MARS治疗与血浆置换联合血液透析治疗肝性脑病的观察

Observation on molecular adsorbent recirculating system and plasma exchange plus hemodialysis in treating hepatic encephalopathy

目的观察并比较分子吸附再循环系统(MARS)与血浆置换(PE)联合血液透析(HD)对肝性脑病的治疗效果。方法60例有肝性脑病的急性或亚急性重型肝炎患者随机分为MARS治疗组、PE+HD治疗组,每组30例。观察并比较两组治疗前后平均动脉压(MAP)、心率、血氨浓度、血浆渗透压(POP)以及肝性脑病的临床变化情况。结果MARS组治疗前与治疗9h后MAP、POP、血氨浓度分别为(63.5±5.2)mmHg、(81.1±19.3)mOsm/L、(314.1±4.6)mmol/L和(54.0±7.4)mmHg、(37.1±14.6)mOsm/L、(309.9±7.1)mmol/L;PE+HD组对应值分别为(64.6±5.7)mmHg、(79.5±19.7)mOsm/L、(312.8±4.9)mmol/L和(63.7±7.3)mmHg、(84.7±22.1)mOsm/L、(300.9±7.8)mmol/l。治疗9h后两组间MAP、POP和血氨浓度的差异有统计学意义(P<0.05)。治疗过程中MARS组MAP、POP和血氨浓度的变化较PE+HD组平稳。MARS组治疗9h后肝性脑病好转率为66.7%(20/30),PE+HD组为10%(3/30),差异有统计学意义(P<0.05)。结论与PE+HD比较,MARS对血氨、血流动力学指标和POP的改善更为平稳,对肝性脑病的治疗效果更佳。

Objective To observe and compare the effect of molecular adsorbent recirculating system （MARS） with plasma exchange （PE） plus hemodialysis （HD） in treating hepatic encephalopathy. Methods Sixty patients with acute or sub-acute severe hepatitis and hepatic encephalopathy were enrolled and were divided into 2 groups randomly. Thirty of them were treated with MARS. Others were treated with PE＋HD. The mean arterial pressure, （MAP） , heart rate, the concentration of serum ammonia, plasma osmotic pressure （POP） and hepatic encephalopathy stages were observed before and after treating. Results The MAP, POP, ammonia concentration of MARS group was （63.5±5.2） mmHg,（81.1± 19.3）mOsm/1 and （314.1±4.6）mmol/L before treatment. They became （54.0±7.4）mmHg,（37.1±14.6）mOsm/L and（309.9±7.1）mmol/L after 9 hour therapy. The MAP, POP, ammonia concentration of PE＋HD group was （64.6±5.7）mmHg, （79.5±19.7）mOsm/L and （312.8±4.9） mmol/L before treatment. And they became （63.7±7.3） mmHg, （84.7±22.1）mOsm/L and （300.9±7.8）mmol/L after 9 hours therapy. There was statistically difference between two groups in MAP, POP and ammonia concentration after treating 9 hours （P〈0.05）. The MAP, POP and ammonia concentration of MARS group changed more stably than those of PE ＋HD group. After 9 hours treating, the mending rate of hepatic encephalopathy in MARS group was 66.7 % （20/30）, and in PE＋HD was 10%（3/30）. There was statistically difference between two groups（P〈0.05）. Conclusion Compared with PE ＋HD, MARS ameliorate ammonia concentration, flow kinetic indexes and POP more smoothly. And it is better than PE＋HD while curing hepatic encephalopathy.