血浆置换在肝衰竭治疗中的临床应用体会

Clinical application experience of plasma exchange in the treatment of liver failure

目的观察血浆置换(PE)治疗肝衰竭的临床疗效及安全性。方法 38例肝功能衰竭病例在常规内科治疗基础上给予血浆置换治疗(治疗组),34例采用常规内科治疗(对照组)。比较治疗前后临床症状,肝功能、凝血功能等指标的变化并分析其疗效。结果血浆置换组患者临床症状有不同程度的改善,血清总胆红素(TBIL)明显下降;凝血酶原时间缩短,PTA升高,3个月近期随访治疗组好转23例,好转率为60.53%,比对照组高,其中早期90.0%,中期56.81%,晚期16.67%,差异有统计学意义(P<0.05)。结论血浆置换治疗肝衰竭可明显改善临床症状,降低血清TBIL、缩短凝血酶时间,对早、中期肝功能衰竭更适宜,且安全可行,是目前治疗肝功能衰竭的重要手段之一。

Objective To observe clinical efficacy and safety of plasma exchange （PE） in the treatment of liver failure.Methods 38 cases with liver failure were treated with plasma exchange on the basis of conventional medicine（treatment group）,34 cases were treated with conventional medicine （control group）,compare the change of the index：clinical symptoms liver function,blood clotting and so on,analyzes its curative effect.Results After the plasma exchange,the clinical symptoms were alleviated of varied degree,the serum total bilirubin（TBIL） decreased greatly,and prothrombin time shortened,while prothrombin activity increased significantly,23 cases were improved in treatment group within three months follow-up recently,and the improvement rate was 60.53% higher than that in the control group.The improvement rate of patients in early stage was 90.0% higher than 56.81% in middle stage and 16.67% in late stage,and the differences were statistically significant（P0.05）.Conclusion Plasma exchange can significantly improve clinical symptoms,decrease serum TBIL,shorten prothrombin time.It Is more suitable to treat liver failure in early and middle stage,moreover safe and feasible.At present,plasma exchange is one of the important therapies for the patients with liver failure.