血浆置换联合高通量血液透析滤过治疗重症肝炎的效果及对血流动力学的影响  

Study on the efficacy and hemodynamics of plasma exchange combined with high throughput hemodiafiltration in treatment of severe hepatitis

作　　者：李元元 田秀娟 仲雅 LI Yuan-yuan;TIAN Xiu-juan;ZHONG Ya(Hemopurification Center of Department of Nephrology,the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院肾脏内科血液净化中心,陕西西安710032 [2]空军军医大学第一附属医院重症医学科,陕西西安710032

出　　处：《创伤与急危重病医学》2024年第6期373-376,共4页Trauma and Critical Care Medicine

基　　金：国家自然科学基金青年项目(82102322)。

摘　　要：目的探讨血浆置换联合高通量血液透析滤过治疗重症肝炎的治疗效果及对患者血流动力学、生活质量的影响。方法选取102例重症肝炎患者为研究对象,男性56例,女性46例;年龄(51.34±5.71)岁,年龄范围为35~68岁,采用随机数表法将患者随机分为常规组与观察组,每组51例。常规组予以常规治疗,观察组在常规组治疗方法的基础上,采用血浆置换与高通量血液透析滤过相结合的治疗策略,比较两组的血清指标、临床治疗效果、血流动力学及生活质量。结果观察组治疗有效率为94.1%(48/51),显著高于常规组的74.5%(38/51),差异有统计学意义(P<0.05)。治疗前,两组患者的血清总胆红素、丙氨酸转氨酶(ALT)、内毒素、简明健康调查量表(SF-36)各维度评分及门静脉血流量、平均流速比较,差异无统计学意义(P>0.05)。治疗后,两组总胆红素、ALT、内毒素水平均明显降低,且观察组比常规组更低,差异有统计学意义(P<0.05)。治疗后,两组患者的门静脉血流量、门静脉平均流速及SF-36表各维度评分均比治疗前明显升高,且观察组比常规组更高,差异有统计学意义(P<0.05)。结论采用血浆置换联合高通量血液透析滤过治疗重症肝炎患者效果显著,有助于改善患者的血流动力学和生活质量。Objective To investigate the effect of plasma exchange combined with high throughput hemodialysis filtration on patients with severe hepatitis and its influence on hemodynamics and quality of life.Method A total of 102 patients with severe hepatitis were selected,including 56 males and 46 females,aged(51.34±5.71)years old,ranging from 35 to 68 years old.The patients divided into routine group and observation group according to random number table method,with 51 cases in each group.The conventional group was treated with routine treatment,and the observation group was treated with the combination of plasma exchange and high-throughput hemodiafiltration on the basis of the conventional treatment,and the serum indexes,clinical efficacy,hemodynamics and quality of life of the two groups were compared.Results The total effective rate of observation group was 94.1%(48/51),which was significantly higher than that of conventional group 74.5%(38/51),and the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in serum total bilirubin(TBiL),alanine aminotransferase(ALT),endotoxin,the MOS item short from health survey(SF-36),portal venous blood flow and average velocity between 2 groups(P>0.05).After treatment,the levels of TBiL,ALT and endotoxin in both groups were significantly decreased,and the observation group was lower than the conventional group,the difference was statistically significant(P<0.05).After treatment,portal vein blood flow,portal vein average velocity and SF-6 scores of 2 groups were significantly higher than before treatment,and the observation group was higher than the conventional group,with statistical significance(P<0.05).Conclusion Plasma exchange combined with high throughput hemodiafiltration is effective in the treatment of severe hepatitis patients,which is helpful to improve the hemodynamics and quality of life of patients.

关 键 词：血浆置换 高通量血液透析 重症肝炎 血流动力学 

分 类 号：R459.5[医药卫生—治疗学]