血浆置换与双重血浆吸附治疗肝衰竭的疗效观察  

Comparison of clinical effects between plasma exchange and double plasma molecular adsorption system for treatment of patients with liver failure

作　　者：李丽丽 闫国胜 吴晨晨 姜少利 王美田 孟松[1] Li Lili;Yan Guosheng;Wu Chenchen;Jiang Shaoli;Wang Meitian;Meng Song(Department of Blood Purification,the Sixth People's Hospital of Zhengzhou,Zhengzhou 450000,Henan,China)

机构地区：[1]郑州市第六人民医院血液净化科,河南郑州450000

出　　处：《中国中西医结合急救杂志》2020年第1期106-109,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的观察血浆置换(PE)和双重血浆分子吸附系统(DPMAS)在治疗肝衰竭中的临床疗效,为肝衰竭的治疗寻求更好的人工肝模式.方法回顾性分析2016年1月至2018年12月在郑州市第六人民医院行人工肝治疗186例肝衰竭患者的临床资料,按人工肝模式的不同将患者分为PE组(92例)和DPMAS组(94例).观察两组单次治疗前后血生化指标的变化、治疗过程中的不良反应及治疗后的临床疗效.结果两组治疗后总胆红素(TBIL)、丙氨酸转氨酶(ALT)、球蛋白(GLOB)、C-反应蛋白(CRP)水平均较治疗前明显降低〔PE组:TBIL(μmol/L)为230.00±128.88比354.85±134.39,ALT(U/L)为96.67±68.02比184.31±136.37,GLOB(g/L)为27.78±5.27比28.29±5.24,CRP(mg/L)为41.73±16.20比76.37±25.92;DPMAS组:TBIL(μmol/L)为188.26±64.04比314.70±115.52,ALT(U/L)为158.42±102.32比274.74±176.13,GLOB(g/L)为30.91±5.81比31.64±5.83,CRP(mg/L)为33.12±20.30比56.96±31.89,均P<0.01〕.PE组治疗后白蛋白(ALB)、凝血酶原活动度(PTA)均较治疗前明显升高〔ALB(g/L):28.42±3.84比27.20±5.13,PTA:(50.37±20.14)%比(44.19±20.05)%,均P<0.01〕;DPMAS组治疗后ALB、PTA较治疗前明显降低〔ALB(g/L):28.40±5.75比29.31±5.41,PTA:(47.18±18.87)%比(48.74±17.38)%,均P<0.01〕;DPMAS组ALB、PTA的下降率明显高于PE组〔ALB下降率:(3.05±1.90)%比(-5.94±4.02)%,PTA下降率:(3.52±2.79)%比(-19.95±15.77)%,均P<0.05〕.两组治疗后临床症状均得到改善,DPMAS组好转率高于PE组〔90.42%(85/94)比89.13%(82/92)〕,但两组比较差异无统计学意义(P>0.05).PE组不良反应发生率为10.3%(27/261),DPMAS组未出现不良反应.结论PE血浆获得困难,本研究中PE组不良反应发生率高,DPMAS组无不良反应但对改善凝血方面不及PE组.因此将不同非生物型人工肝支持系统有效联合应用,利用各自优势取长补短,能为肝衰竭患者提供更好的治疗.Objective To observe the clinical effects of plasma exchange(PE)and double plasma molecular adsorption system(DPMAS)for treatment of patients with liver failure in order to explore a better artificial liver model.Methods The clinical data of 186 patients with liver failure who received artificial liver therapy in the Sixth People's Hospital of Zhengzhou from January 2016 to December 2018 were retrospectively analyzed.The patients were divided into a plasma exchange(PE)group(92 cases)and a double plasma molecular adsorption system(DPMAS)group(94 cases)according to difference in artificial liver modes.The changes of blood biochemical indexes before and after single treatment,adverse reactions in the course of treatment and the changes of clinical symptoms after treatment were observed.Results The levels of total bilirubin(TBIL),alanine aminotransferase(ALT),globulin(GLOB)and C-reactive protein(CRP)after treatment in the two groups were all lower than those before treatment[PE group:TBIL(μmol/L)was 230.00±128.88 vs.354.85±134.39,ALT(U/L)was 96.67±68.02 vs.184.31±136.37,GLOB(g/L)was 27.78±5.27 vs.28.29±5.24,CRP(mg/L)was 41.73±16.20 vs.76.37±25.92;DPMAS group:TBIL(μmol/L)was 188.26±64.04 vs.314.70±115.52,ALT(U/L)was 158.42±102.32 vs.274.74±176.13,GLOB(g/L)was 30.91±5.81 vs.31.64±5.83,CRP(mg/L)was 33.12±20.30 vs.56.96±31.89,all P<0.01].In PE group,the levels of albumin(ALB)and prothrombin activity(PTA)after treatment were higher than those before treatment[ALB(g/L):28.42±3.84 vs.27.20±5.13,PTA:(50.37±20.14)%vs.(44.19±20.05)%,all P<0.01];in DPMAS group after treatment,the levels of ALB and PTA were obviously lower than those before treatment[ALB(g/L):28.40±5.75 vs.29.31±5.41,PTA:(47.18±18.87)%vs.(48.74±17.38)%,all P<0.01];the decrease rates of ALB and PTA in DPMAS group were significantly higher than those in PE group[decrease rate of ALB was(3.05±1.90)%vs.(-5.94±4.02)%,and the decrease rate of PTA was(3.52±2.79)%vs.(-19.95±15.77)%,both P<0.05].The clinical symptoms of both groups were impr

关 键 词：肝衰竭 人工肝 血浆置换 双重血浆吸附 

分 类 号：R54[医药卫生—心血管疾病]