双重血浆分子吸附联合低容量血浆置换治疗慢加急性肝衰竭的疗效和安全性  

Efficacy and safety of dual plasma molecular adsorption combined with low-volume plasmapheresis in the treatment of chronic acute liver failure

作　　者：谢能文[1] 朱龙川[1] 甘达凯 付苏红[1] 姜坚红 熊墨龙[1] XIE Nengwen;ZHU Longchuan;GAN Dakai;FU Suhong;JIANG Jianhong;XIONG Molong(Department of Severe Liver Diseases,the Ninth Hospital of Nanchang,Nanchang 330002,China;Department of Infectious Diseases,Jinxian County People′s Hospital in Jiangxi Province,Jinxian 331700,China)

机构地区：[1]南昌市第九医院重症肝病科,江西南昌330002 [2]江西省进贤县人民医院感染科,江西进贤331700

出　　处：《中国现代医生》2021年第18期1-5,共5页China Modern Doctor

基　　金：江西省南昌市科技局指导性科技计划项目(洪科发计字[2018]39号第51项)。

摘　　要：目的探讨双重血浆分子吸附联合低容量血浆置换治疗慢加急性肝衰竭的疗效及安全性。方法回顾性分析2018年1月至2019年12月南昌市第九医院住院的112例慢加急性肝衰竭患者的病历资料,根据其治疗方式不同分为DPMAS+PE组(常规药物基础上双重血浆分子吸附联合低容量血浆置换治疗)56例和PE组(常规药物基础上血浆置换治疗)56例,分析两组患者治疗前后的临床症状、体征及肝功能(ALT、AST、TBIL、ALB、TBA)、肾功能(BUN、Cr)、血常规(WBC、HGB、PLT)、凝血功能(PT、PTA、INR)的变化情况及不良反应。结果 DPMAS+PE组患者的临床疗效与PE组相比,差异无统计学意义(P>0.05),均能获得较好疗效;DPMAS+PE组治疗后ALT、AST、TBIL、TBA较治疗前均有下降,差异有统计学意义(P<0.05),ALB均无明显下降(P>0.05);两组患者治疗后Cr、BUN较前无明显变化,均未发生电解质紊乱(P>0.05);DPMAS+PE组治疗后WBC无明显变化,但HGB、PLT下降;DPMAS+PE组和PE组治疗后均出现PT缩短、INR下降和PTA上升(P<0.05);PE组不良反应发生率高于DPMAS+PE组,差异有统计学意义(χ^(2)=4.932,P=0.026)。结论双重血浆分子吸附联合低容量血浆置换治疗可改善慢加急性肝衰竭患者的临床症状,提高治疗的有效率,无明显副作用,减少血浆用量限制、血浆过敏、输血感染风险等不良反应机会,是一种安全、有效的人工肝治疗手段。Objective To explore the efficacy and safety of dual plasma molecular adsorption combined with low-vol-ume plasmapheresis in the treatment of chronic onset acute liver failure.Methods The case data of 112 patients with chronic acute liver failure who were hospitalized in the Ninth Hospital of Nanchang from January 2018 to December 2019 were retrospectively analyzed.According to their different treatment methods,they were divided into the DPMAS+PE group with 56 cases(double plasma molecular adsorption combined with low-volume plasma exchange treatment on the basis of conventional drugs)and the PE group with 56 cases(plasma exchange treatment based on conventional drugs).The clinical symptoms,signs and liver function(ALT,AST,TBIL,ALB,ALB,ALT,AST,TBIL,ALB,TBA),renal function(BUN,Cr),blood routine(WBC,HGB,PLT),coagulation function(PT,PTA,INR)changes and adverse reac-tions before and after treatment of two groups were analyzed.Results There was no difference in the clinical efficacy between the DPMAS+PE group and the PE group.They were all able to obtain better efficacy.After treatment,the ALT,AST,TBIL,and TBA in the DPMAS+PE group decreased compared with before treatment,and the difference was sta-tistically significant(P<0.05).There was no significant decrease in ALB(P>0.05).There were no significant changes in Cr and BUN after treatment in the two groups,and there was no electrolyte disorder(P>0.05).There was no significant change in WBC in the DPMAS+PE group after treatment,but HGB and PLT decreased.In the DPMAS+PE group and PE group,PT shortened,INR decreased,and PTA increased after treatment(P<0.05).The incidence of adverse reactions in the PE group was higher than that in the DPMAS+PE group,and the difference was statistically significant(χ^(2)=4.932,P=0.026).Conclusion Dual plasma molecular adsorption combined with low-volume plasmapheresis therapy can im-prove the clinical symptoms of patients with chronic onset acute liver failure,increase the effective rate of treatment,without obvious side effects,and red

关 键 词：双重血浆分子吸附 血浆置换 肝衰竭 临床疗效 安全性 

分 类 号：R657.3[医药卫生—外科学]