血浆置换治疗慢性肝衰竭的临床疗效观察

Clinical observation of plasma exchange in treatment of 41 patients with chronic liver failure

目的观察血浆置换治疗慢性肝衰竭的临床疗效,探讨其临床价值、安全性及有效性。方法 41例慢性肝衰竭患者在内科综合治疗的基础上联合人工肝治疗,采用血浆置换法,通过比较治疗前后患者的临床症状、肝肾功能、凝血酶原时间、国际标准化比率(INR)等指标判断临床疗效,同时观察治疗中出现的不良反应和生存率。结果人工肝血浆置换治疗可明显改善患者的临床症状,使得患者的血清总胆红素(TBIL)、血清肌酐(Cr)、凝血酶原时间(PT)、国际标准化比率(INR)均有不同程度的降低,清蛋白水平升高,差异有统计学意义(P<0.05)。治疗过程中出现的不良反应,经对症处理后很快好转,未出现严重不良反应。经血浆置换治疗后总生存率为63.4%,早期及中晚期慢性肝衰竭的患者生存率分别为88.9%及43.9%(P<0.05),相比存在统计学差异。结论血浆置换是治疗慢性肝衰竭的一项有效治疗手段,对早期慢性肝衰竭患者疗效优于中晚期患者,安全性好。

Objective To observe the effectiveness, clinical value and safety of plasma exchange in treatment of chronic liver failure. Methods 41 patients with chronic liver failure were employed with artificial liver plasma exchange based on comprehensive internal medicine therapy. Clinical symptoms, liver function, prothrombin time, international normalized ratio （INR） and other indicators were compared before and after plasma exchange treatment, meanwhile, adverse reactions were also observed. Results Artificial liver plasma exchange therapy could significantly ameliorate the clinical symptoms of the patients. Serum total bilirubin （TBIL）, creatinine （Cr）, prothrombin time （F＇F）, the international normalized ratio （INR） decreased, on the other hand, serum albumin levels increased significantly （P〈0.05）. Some insignificant adverse reactions, but no severe complications were observed during the treatment process. The survival rate of patients who employed plasma exchange was 63.4%, improved significantly when compared with that in the early and late stages of chronic liver failure （88.9%, 43.9%） （P〈 0.05）. Conclusion Plasma exchange is effective and with satisfied safety in treatment of patients with chronic liver failure.