不同血液净化模式治疗儿童急性肝功能衰竭的临床疗效及预后分析  

Clinical effect and prognosis analysis of different blood purification patterns in the treatment of acute liver failure in children

作　　者：黄娇甜[1] 卢秀兰[1] 肖政辉[2] 臧平[1] 朱德胜[1] Huang Jiaotian;Lu Xiulan;Xiao Zhenghui;Zang Ping;Zhu Desheng(Department of Critical Care Medicine,Emergency Center,Children′s Hospital of Hunan Province,Changsha 410007,China;First Aid Centre,Emergency Center,Children′s Hospital of Hunan Province,Changsha 410007,China)

机构地区：[1]湖南省儿童医院重症医学科,长沙410007 [2]湖南省儿童医院急救中心,长沙410007

出　　处：《中国小儿急救医学》2019年第6期447-453,共7页Chinese Pediatric Emergency Medicine

基　　金：国家科技支撑计划(2012BAI04B02);儿童急救医学湖南省重点实验室(2018TP1028).

摘　　要：目的比较不同血液净化方式对急性肝功能衰竭儿童的临床疗效,探讨血液净化在儿童急性肝功能衰竭中的临床应用模式、使用时机和预后评估。方法回顾性分析2010年1月至2016年10月湖南省儿童医院PICU收治的85例急性肝功能衰竭患儿的临床资料,其中16例患儿(保守组)采用常规内科综合治疗,27例患儿(CBP组)在常规内科综合治疗基础上采用持续血液透析滤过(continuous venovenous hemodiafiltration,CVVHDF)模式非生物型人工肝治疗,16例患儿(PE组)选用血浆置换(plasma exchange,PE)治疗,26例患儿(联合组)选用PE联合CVVHDF模式治疗,比较每组患儿治疗前后及组与组之间治疗后主要生化指标、凝血功能指标、终末期肝病模型评分(model for end-stage liver disease,MELD)及△MELD的变化。结果与治疗前比较,保守组患儿治疗后肝功能改善及预后改善方面不明显,差异无统计学意义。而其余使用非生物型人工肝治疗的3组患儿,与治疗前比较,治疗后肝功能改善及预后改善方面差异有统计学意义。比较不同模式非生物型人工肝治疗的3组患儿治疗后的生化指标及预后情况,PE组和CBP组总有效率比较差异无统计学意义[56.3%(9/16)比55.6%(15/27),P>0.05],而联合组总有效率[84.6%(22/26)]明显高于PE组和CBP组(P均<0.05);PE组和CBP组治疗后肝功能改善方面比较差异无统计学意义(P均>0.05),但联合组患儿肝功能指标(谷丙转氨酶、谷草转氨酶、总胆红素、血氨)均较PE组和CBP组明显降低(P均<0.05),明显升高了凝血酶原活动度、白蛋白及甲胎蛋白水平(P均<0.05)。死亡组患儿入院时的降钙素原水平、序贯性器官功能衰竭评分、儿童终末期肝病模型评分及MELD评分均明显高于存活组,两组比较差异有统计学意义(P<0.05)。而MELD<25分及MELD>40分两亚组急性肝功能衰竭的患儿给予非生物型人工肝治疗效果不佳。结论PE与CBP对治疗急性肝功能衰竭�Objective To compare the clinical efficacy of different blood purification methods in children with acute liver failure, and to explore the clinical application mode, time and prognosis of blood purification in children with acute liver failure. Methods The clinical data of 85 children with acute liver failure admitted to PICU of Hunan Children′s Hospital from January 2010 to October 2016 were retrospectively analyzed.Sixteen patients were treated with general integrated medical treatment(conservative group). Twenty-seven patients were treated with continuous venovenous hemodiafiltration (CVVHDF) model non-biological artificial liver on the basis of general integrated medical treatment(CBP group). Sixteen cases were treated with plasma exchange(PE group). Twenty-six cases were treated with plasma exchange combined with CVVHDF mode (combination group). The main biochemical indexes, coagulation function, model for end-stage liver disease(MELD) score and delta MELD before and after treatment among groups were compared. Results Compared with those before treatment, the improvement of liver function and prognosis in the conservative was not significant after treatment.There were significant differences in the improvement of liver function and prognosis among the other three groups treated with non-biological artificial liver.Comparing the biochemical indexes and prognosis of three groups of children treated with different modes of non-biological artificial liver, there was no significant difference in the total effective rate between PE group and CBP group[56.3%(9/16) vs 55.6%(15/27), P>0.05]. The total effective rate of combined group[84.6%(22/26)] was significantly higher than those of PE group and CBP group.There was no significant difference in the improvement of liver function between PE group and CBP group (all P>0.05), but the indexes of liver function in combined group were significantly lower than those in PE group and CBP group (P<0.05). It significantly increased prothrombin activity, albumin and alpha-fe

关 键 词：急性肝功能衰竭 非生物型人工肝 终末期肝病模型评分 血液净化 

分 类 号：R725.7[医药卫生—儿科]