双重血浆分子吸附系统联合低置换量血浆置换治疗急性肝衰竭的临床研究  

Clinical study of double plasma molecular adsorption system combined with low-displacement plasma exchange in the treatment of acute liver failure

作　　者：李文耀[1] 牛文堂[1] 崔玉红 LI Wen-yao;NIU Wen-tang;CUI Yu-hong(Department of Critical Care Medicine,Heze Municipal Hospital,Heze 274000,China)

机构地区：[1]山东省菏泽市立医院重症医学科,274000

出　　处：《中国实用医药》2021年第17期39-42,共4页China Practical Medicine

摘　　要：目的观察双重血浆分子吸附系统(DPMAS)联合低置换量血浆置换(LPE)治疗急性肝衰竭(ALF)的近期疗效及安全性。方法45例急性肝衰竭患者,按治疗方法不同分为LPE组(22例)和DPMAS+LPE组(23例)。LPE组采用单纯低置换量LPE治疗,DPMAS+LPE组采用DPMAS联合低置换量LPE治疗。统计两组患者存活、死亡情况。比较两组不良反应发生情况及治疗前后肝功能指标、凝血功能指标、炎症因子变化。结果45例患者存活35例,死亡10例,存活率为77.78%;其中DPMAS+LPE组死亡4例,死亡率为17.39%;LPE组死亡6例,死亡率为27.27%。治疗后,两组丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)及总胆汁酸(TBA)水平均低于治疗前,白蛋白(ALB)水平高于治疗前,且DPMAS+LPE组ALT、TBIL及TBA水平均低于LPE组,差异有统计学意义(P<0.05),两组ALB水平比较差异无统计学意义(P>0.05)。治疗后,两组纤维蛋白原(FIB)、凝血酶原活动度(PTA)水平均高于治疗前,白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均低于治疗前,且DPMAS+LPE组IL-6、TNF-α水平均低于LPE组,差异均有统计学意义(P<0.05),两组FIB、PTA水平比较差异无统计学意义(P>0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论较单纯低置换量LPE治疗,低置换量LPE联合DPMAS治疗能明显提高急性肝衰竭患者TBIL、TBA及炎症因子等有毒物质的清除能力,有效补充凝血因子和ALB等活性因子,改善肝功能及凝血功能,减少血浆用量,提高患者生存率,并且不良反应轻微,是一种安全、有效的人工肝联合治疗模式。Objective To observe the short-term efficacy and safety of double plasma molecular adsorption system(DPMAS)combined with low-displacement plasma exchange(LPE)in the treatment of acute liver failure(ALF).Methods A total of 45 patients with cute liver failure were divided into LPE group(22 cases)and DPMAS+LPE group(23 cases).LPE group was treated with simple low-displacement plasma exchange,and DPMAS+LPE group was treated with DPMAS combined with LPE.The survival and death of the two groups were statistically analyzed.The incidence of adverse reactions and the changes of liver function indexes,coagulation function indexes and inflammatory factors before and after treatment were compared between the two groups.Results Among 45 patients,35 cases survived,10 cases died,and the survival rate was 77.78%;among them,4 cases died in the DPMAS+LPE group,and the mortality was 17.39%;6 cases died in the LPE group,and the mortality was 27.27%.After treatment,the levels of alanine aminotransferase(ALT),total bilirubin(TBIL)and total bile acid(TBA)of the two groups were lower than those before treatment,and albumin(ALB)was higher than that before treatment,and the levels of ALT,TBIL and TBA of DPMAS+LPE group were all lower than those of LPE group.The difference was statistically significant(P<0.05).There was no statistically significant difference in ALB level between the two groups(P>0.05).After treatment,the levels of fibrinogen(FIB),prothrombin activity(PTA)of the two groups were higher than those before treatment,and levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)were lower than those before treatment.The levels of IL-6 and TNF-αof DPMAS+LPE group were lower than those of LPE group.The difference was statistically significant(P<0.05).There was no statistically significant difference in levels of FIB and PTA between the two groups(P>0.05).There was no statistically significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with LPE therapy,LPE combined with DPM

关 键 词：急性肝衰竭 双重血浆分子吸附系统 低置换量血浆置换 

分 类 号：R575.3[医药卫生—消化系统]