HA树脂血液灌流治疗重型肝炎40例

Treatment of severe hepatitis by HA neutral macroporous resin hemoperfusion:an analysis of 40 cases

目的:探讨HA中性大孔树脂(HA330-Ⅱ)治疗重型肝炎的疗效,把握血液灌流治疗的重要护理环节和过程,提高治疗成功率.方法:应用HA中性大孔树脂进行血液灌流治疗重型肝炎肝衰竭患者40例,共96次,在灌流前后观察患者临床症状及体征,最终治疗效果,检测肝功能、肾功能、凝血酶原活动度(PTA)、血常规、肿瘤坏死因子(TNF-α)、白介素(IL-6)的水平.首选直接动静脉穿刺建立循环回路,如穿刺困难则采用股静脉穿刺置管术.结果:灌流后患者临床症状体征均有不同程度改善;ALT、TBIL、DBIL等明显下降(92.3±53.1IU/Lvs176.8±120.2IU/L;283.2±90.2μmol/Lvs363.0±140.3μmol/L;122.8±71.7μmol/Lvs247.5±106.4μmol/L;均P<0.01);PTA明显升高(39.6%±12.5%vs29.2%±14.8%,P<0.01);灌流后患者IL-6、TNF-2明显下降(27.6±22.5ng/Lvs88.5±32.8ng/L,0.47±0.4μg/Lvs0.83±0.6μg/L;均P<0.01);电解质及血常规无明显变化.患者病情好转出院29例(72.5%),病情危重自动出院3例(7.5%),死亡8例(20%).在治疗过程直接动静脉穿刺成功者36例(90%),股静脉穿刺置管术4例(10%).结论:HA树脂血液灌流治疗能清除重型肝炎患者体内的毒素,能不同程度改善患者的临床症状、体征及治疗效果.充分准备、熟练技术、密切观察和及时处理不良反应是保证血液灌流治疗效果的关键.

AIM： To investigate the efficacy of hemoperfusion with HA neutral macroporous resin in the treatment of severe hepatitis, and to find out the important nursing points to get better results. METHODS： A total of 40 severe hepatitis patients were treated by HA neutral macroporous resin （HA330-Ⅱ） hemoperfusion （96 times in total）. The symptoms, signs, liver function, renal function, prothrombin activity （PTA）, tumor necrosis factor-α （TNF-α）, and interleukin-6 （IL-6） levels were analyzed before and after treatment. Venous cannula or venepuncture was used to set up blood circulation. RESULTS： After hemoperfusion, the symptoms and signs were improved to different extents in most of the patients; the levels of ALT, TBIL, DBIL were decreased significantly （92.3 ± 53.1IU/L vs 176.8 ± 120.2 IU/L; 283.2 ± 90.2 umol/L vs 363.0 ± 140.3 umol/L; 122.8 ± 71.7 umol/L vs 247.5 ± 106.4 umol/L; all P 〈 0.01）; PTA was increazed （39.6% ± 12.5% vs 29.2% ± 14.8%, P 〈 0.01）. Meanwhile, the levels of IL-6 and TNF-α were decreased （27.6 ± 22.5 ng/L vs 88.5 ± 32.8 ng/L, 0.47 ± 0.4 ug/L vs 0.83 ± 0.6ug/L; both P 〈 0.01） after hemoperfusion. Of the 40 patients, 29 cases recovered （72.5%）; 3 cases were found without improvements and discharged from hospital （7.5%）; 8 cases died （20%）. Thirty-six patients （90%） finished hemoperfusion by vene- puncture and 4 patients （10%） by venous cannula. CONCLUSION： HA resin hemoperfusion is able to remove toxins in patients with severe hepati- tis, and improve the clinical symptoms and signs to some extent. Full preparation, skillful techniques, close observation and timely treatment of side effects contribute to a favorable efficacy.