持续缓慢血液透析滤过在慢性乙型肝炎重型晚期治疗中的应用价值  

Application of continuous hemodiafiltration therapy to patients with end stage chronic severe hepatitis B: initial experiences

作　　者：胡肖兵[1] 周颖[1] 赵燕芹[1] 廖明儿[1] 何敏茹[1] 

机构地区：[1]广州市第八人民医院重症肝病科,广州510060

出　　处：《中国血液净化》2003年第10期560-564,共5页Chinese Journal of Blood Purification

摘　　要：目的　应用持续缓慢血液透析滤过技术 (CHDF)治疗慢性乙型肝炎重型晚期患者 ,探讨其在肝脏支持及并发症处理方面的应用价值。方法　治疗组 4 2例慢性乙型肝炎重型晚期患者 ,或有并发症或多器官功能障碍综合征 (MODS)或多器官衰竭 (MOF) ,经CHDF治疗 116次 ,平均 3.2次 /人 ,比较治疗前后临床表现 ,肝功能 ,血常规 ,血氨 ,凝血功能指标 ,尿素氮 (BUN)、血肌酐 (Cr)、电解质及酸碱平衡等指标。对照组 36例同类患者。结果　CHDF治疗能提高患者短期生存率 ,对肝脏有一定的支持作用 ,对清除血氨 ,治疗II°以下肝性脑病 ,缓解脑水肿、全身性炎性反应综合征 (SIRS) ,改善肾功能 ,调整电解质及酸碱平衡 ,提高晶体渗透压 ,治疗浮肿和腹胀 ,创造补液空间等方面具有较好的治疗效果。同时具有较好的治疗安全性。结论　CHDF治疗在肝脏支持方面有一定的作用 ,但其在并发症、MODS。Objectives To evaluate the therapeutic effect of continuous hemodiafiltraton(CHDF) therapy on liver support and complications management in patients with chronic severe hepatitis B. Methods Seventy-eight end stage chronic severe hepatitis B patients complicated with MODS or MOF were randomly divided into CHDF therapy group (42 patients) and control group (36 patients),116 CHDF treatments were performed with average of 3.2 sessions per patient, all were evaluated with liver function, hemogram, ammonia level, blood coagulation, kidney function, electrolyte and acid/base balance before and after the treatment period. Results CHDF treatments result in safely effective improvement of multiple organ function and various complications including liver, renal, cerebral, SIRS, hemodynamics and clinical severe manifestations such as edema and tympanites, and marked decrease of serum ammonia level, HE grade or hydrocephalus, which contribute to the improvement in immediate survival rate. Conclusions CHDF technique represents a therapeutic liver support therapy, and can be regarded as a valid treatment option on clinical managements in severe hepatitis patients complicated with MODS or MOF.

关 键 词：持续缓慢血液透析滤过 晚期慢性重型乙型肝炎 治疗 并发症 全身性炎性反应综合征 

分 类 号：R512.62[医药卫生—内科学] R459.5[医药卫生—临床医学]