical hepatitis

作　　者：饶美英[1] 孙珂[2] 喻蓉艳[2] 刘翠芸[2] 陈明发[2] 罗杰[2] 刘燕[2] 杨文龙[2] 席文娜[2] 高珍[2] 姚雪兵[2] 孙水林[2] RAO Meiying;SUN Ke;YU Rongyan;LIU Cuiyun;CHEN Ming~a;LUO Jie;LIU Yan;YANG Wenlong;XI Wen na;GAO Zhen;YAO Xuebin;SUN Shuilin(Department of Blood transfusion Department,The Second Affiliated Hospital Of Nanchang University,Nan-chang 330006,China;Department Of Infectious Disease Department,The Second Affiliate Hospital Of Nanchang University,JiangXi,Nanchang 330006,China.)

机构地区：[1]南昌大学第二附属医院输血科,江西南昌330006 [2]南昌大学第二附属医院感染性疾病科,江西南昌330006

出　　处：《中国输血杂志》2018年第8期851-853,共3页Chinese Journal of Blood Transfusion

基　　金：江西省科技支撑项目(20151BBG70164)

摘　　要：目的探讨血浆透析滤过（PDF）模式应用在重症肝炎患者治疗中的有效性及安全性。方法收集9例本院住院的重型肝炎肝衰竭应用PDF模式的临床资料,包括应用前后的临床表现、血生化等主要指标,院内感染、输血不良反应等次要指标,做回顾性分析与统计学处理。结果 1）重症肝炎患者应用PDF模式后,乏力、纳差、黄疸症状缓解（改善） 87. 5%（14/16）、75%（12/16）、100. 0%（16/16）,表现为食欲增加、尿色变淡、黄疸消退以及精神好转等; 2）应用PDF模式前后,ALT（U/L）、AST（U/L）、TBIL（μmol/L）、DBIL（μmol/L）及GLB（g/L）分别为221. 8±221. 7vs 114. 1±121. 7、109. 5±104. 7 vs 58. 0±57. 7、370. 3±118. 8 vs 223. 8±91. 9、230. 0±76. 9 vs 133. 8±58. 7及24. 1±4. 2vs 26. 1±3. 8 （P 〈0. 05）,ALB（g/L）为30. 6±2. 1 vs 29. 4±2. 9 （P〉 0. 05）; 3）应用PDF模式前后,凝血酶原活动度（PTA）明显上升,凝血酶原时间（PT）明显缩短（P〈0. 05）; 4） PDF治疗后,血Na~＋、Ca^（2＋）、Cl^-均有所上升（P〈0. 05）,血Mg^（2＋）稍有下降、K~＋稍有上升（P〉0. 05）。5）应用PDF模式后,院内感染率0（0/9）,荨麻疹率11. 1%（1/9）。结论PDF模式是重症肝炎治疗中1种安全有效的支持治疗手段,可大大减少患者血浆用量,适用于临床应用推广。Objective To explore availability and security of Plasma Dialysis Filtration in patients with critical hepatitis. Methods Collect 9 patients with critical hepatitis in our hospital before treatment and after treatment by Plasma Dialysis Filtration,the blood of patients were taken to test the changes of patients＇ serum level in biochemical indexes,such as ALT, AST,TBIL,DBIL,PTA, PT, etc.Clinical symptoms and signs were observed. The efficiency of Plasma Dialysis Filtration in patients with liver failure was analyzed. The effect of biochemical parameters and complication from severe hepatitis was eval- uated by univariate analysis. Results 1 ） The clinical symptoms and signs of the patients improved significantly after treat- ment by Plasma Dialysis Filtration. 2） When comparing before treatment and after treatment by Plasma Dialysis Filtration, liver function tests also improved： ALT （u/L） 221.8±221.7 vs 114. 1 ± 121.7 （P〈0. 05）, AST（u/L） 109. 5± 104. 7 vs 58.0±57.7（P〈0. 05）, TBILI（umol/L） 370. 3±118. 8 vs 223.8±91.9（P〈0. 05）, DBIL （umol/L） 230.0±76. 9 vs 133.8 ±58.7（P〈0.05） ,GLB（g/L） 24. 1±4. 2 vs 26. 1±3.8（P〈0. 05）, ALB（g/L） 30. 6±2. 1 vs 29.4±2. 9（P〉0. 05）, 3） coagulation time was cutted down. The value of PTA（%） （45.8±19. 9 vs 64.4±25.2） significantly increased after treatment by Plasma Dialysis Filtration（ P〈0. 05 ） and PT（ sec ） （21.5± 10. 8 vs 14. 7±2. 5 ） significantly reduced after treatment by Plas- ma Dialysis Filtration （P〈0. 05）. 4）The value of Na±, Ca2±, C1- increase after treatment by Plasma Dialysis Filtration（ P〈 0. 05）. The differences in Mg2± and K± after treatment were not statistically significant （P〉0. 05 ）. 5 ）There were no severe adverse events of the nine patients after treatment by Plasma Dialysis Filtration,. Conclusion The Plasma Dialysis Filtration is a effective supportive treatment in Liver failure＇ s comprehensive treatment. Compare with a simple pl

关 键 词：血浆透析滤过 重症肝炎 血浆置换 血生化 院内感染 输血反应 

分 类 号：R451.14[医药卫生—治疗学] R512.62[医药卫生—临床医学]