持续缓慢血浆透析滤过治疗肝功能衰竭的临床疗效分析

Analysis of clinical effect of continuous plasma diafiltration for the therapy of liver failure

目的探讨持续缓慢血浆透析滤过(PDF)治疗肝功能衰竭患者的临床疗效及安全性。方法选择中国人民解放军第三○二医院慢性乙型肝炎肝功能衰竭患者160例,随机分为2组。PDF组89例,其中男性72例,女性17例,平均年龄41.39岁;共做PDF治疗210例次。血浆置换(PE)组71例,其中男性64例,女性7例,平均年龄39.37岁。均在内科治疗的基础上加用日本Kuraray公司产的KM-8900型人工肝治疗仪进行人工肝治疗。结果 PDF组治疗结束时低钾、低钠、低氯纠正率分别为100.00%、78.69%、79.37%,而PE组则分别为8.89%、13.46%、6.25%,PDF组电解质紊乱纠正率明显高于PE组(P<0.01);PDF组治疗结束及治疗后48 h血尿素氮及肌酐水平均明显低于治疗前(P<0.05),而PE组治疗前后无明显差异;PDF组治疗结束时及治疗后48 h血氨水平均明显低于治疗前(P<0.05);PDF组治疗用血浆量及废弃血浆量均明显少于PE组(P<0.01);PDF组治疗结束时总胆红素下降幅度明显高于PE组(P<0.01),且治疗48 h后总胆红素"反弹"幅度小于PE组(P<0.01);PDF组患者治愈好转率71.91%,高于PE组(56.34%)(P<0.01)。结论持续缓慢PDF是治疗肝功能衰竭患者的安全且有效的人工肝治疗方法。

Objective To study the clinical effect and safety of continuous plasma diafihration （PDF） for treatment of patients with liver failure. Methods A total of 160 patients with chronic hepatitis B liver failure were enrolled, and divided into 2 groups randomly. There were 89 cases in PDF group, male 72, female 17, mean age 41.39, which performed 210 times PDF treatment. There were 71 cases in plasma exchange（PE） group, male 64, female 7, mean age 39.37 years old. All patients were performed the treatment of artificial liver with KM-8900 artificial liver therapy instrument made in Japan. Results In PDF group, the electrolyte disturbance rectification rate of hypokalemia, hyponatremia and hvpochloraemia at the end of therapy was 100.00 %, 78.69 % and 79.37 %, respectively, which were higher than the levels of patients treated by PE（P 〈 0.01）. In addition, the levels of blood urea nitrogen, inosine and ammonia immediately after treatment and 48-hour after treatment were significantly lower than that of before treatment（P〈 0.05） in PDF group. However, in PE group, the levels of blood urea nitrogen and creatinine immediately after treatment and 48-hour after treatmen was comparable to the levels before treatment. The volume of plasma used in or discarded by PDF group patients was obviously fewer than that of PE group（P 〈 0.01）. The average level of total bilirubin in serum of PDF group decreased more than that of PE group at after treatment（P 〈 0.01）. The levels of total bilirubin in serum increased less than that of 48- hour after treatment in PE group（P〈 0.01）. Of all 89 patients in PDF group, the total survival rate was 71.91%（64/89）, and the survival rate of PE group was 56.34 %（P〈 0.01）. Conclusion It is demonstrated that PDF is a safe and an effective therapy, and could improve the symptoms and blood parameters of patients with liver failure.