以血浆作透析液在肝移植术前的应用

Hemodialysis with plasma-based dialysate for hyperbilirubinemia before undergoing liver transplantation

目的以人体新鲜冰冻血浆作透析液行血液透析(PHD)后继续进行连续性静脉-静脉血液滤过(CVVH),观察其对肝移植术前高胆红素血症及血浆细胞因子水平的影响。方法4例拟行肝移植手术的肝功能衰竭患者行PHD治疗6 h后,应用同一滤器(AV600)继续行CVVH治疗24 h。分别检测治疗前后血清胆红素(TB、DB、IB)、总胆汁酸(TBA)、血氨(BA)及细胞因子TNF-a,IL-6和IL-8的水平。结果PHD治疗6 h后患者总胆红素(TB)、直接胆红素(DB)、间接胆红素(IB)和总胆汁酸(TBA)分别下降(24.38±4.89)%(、26.23±2.67)%(、25.02±0.01)%、(27.38±8.59)%(P<0.05);PHD后继续行CVVH治疗24 h,总胆红素(TB)仍有所下降(10.61±0.32)%;CVVH在清除血氨,纠正电解质和酸碱失衡方面比PHD更有效(P<0.05);PHD及CVVH治疗后TNF-aI、L 6、IL-8较治疗前明显下降(P<0.05)。结论对肝功能衰竭患者,PHD联合CVVH治疗能显著降低血清胆红素、总胆汁酸、血氨及炎性细胞因子水平,调节水、电解质和酸碱平衡。

Objective To apply a new blood purification modality-hemodialysis with fresh frozen plasma-based dialysate（HD-PBD） plus continuous veinvein hemofiltration（CVVH） to 4 patients before undergoing liver transplantation, and to evaluate the effect of the treatment on levels of plasma bilirubin and cytokines.Methods 4 patients with hepatic failure before undergoing liver transplantation received HD-PBD therapy in first 6 hours,and then were treated with CVVH in next 24 hours with the same filter（AV600）.The levels of bilirubin（total bilirubin TB,direct bilirubin DB,indirect bilirubin IB）,total bile acid（TBA）,TNF-α,IL-6 and IL-8 in plasma pre-and post-HD-PDB＋CVVH were tested respectively.Results HD-PBD for first 6 hours was more effective than CVVH in next 24 hours in removal of serum bilirubin and TBA（P〈0.05）.Serum ammonia,BUN,Scr,and electrolytes did not show significant difference before and after HD-PBD,but these parameters and cytokines（TNF-α,IL-6 and IL-8） significantly decreased pre-and post-CVVH（P〈0.05）.Conclusions HD-PDB plus CVVH,a new blood purification mode,can effectively decreased serum bilirubin,TBA,BUN,Scr,ammonia and cytokines,and adjust water-electrolyte as well as acid-alkali balance.