人工肝支持系统在各型重型肝炎治疗中的应用

Application of artificial liver support system in treatment of severe hepatitis

目的 探讨人工肝体外支持系统在重型肝炎治疗中的疗效及其影响疗效的因素。方法 采用血浆交换仪进行血浆交换和胆红素吸附治疗各型重型肝炎患者 75例 ,共 141例次。结果 75例重型肝炎患者经血浆置换和 /或胆红素吸附治疗后临床症状得到一定程度的改善 ,血清胆红素从平均 495 6 μmol/L降至 2 5 6 7μmol/L ,凝血酶原活动度从 2 6 9%提高至 5 4 3%。人工肝支持治疗后总生存率为 5 8 6 % (4 4/ 75 ) ,但该疗法对早期慢性重型肝炎疗效最佳 ,其存活率达 86 2 % (2 5 / 2 9)。肝肾综合征对该治疗效果影响最大 ,出现该并发症的患者病死率高达 82 6 % (19/ 2 3)。结论 人工肝支持治疗对重型肝炎病情的改善、存活率的提高、黄疸的消退、凝血功能的改善均有肯定的疗效 ;该治疗对早期慢性重型肝炎疗效较好。

Objective In order to observe the effect of artificial liver support system (ALSS) and the factors influencing the therapeutic results in the treatment of severe hepatitis.Methods The plasma exchange device was used in the treatment of 75 cases of acute or chronic severe hepatitis by means of 141 operations of plasma exchange and/or bilirubin plasmabsorption.Results The level of total serum bilirubin was obviously decreased from 495 6μmol/L to 256 7μmol/L and prothrombin activity was clearly elevated from 26 9% to 54 3% in all of the patients after the treatment of plasma exchange and/or bilirubin plasmabsorption.The general survival rate was 58 6%(44/75).But the survival rate of the patients in early stage was 86 2%(25/29).The mortality was 82 6%(19/23) in severe hepatitis patients with the complication of liver kidney syndrome,which was clearly higher than that in the patients with other complications.Conclusion The data indicates that ALSS has good effects in the treatment of the patients with severe liver disease,especially in the early stage or patients with mild symptoms.