不同的血液净化方法治疗肝衰竭疗效分析

Analysis effect of different blood purification treatments in liver failure

目的评价不同的血液净化方法治疗肝衰竭的疗效。方法选择96例肝衰竭患者,其中男性59例,女性37例;年龄36~73岁,平均年龄49.46岁。前瞻性随机分为4组进行不同方法的血液净化治疗（血液滤过、血液灌流、血浆置换）,即血滤组（21例）、血滤＋灌流组（25例）、灌流组（25例）、血浆置换组（25例）。比较治疗前后肝功能、凝血、肾功能的改变。结果血滤组、血滤＋灌流组、灌流组3种方法中,治疗前后两两比较,差异无统计学意义（P〉0.05）。以上3组分别与血浆置换组比较,其中灌流组、血滤＋灌流组与血浆置换组比较,差异均有统计学意义（P〈0.05）;血滤组在改善凝血、降肌酐方面与血浆置换组差异也有统计学意义（P〈0.05）。结论以血液滤过、血液滤过＋血液灌流、血液灌流的血液净化方法治疗肝衰竭,均可以达到治疗目的,且可以认为3种方法治疗效果基本相同;血液滤过＋血液灌流、血液灌流2种方式与血浆置换方式比较,在降酶、改善凝血状态、降肌酐三方面均存在优势;血液滤过方式与血浆置换治疗方式比较,在改善凝血状态、降肌酐效果上存在优势。

Objective To investigate the efficacy of different blood purification methods for the treatment in liver failure.Methods A total of 96 cases with liver failure were enrolled, which included 59 males and 37 females, aged 36- 73 years old with mean age of 49.46 years old. All of them were divided into 4 groups accorded to different blood purification methods, which were hemofiltration group（HF, n = 21）, hemofiltration combined with hemoperfusion group（HF ＋ HP, n = 25）, hemoperfusion group（HP, n = 25） and plasmapheresis group（PE, n = 25）. The vital signs, liver function, coagulation and renal function changes before and after treatment of 4 groups were compared. Results There were no statistical differences among HF, HF ＋ HP and HP groups（P 〉 0.05）, but compared with PE group, there were statistical differences between HF ＋ HP and HP group（P 〈 0.05）. Compared with PE group, the HF group showed statistical differences on improvement of coagulation and reduction of creatinine（P 〈 0.05）.Conclusion It is demonstrated that the HF, HF ＋ HP and HP are effective methods on treatment of liver failure with same effector. The HF ＋ HP and HP are better than PE on reducing liver enzyme, improving coagulation and reducing creatinine, and HF also shows more efficiency than PE on improving coagulation and reducing creatinine.