不同类型人工肝治疗191例严重肝炎时并发症防治

Prevention and Treatment for the Complication of Various Artificial Liver Support System in 191 Cases With Severe Hepatitis

目的探讨不同类型人工肝治疗严重肝炎时并发症的发生原因及防治措施,筛选相对安全有效的方法。方法比较血浆置换、血浆置换联合连续性静脉-静脉血液滤过、血浆置换同步并联血液透析滤过、血浆置换联合血浆吸附、分子吸附再循环系统5种不同类型人工肝在191例严重肝炎治疗中出现的并发症的有关资料,分析各种并发症发生的原因。结果569次治疗中共出现并发症287次,发生率达50.44%。按发生率高低依次为皮疹、麻木和(或)搐搦、血压下降、凝血、胸闷、失衡综合征、置管处渗血及置管处渗液。75.61%的并发症由血浆置换导致。在联合疗法中,以血浆置换同步并联血液透析滤过的并发症较少。全部并发症均经处理缓解。结论不同类型人工肝治疗严重肝炎时并发症的发生率高,但经处理均能缓解,可以在严密监护下实施。血浆置换同步并联血液透析滤过相对更安全。

Objective To investigate the safe model to prevent and treat complications caused by various artificial liver support system（ALSS）. Methods The complications in 191 patients with severe hepatitis during the ALSS（ Including plasma exchange、plasma exchange associated with continuous venovenous hemofiltration、plasma exchange associated with hemodiafiltration、plasma exchange associated with plasma absorption、molecular absorbents recycling system） treatment were observed and analyzed. Results During the treatment 287 episodes occurred and the rate of complications was 50.44% （287/569）. The clinical manifestation included rash, numbness/tetany, hypotension, blood clotting in the channel,chest distress, disequilibrium syndrome,errhysis on dwell catheter, effusion on dwell catheter. 75.61% of these complications was caused by plasma exchange. The rate of complications was the lowest during the treatment of plasma exchange associated with hemodiafiltration. All of these complications got better after prompt sypotomatic therapies were taken. Conclusions Although the rate of complications was high during the treatment of ALSS,all of the complications got better after prompt sypotomatic therapies were taken. This therapeusis must be performed by intensive care. It is more safe than others during the treatment of plasma exchange associated with hemodiafiltration.