持续缓慢血浆置换加血液透析滤过治疗重型肝炎临床研究

Analysis of the clinical significance of continuous plasma exchange and hemodiafiltration on patients with severe hepatitis

目的探讨持续缓慢血浆置换加血液透析滤过治疗重型肝炎患者的临床疗效及安全性。方法选择解放军302医院重型肝炎患者,治疗组41例(其中慢性乙型肝炎重型34例),单纯对照组37例(其中慢性乙型肝炎重型32例)。2组患者均有不同程度的并发症,均在内科治疗的基础上加用日本KURARAY公司产的KM-8900型人工肝治疗仪进行人工肝治疗。结果治疗组患者治愈好转率51.22%,高于对照组(32.43%),差异有统计学意义(P<0.05);治疗组能很好的纠正电解质紊乱,清除尿素氮(BUN)、肌酐(Scr)、血氨,而对照组则不能(P<0.01);治疗组治疗用血浆量及废弃血浆量均明显少于对照组(P<0.01);治疗组患者治疗结束时总胆红素下降幅度高于对照组(P>0.05),但治疗组在治疗48h后总胆红素“反弹”幅度小于对照组(P<0.05);结论持续缓慢血浆置换加血液透析滤过治疗重型肝炎可有效改善患者临床症状及生化指标,延缓治疗后胆红素“反弹”,提高治愈好转率,且安全可行,操作简单,值得在国内推广应用。

Objective To study the clinical effects and safety of continuous plasma ex- change and hemodiafiltration on the patients with severe hepatitis. Methods All the patients enrolled suffered from severe hepatitis. Fourty-one cases in the treatment group（34 cases with chronic severe hepatitis B） were treated with continuous plasma change and hemodiafiltration. Except routine therapy, an additional artificial liver support system of KM-8900 purfusion device made in Japan was used to treat the treatment group patients. Thirty-seven cases in the control group （32 cases with chronic severe hepatitis B） were treated with plasma exchange. Patients in both groups suffered from some complications. Results Of all 41 patients in the treatment group, the total survival rate was 51.22%（21/41）, and the survival rate of control group was 32.43%. The difference was significant （P〈0. 05）. In the treatment group patients, dialysis disorder were improved effectively, and their urea, creatine, NH3 in serum decreased obviously, but not in the control group （P〈0.01）. The volums of plasma used or discarded by the treatment group patients were obviously less than that of the control group（P〈0.01）. Although the average content of serum total bilirubin of the treatment group patients decreased more than that of the control group patients at the end of the study, the difference was insignificant. While the content of serum total bilirubin increased less than that of the control group patients 48 hours after therapy （P〈0. 05）. Conclusion Continuous plasma diafiltration is safe and effective. It can improve the symptoms and blood parameters of severe hepatitis patients delay the serum bilirubin re bounce and efficiently increase survival rate. It is worthwhile to be wide spread.