血浆置换联合连续性血液净化治疗肝衰竭疗效观察

Therapeutic effect of plasma exchange combined with continuous blood purification in the treatment of liver failure

目的:探讨人工肝辅助装置血浆置换(PE)联合连续性静-静脉血液滤过(CVVH)治疗重型肝炎肝衰竭的疗效、安全性及可行性。方法:对25例重型肝炎肝衰竭患者应用上述人工肝方法进行治疗70次,通过比较治疗前后患者临床症状、肝功能、凝血酶原活动度(PTA)、血氨、胆碱酯酶等指标判断临床疗效,观察治疗相关的不良反应及患者耐受情况,判断安全性及可行性。结果:患者意识模糊、黄疸、乏力、腹胀、纳差等症状均明显缓解,血清总胆红素治疗后较治疗前降低,PTA上升,治疗后近期有效率达72%,不良反应主要以血浆过敏居多,未发生大出血、休克等严重并发症,患者耐受良好。结论:在内科综合治疗的基础上PE联合CVVH可显著改善重型肝炎肝衰竭患者临床症状及生化指标,提高近期存活率,且安全可行,值得在国内推广应用。

Objective To explore the efficacy, safety and feasibility of plasma exchange （PE） combined with continuous veno-venous hemofihration（CVVH） in the treatment of liver failure caused by severe hepatitis. Methods A total of 25 patients with hepatic failure were treated with PE plus CVVH. The changes of clinical symptoms, liver function, plasma thrombinogen activity, ammonia, and cholinesterase were detected before and after treatment. The feasibility and safety of the procedure were assessed by therapy-related adverse reactions and patients＇ tolerance. Results After treatment, symptoms including conscious disturbance, jaundice, fatigue, abdominal distention, and anorexia were markedly relieved. The effective rate was 72% with a significant decrease in serum total bilirubin and an increase in PTA. Major adverse reaction was allergy to plasma and no severe hemorrhage and shock occurred. The combined therapy was well tolerated. Conclusions PE combined with CVVH can significantly improve symptoms and biochemical indices in patients with liver failure secondary to severe hepatitis and enhance short-term survival rate. It is safe, feasible, and worth to be popularized.