血液灌流联合连续血液滤过治疗重型肝炎的临床研究

The clinical study on severe hepatitis treated by hemoperfusion combined with continuous hemofiltration

目的:了解血液灌流联合连续性血液滤过治疗重型肝炎的临床效果。方法:回顾实施血液灌流联合连续性血液滤过的26例患者临床资料,对76例次治疗前后肝肾功能、电解质、血氨、凝血象和肝性脑病程度进行比较,并根据相关资料计算治疗前后CTP积分、MELD积分和MELD-Na积分变化情况。结果:治疗前后血钾、血氯、PT没有明显改变,血钠明显升高,28例次低钠血症均获得纠正,血氨和总胆红素显著下降,CTP积分,MELD积分以及MELD-Na积分下降明显,治疗后肝性脑病有不同程度好转,26例患者经上述治疗17例好转出院,9例死亡。结论:血液灌流联合连续性血液滤过治疗可有效纠正电解质紊乱,促进肝性脑病清醒,为重型肝炎的治疗提供了新的选择。

Objective： To investigate the clinical efficacy of hemoperfusion combined with continuous hemofihration in treatment of severe hepatitis. Methods： The cinical data of 26 patients with severe hepatitis treated with hemoperfusion and continuous hemofiltration were reviewed respectively.And the liver and renal function, electrolytes, blood ammonia, coagulogram and hepatic encephalopathy degree were collected and anlysised, the CTP, MELD, MELD-Na were calculated and compared pre and post therapy. Results： Compared with pretherapy,the value of blood potassium, chlorinum and PT didn＇t change obviously,while natrium increased obviously, 28 times hyponatremia were corrected,TBi and blood ammonia descented statistically, the scores of CTP,MELD, and MELD-Na decreased, hepatic encephalopathy degree improved significantly,17 of 26 patients were cured, and 9 patients died. Conclusion： Hemopeffusion combined with continuous hemofihration may promote consciousness of hepatic eneephalopathy, and nomalize electrolyte disturbance. It may be a new choice of the treatments for severe hepatitis patients.