血浆置换联合持续性血液透析滤过治疗肝衰竭的疗效分析

Effect of plasma exchange combined with continuous hemodiafiltration on the treatment of liver failure

目的回顾性分析人工肝血浆置换联合持续性血液透析滤过治疗肝衰竭的疗效及其影响因素。方法收集2008年1月至2012年12月于佛山市第一人民医院在内科综合治疗基础上接受血浆置换联合持续性血液透析滤过治疗的肝衰竭患者77例,观察人工肝治疗前后的临床症状、生化指标(转氨酶、胆红素、凝血功能、肾功能、电解质)和不良反应。结果人工肝治疗的肝衰竭患者,治疗后临床症状改善有效率为64.9%,转氨酶、总胆红素、凝血功能、肾功能、电解质均较治疗前有明显改善,差异有统计学意义(P<0.05),其疗效与肝衰竭分期相关,以早期有效率最高(P<0.05)。治疗过程中出现35例次不良反应,经对症处理后,所有不良反应均可缓解。结论在内科综合治疗基础之上,血浆置换联合持续性血液透析滤过治疗能有效治疗肝衰竭患者,不良反应少,可作为治疗肝衰竭的重要手段。

Objective To analyze the therapeutic effects of artificial liver support system （ALSS） of plasma exchange combined with continuous hemodiafihration on liver failure. Methods A total of 77 cases with liver failure were enrolled and treated with medical comprehensive therapy and combined with ALSS. The clinical symptoms, biochemical indicators （eg： transaminases, bilirubin, coagulation function, renal function, electrolyte） and side effects were observes before and after treatment. Results The improvement rate of clinical symptoms was 64.9% .It showed significant differences in transaminases, total bilirubin, coagulation function, renal function and electrolyte after ALSS （P〈0.05）. The curative effect of ALSS was with liver failure stage,and was most effective at early stage （P〈0.05）.There were 35 times of adverse reactions happened in the process of treatment,which can be alleviated after symptomatic treatment. Conclusion Based on medical comprehensive therapy ,plasma exchange combined with continuous hemodiafiltration can be used as an important mean in the treatment of liver failure, because it has many advantages, such as better therapeutic effects and less adverse reaction.