血浆置换联合持缓式血液透析滤过治疗重型肝炎的临床研究

Clinical Study of Plasma Exchange Combined with Slow Type Hemodialysis in the Treatment of Severe Hepatitis

目的探讨血浆置换联合持缓式血液透析滤过治疗重型肝炎的疗效和安全性。方法选择40例重型肝炎患者序贯应用血浆置换联合持缓式血液透析滤过治疗作为治疗组,40例重型肝炎患者单纯应用血浆置换作为对照组,分别观察两组治疗前后症状、体征变化,比较治疗前后血生化及血氨。结果两组患者均能完成治疗。两组患者治疗前后各肝功能指标比较差异有统计学意义(P<0.05),治疗组低血钠改善、近期有效率增高、病死率降低(P<0.05)。结论血浆置换联合持缓式血液透析滤过治疗能显著改善重型肝炎患者肝功能,疗效比单纯应用血浆置换治疗提高,是辅助治疗重型肝炎的一种安全有效治疗手段。

Objective To study the efficacy and safety of plasma exchange combined with slow type hemodialysis in the treatment of severe hepatitis. Methods 40 severe hepatitis patients with sequential application of plasma exchange combined with a slow type hemodialysis therapy were selected as the treatment group, 40 severe hepatitis patients with simple application of plasma exchange were selected as the control group. The primary outcome was a composite of the changes of symptoms and signs before and after treatment, blood chemistry and blood ammonia levels before and after treatment. Results Both of the patients in the two groups were able to complete the treatment. The liver function indexes before the treatment were significantly different from those after the treatment （P〈0.05）. Hyponatremia in the treatment group and recent efficiency improved, while fatality rate reduced （P〈0.05）. Conclusions Plasma exchange combined with a slow type hemodialysis therapy can significantly improve the liver function of patients with severe hepatitis, which is more effective than plasma-exchange-only therapy. It is a safe and effective adjunctive therapy for severe hepatitis.