血浆置换治疗肝衰竭的疗效评估及影响因素分析

Analysis of efficacy and influence factors of plasma exchange for the treatment of liver failure

目的回顾分析血浆置换(plasmaexchange,PE)在急、慢性肝衰竭治疗中的疗效和影响预后的因素。方法选择广东省深圳市东湖医院342例急、慢性肝衰竭患者在内科综合治疗基础上辅以PE治疗,回顾性分析影响PE疗效的因素。结果辅以PE治疗的342例患者总的治愈或好转数188例(55%);过渡到肝移植18例,存活6例;住院期间死亡122例(35.7%),其中13例患者在肝衰竭得到明显纠正8周后出现消化道或颅内出血死亡;14例放弃治疗患者9例经证实死亡,5例结果不详。PE的疗效与肝衰竭的类型及病因、PE治疗后凝血酶原活动度及血清胆红素的降低幅度和稳定程度、并发症及器官衰竭的种类和发生率密切相关(P<0.01或P<0.05),而与治疗频率及置换量无明显相关性(P>0.05)。结论PE对肝衰竭是一种安全可行的治疗手段,其疗效与患者病情特点和整体性、个体化治疗密切相关。

Objective To review retrospectively the clinic effect and influence factors of plasma exchange（PE） in treating patients with liver failure. Method Three hundred and fourty-two patients with acute or chronic liver failure were treated with PE. The patients＇ clinical characterization and the influence factors of PE on efficacy were andyzed. Results One hundred and eighty-eight patients survived（55%）. Eighteen cases received liver trasplantation, 6 of them survived, 122 cases （35.7%） died during hospitalization. Thirteen patients died of variceal bleeding or intracranial haemorrhage after the liver function being improved significantly. Fourteen cases gave up any treatment and nine of them died at home. The efficacy of PE was closely associated with the types and causes of liver failure, the decreasing degree of prothrombin time and serum bilirubin after PE as well as the occurrence of complication（P〈0.01 or 〈0.05）. The efficacy of PE was not associated with the therapy frequenay and the volume of substitution fluid. Conclusion PE is an effective and safe therapy for liver failure, but it is only a support therapy for liver failure.