血浆置换治疗重型肝炎42例

Plasma replacement therapy for severe viral hepatitis: an analysis of 42 cases

目的:探讨应用血浆置换治疗重型肝炎的临床疗效及不良反应.方法:我院住院的重型肝炎患者42例,在内科治疗效果不佳时,给予血浆置换治疗.观察患者三次治疗前后的临床症状、体征和肝肾功能、电解质、凝血功能的变化.结果:42例患者经血浆置换治疗后,临床症状及体征均有明显改善,肝功能有明显好转.三次治疗后与治疗前相比,ALB、CHE显著升高,而ALT、AST、ALP、GGT、TBA、TBIL明显下降,均有显著性差异,血NH3第3次和第1次治疗前比较明显下降,有显著性差异(49.00±12.03vs69.96±34.87,P<0.05),血电解质变化不大,凝血功能有所改善,肾功能有轻微下降,但均无显著性差异.结论:应用血浆置换治疗重症肝炎,可以广泛迅速地清除肝衰竭患者体内的多种毒素,同时补充肝功能不全患者所缺乏的多种生物活性物质,改善机体内环境和肝功能,防治并发症,降低病死率,改善预后.

AIM： To explore the clinical efficacy and side effects of plasma replacement therapy for severe viral hepatitis. METHODS： Forty-two cases of severe hepatitis patients were enrolled who were not responsive to medication therapy, Clinical symptoms and signs, liver and kidney function, electrolytes and coagulation of patients were observed for the first three times before and after treatment. RESULTS： Clinical symptoms, signs and liver function improved significantly after treatment with plasma replacement, Compared with pretreatment, ALB and CHE after treatment increased significantly, but ALT, AST, ALP, GGT, TBA and TBIL decreased significantly. There was a significance difference in ammonia level between the third time and pre-treatment （49.00 ± 12.03 vs 69.96 ± 34.87, P 〈 0.05）. There were no significant differences in blood electrolyte change, coagulation and kidney function between post-treatment and pre-treatment. CONCLUSION： Plasma replacement therapy remove toxins of hepatitis patients, supply biologically active substances in patients with liver dysfunction, improve the local environment and liver function, prevent complications, decrease mortality and improve the prognosis.