不同种类血浆用于慢加急肝衰竭患者血浆置换的疗效比较

Effects of plasma exchange using different kinds of frozen plasma in patients with acuteonchronic liver failure

目的:比较新鲜冰冻血浆、普通冰冻血浆及二者各半用于血浆置换治疗慢加急肝衰竭的疗效,评价普通冰冻血浆在血浆置换中应用价值.方法:选择2013-06/2013-12符合条件的慢加急肝衰竭患者114例,分为3组:38例用2000mL普通冰冻血浆,38例用2000 mL新鲜冰冻血浆,38例用1000 mL普通冰冻血浆+1000mL新鲜冰冻血浆两种血浆进行血浆置换.对3组患者血浆置换前后凝血功能和生化指标、治疗过程中的不良反应发生率、血浆置换后7 d生化指标和凝血指标反弹百分比及出院时好转率和死亡率进行比较.结果:新鲜冰冻血浆和普通冰冻血浆及二者各半的混合血浆中FⅡ:C(104.25%±5.43%vs 86.42%±8.76%vs 94.95%±7.52%)、FⅦ:C(88.26%±21.49%vs 89.59%±12.10%vs 88.63%±14.46%)差异无统计学意义(P>0.05);FⅤ:C(103.28%±25.32%vs72.13%±21.49%vs 89.98%±22.33%)差异显著(P<0.01);凝血功能的差异具有显著性(P<0.05).3组患者血浆置换前生化指标和凝血因子及凝血功能没有显著性差异(P>0.05);置换术后凝血因子、凝血功能及生化指标、治疗过程中不良反应发生率、血浆置换术后7 d生化指标和凝血指标反弹百分比及出院时好转率和死亡率没有显著性差异(P>0.05).结论:在新鲜冰冻血浆短缺时,普通冰冻血浆可以部分或全部代替新鲜冰冻血浆进行血浆置换.

AIM： To compare the therapeutic efficacy of plasma exchange using fresh frozen plasma （FFP）, frozen plasma （FP） or FFP ＋ FP （1 ： 1） in patients with acute-on-chronic liver failure. METHODS： One hundred and fourteen patients with acute-on-chronic liver failure hospitalized at our hospital from June 2013 to December 2013 were divided into three groups, including 38 cases who underwent plasma exchange with FFP, 38 cases with FP, and 38 cases with FFP ＋ FP （1 ： 1）. Before plasma exchange, we compared the activation of coagulation factors and clotting function of FFP, FP and FFP ＋ FP. Biochemical and clotting indicators before and after plasma exchange in the three groups of patients were tested and compared. RESULTS： The activation levels of FII：C （104.25% ± 5.43% vs 86.42% ±8.76% vs 94.95% ± 7.52%） and FVII：C （88.26%± 21.49% vs 89.59% ± 12.10% vs 88.63%± 14.46%） in FFP, FP and their mixture showed no significantly differences （P 〉 0.05）; however, the activation level of F V ：C （103.28%± 25.32% vs 72.13% ±21.49% vs 89.98% ± 22.33%）, prothrombin time, activated partial prothrombin time, prothrombin activity, international normalized ratio, and the contents of Fig were significantly different （P 〈 0.05）. There were no significant differences in clotting and biochemical indicators after plasma exchange, the incidence of adverse reactions during the procedure, rebound percentage of some indicators after 7 d, or the mortality and improvement rates when discharged in the three groups. CONCLUSION： FFP can be replaced by FP in plasma exchange when there is a shortage of FFP.