血浆置换疗法治疗重型肝炎的临床观察

Clinical study of plasma exchange on patients with hepatic failure

目的探讨血浆置换疗法对重型病毒性肝炎的疗效及其安全性。方法1999年12月至2000年11月 ,收住院的40例重型肝炎患者进行配对分为治疗组和对照组 ,两组均为20例。对照组综合内科治疗 ,治疗组在对照组的基础上加用血浆置换治疗。结果治疗组患者在血浆置换结束后3～48小时就能迅速改善神志、食欲 ,恶心消失 ,腹胀、乏力好转 ;对照组的有效病例的上述症状好转要20天后好转。治疗组BIL复常时间和复常率45.80±20.4天和85 %优于对照组的59.20±24.7天和50 % (P<0.05) ,ALT、AST好转亦快于对照组 (P<0.05) ,有效率和存活率治疗组是85 %和75 % ,高于对照组的50 %和35 % (P<0.05)。副作用发生率为26.32% ,主要为血浆过敏反应 ,一般对症处理后均能完成治疗。结论血浆置换确能有效清除体内的毒素 ,改善临床症状和肝功能 ,提高存活率 ,降低死亡率,为抢救重型肝炎提供了安全有效的手段 ;其不良反应可通过措施进行预防。

Objective To evaluate the efficacy and safety of plasma exchange treatment on patients with acute (or sub acute, chronic) fulminate hepatitis and hepatic failure. Methods 40 patients suffering from liver failure were divided into two groups at ration (treatment and controlled group). 20 patients of controlled group received general treatment.20 patients who were in treatment group were treated by plasma exchange treatment and general treatment as the controlled group. The efficacy and safety were evaluated with clinic, biochemical test. Results Clinical symptoms of the patients, which underwent plasma_exchanging treatment, showed significant improvements in 3～48 hours and the others one in 20 days. There was remarkable statistic difference in the function in recent period of anti_icterus and majority of rate of the two groups (P<0.05). The plasma exchanging treatment group was 45.80±20.40 days and 85% but the controlled group was 59.20±24.70 days and 50% .The effect in reducing enzyme (ALT and AST) of the former was superiority to the latter (P<0.05).The effective and survival rate of two groups were 85%, 35% and75%, 50%. There was a remarkable statistic difference between two groups (P<0.05). The mild side effects were found (26.32%). They were Bp reduction and plasma allergy. All patients in treatment group were well tolerated to the therapies under symptom treatment. Conclusions Plasma exchanging treatment can effectively recover the clinical symptoms and improve livere′s function and increase survival rate. There are mild side effects.