人工肝支持系统治疗重型肝炎的临床研究

Clinical study of artificial liver support system on treating patients with severe hepatitis

目的 探讨人工肝支持治疗(ALSS) -血浆置换(PE)、血浆置换联合血浆吸附(PA)治疗重型肝炎的疗效、时机、可行性。方法 对4 9例重型肝炎中6例采用HA灌流器进行血浆吸附;余4 3例随机分为血浆置换组2 2例和血浆置换联合血浆吸附组2 1例,均在综合治疗的基础上给予相应的ALSS治疗,并及时观察治疗前后的症状体征、有关实验室检查。结果 3组重型肝炎患者经ALSS治疗后症状体征均明显好转,TBil、EhT、PTA、NH3 改善明显(P <0 .0 1)。治愈好转率:血浆置换组6 3.6 4 % ;血浆置换联合血浆吸附组76 .19% ,比较差异有显著意义(P <0 .0 5 )。血浆吸附无不良反应,血浆置换不良反应发生率2 9.13%(37/ 12 7)。结论 ALSS治疗重型肝炎能明显改善症状体征,显著改善肝功能,明显提高治愈好转率,尤其早期患者疗效显著好于晚期患者,对于重型肝炎是安全有效的。

Objectives To explore the therapeutic effects and applications of artificial liver support system (ALSS) about plasma exchange (PE), plasma absorption (PA) combined with plasma exchange on patients with severe hepatitis. Methods Of 49 patients with severe hepatitis, 6 cases were treated with PA used by HA perfusion device; the 43 cases were randomly divided into two groups, and were treated with conventional therapy in addition to liver support system, PE was used in 22 cases and PE combined to PA was used in 21 cases. The clinical symptoms and the laboratory examination were determined before and after the treatment. Results After treating with ALSS, the clinical symptoms and signs of all patients were improved in three groups.TBIL,EhT,PTA and NH 3 were ameliorated(P<0.01); the improvement rate in the PE group was 63.64%, while 76.67% in the PE with PA group, there was a significant difference between the two groups (P<0.05). The incidence of adverse reaction was 29.13% (37/127) in the PE, but the side effect had not been found in the PA. Conclusions ALSS can effectively improve the clinical symptoms and the biochemical indicators, and can also increase the survival rate, the curative effect was move predominant in earlier patients. It is an effective and safe treatment in severe hepatitis.