双重血浆分子吸附系统联合小剂量血浆置换在肝移植围手术期肝衰竭治疗中的应用  

Application of DPMAS combined with low dose plasma exchange in perioperative hepatic failure after liver transplantation

作　　者：王柠[1] 蔡文利[1] 李海霞[1] 丁慧芳 WANG Ning;CAI Wenli;LI Haixia;DING Huifang(Department of Blood Purification,People's Hospitalof Zhengzhou,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省郑州人民医院血液净化科

出　　处：《中国医学工程》2019年第12期54-57,共4页China Medical Engineering

摘　　要：目的观察双重血浆分子吸附系统(DPMAS)联合小剂量血浆置换在肝移植围手术期肝衰竭治疗的疗效。方法回顾性分析2017年10月至2019年3月该院移植科收治的9例急性肝衰竭患者的临床资料,9例患者共接受18次DPMAS联合小剂量的血浆置换治疗,收集患者临床资料和治疗前后的检验指标并进行统计学分析。结果治疗后所有患者症状均有不同程度的好转。肝功能丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB)、总胆汁酸(TBA)呈不同程度下降(P<0.05),胆碱酯酶(CHE)升高(P<0.05)。血氨较治疗前明显降低(P<0.05)。凝血指标凝血酶原时间(PT)有所延长,凝血酶原活动度(PTA)降低,但差异无统计学意义(P>0.05)。治疗过程中3例血压下降,处理后好转,1例出现牙龈出血。结论DPMAS联合小剂量血浆置换用于肝移植围手术期肝衰竭患者,治疗后患者症状改善,肝功能明显好转,血氨降低。治疗后凝血指标有所好转但差异无统计学意义。【Objective】To observe the clinical effect of the double plasma molecular adsorption system(DPMAS)combined with low dose plasma exchange(PE)in the treatment of perioperative period of liver transplantation.【Methods】A total of 9 cases with liver failure who were admitted to the transplantation department of our hospital,from October 2017 to March 2019 were selected and 9 cases were treated with DPMAS combined with low dose plasma exchange for 18 times.The clinical data of patients and the laboratory indexes before and after treatment were collected and analyzed.【Results】After treatment the clinical symptoms were improved to varying degrees.ALT,AST,TB and TBA of liver function decreased in different degrees(P<0.05).CHE increased(P<0.05),and the difference was statistically significant.Blood ammonia was significantly lower than that before treatment(P<0.05).PT was prolonged and PTA was decreased,but there was no statistical significance(P>0.05).During the treatment,blood pressure decreased in 3 cases,improved after medical treatment,and gingival bleeding occurred in 1 case.【Conclusion】DPMAS combined with low-dose plasma exchange was used in patients with liver failure during perioperative period of liver transplantation.After treatment,the clinical symptoms were improved,liver function improved significantly,and blood ammonia decreased.After treatment,coagulation index improved,though there was no statistical significance.

关 键 词：肝移植 肝衰竭 双重血浆分子吸附系统 血浆置换 

分 类 号：R575.3[医药卫生—消化系统]