摘要
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.
出处
《世界华人消化杂志》
CAS
北大核心
2008年第22期2533-2536,共4页
World Chinese Journal of Digestology
关键词
血液灌流
重型肝炎
疗效
护理
Hemoperfusion
Severe hepatitis
Ther-apeutic effect
Nursing