重症肝炎血浆置换治疗前后生化指标的变化

A clinical observation on chronic severe hepatitis treated with plasma exchange

目的观察血浆置换（PE）疗法对重症肝炎预后及肝功能、凝血酶原时间（PT）、凝血酶原活动度（PTA）、尿素氮（BUN）、电解质（K^＋、Na^＋、Cl^-）等影响。方法PE组在综合支持治疗基础上，加用人工肝支持系统（ALSS）PE疗法。常规消毒后行股静脉穿刺置管，留置双腔导管固定，建立血液通路。PE每次交换同型血浆2500—3000ml。每例治疗1—4（2．6±1．4）次。结果PE组82例，存活57例，存活率69．51％；对照组82例，存活33例，存活率40．24％；PE组存活率明显优于对照组（P〈0．01）。PE组治疗后血清胆红素（SB）、血氨（NH3）明显下降，血清白蛋白（ALB）、PT、PTA明显上升（P〈0．01）。PE组与对照组治疗后15、30d比较，SB、丙氨酸转氨酶（ALT）明显下降，ALB、PTA明显上升（P〈0．01）。而血清电解质（K^＋、Na^＋、Cl^-）、BUN等治疗前后无明显变化（P〉0．05）。结论PE疗法可提高重症肝炎患者的存活率，降低SB，提高ALB及PTA，从而为重肝患者肝细胞再生和肝移植赢得时间。

Objective To evaluate the therapeutic effects of liver function and PT, PTA, and safety in treatment with plasma exchange （PE） for patients with chronic severe hepatitis. Methods 164 patients with chronic severe hepatitis were divided into PE therapy group （ treatment group, n = 82） and control group （ n = 82）. The two groups received the same basic treatments. Results For the treatment group, 57 （69.51%） survived; while for the control group, 33 （40. 24% ） survived. The difference in survival rate between the two groups was statistically significant. Liver function was improved obviously after PE with SB ,ALT and NH3 significantly reduced （ P 〈0. 01 ）, and ALB and PTA, significantly increased（ P 〈 0.01 ）. Meanwhile, serum K^＋ , NA^＋ , Cl^ - remained unchanged （ P 〉 0. 05）. Conclusion PE treatment can improve the survival rate and reduce mortality in patients with chronic severe hepatitis. These results suggest that PE is effective and safe for treating chronic severe hepatitis.