人工肝支持联合持续血液滤过透析治疗中晚期重型肝炎探讨

Treatment of fatal hepatitis in the intermediate and advanced stages by artificial liver support system with continuous hemodialysis and filtration

目的 探讨人工肝支持系统(ALSS)联合持续血液滤过透析(CHDF)治疗重型肝炎中晚期病例的临床疗效,观察改善肝性脑病,肝肾综合症和清除细胞因子的作用。方法 治疗组33例重症肝炎中晚期病例使用ALSS联合CHDF治疗96次,平均2.9次,比较治疗前后临床表现,肝性脑病程度,肾功能恢复状况,TBIL、NH_3、PT、PTa、BUN、Cr、电解质、TNF-α、IL-6和LSP水平。设同期住院病情相近似的病例36例为对照组。结果 治疗组存活率达到63.64％,病死率27.27％,对照组为36.11％和52.78％(P<0.05);肝性脑病苏醒率81.80％;13例肝肾综合征9例肾功能恢复,对照组14例肝肾功能2例恢复;TBIL、NH_3、BUN、Cr显著下降,电解质紊乱得到纠正,TNF-α、IL-6、LSP分别由治疗前(81.14±22.65)pg/ml、(66.67±18.37)pg/ml、(3.81±0.62)Eu/ml降至治疗后(53.60±14.27)pg/ml(P<0.01)、(39.48±13.15)pg/ml(P<0.01)和(1.33±0.41)Eu/ml(P<0.05)。21例(64次)血浆置换联合CHDF治疗中发生8例次(12.50％)血浆过敏,9例(25次)血浆吸附联合CHDF和血液灌流联合CHDF治疗后有2例5次出现血小板降低。术后有6例9次静脉穿刺处渗血、1例血浆置换联合CHDF治疗过程中发生右肾破裂;3例单独使用CHDF治疗者未有不良反应。结论

Objective To find the clinical effects of artificial liver support system(ALSS) with continuous hemodialysis and filtration(CHDF) on the treatment of fatal hepatitis in the intermediate and advanced stages (CHDF) and observe if hepatic encephalopathy,hepatorenal syndrome and function of clearing the cellular factor have been improved.Methods To treat 33 cases of fatal hepatitis in the intermediate and advanced stages 96 times,and 2.9 times averagely in the treatment group by the way of ALSS and CHDF,and compare the clinical manifestation,degree of hepatic encephalopath.restoration of renal function and levels of TBIL NH3 PT PTa,BUN Cr electrolytic tension,TNF- a IL-6 and LSP prior to and subsequent to the treatment.The contrast group consists of 36 cases of similar patients who were admitted to the hospital during the same period of time.Results 63.64%at survival rate and 27.27%at case fatality rate in the treatment group,but 36.11% and 52.78% (P < 0.01) respectively in the contrast group: 81.08% at revival rate for hepatic encephalopathy: 9 out of 13 cases of hepatorenal syndrome have restored the renal function,but 2 out of 14 cases of hepatorenal syndrome have restored renal function in the contrast group;TBIL,NH3 ,BUN and Cr have been obviously reduced,the electrolyte disorder has been rectified,and TNF -a.IL - 6.LSP have been redrced respectively to (53.60 + 14.27) pg/ ml (P<0.01),(39.48+ 13.15)pg/ml (P< 0.01) and (1.33 + 0.41)Eu/ml (P<0.05) from (81.14 + 22.65)pg/ ml,(66.67 + 18.37)pg/ml,(3.81 + 0.62)Eu/ml after the treatment.Among 21 patients who have received the treatment of plasma exchange with CHDF(64 times) ,there are 5 cases( 12.5% )of plasma allergy,and among 9 patients who have received the treatment of plasma absorption with CHDF and blood perfusion with (25 times) .There are 2 cases of thrombocy-topenia 5 times.After the operation,there are 6 cases of capillary hemorrhage (9 times) in the region of venepuncture.and 1 case of rupture of right kidney in the therapeutic process of plasma exchange with CHDF; the side effect has not been found in 3 cases following the treatment of CHDF only.Conclusion ALSS with CHDF on the treatment of fatal hepatitis in the intermediate and advanced stages can effectively improve the clinical symptoms,increase the revival percentage of encephalopathy.facilitate the restoration of renal function,remarkably improve the biochemical indicators,and reduce TNF - a,IL - 6 and LSP and increase the short - term survival percentage,it is,after all,a kind of sound and reliable method in therapeutic treatment.