双重血浆吸附联合血浆置换治疗重型乙型肝炎的临床观察

Clinical observation of double plasma molecular adsorption system combined with plasma exchange in treatment of severe hepatitis B

目的观察双重血浆分子吸附系统联合血浆置换治疗重型乙型肝炎的疗效及安全性。方法 32例重型乙型肝炎患者在内科综合治疗的基础上,根据病情给予双重血浆分子吸附联合血浆置换共治疗40例次,观察治疗前后患者临床症状及肝功能、肾功能、凝血、血常规、电解质、血浆氨、内毒素变化及不良反应,评价其疗效及安全性。结果治疗后患者的临床症状有不同程度的改善,肝功能明显好转:丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB)、总胆汁酸(TBA)显著下降,胆碱酯酶(CHE)上升,凝血酶原时间下降,凝血酶原活动度(PTA)升高,血浆氨降低,与治疗前比较,差异均有统计学意义(P<0.05),内毒素治疗前后均呈阴性,治疗前后血常规及肾功能、电解质均无明显变化,40例次双重血浆分子吸附联合血浆置换治疗中38例次顺利完成治疗,1例次因管路内凝血提前终止治疗,1例次出现血压下降,经对症处理后继续完成治疗。结论双重血浆分子吸附联合血浆置换治疗重型乙型肝炎疗效确切,不良反应少,安全性较高。

Objective To observe the effect and safety of the double plasma molecular adsorption system combined with plasma exchange（PE）in the treatment of severe hepatitis B.Methods Based on the comprehensive treatment with medicines,a total of 32 patients with severe hepatitis B were treated with DPMAS combined with PE treatment for 40 times.Clinical symptoms,liver function,renal function,blood coagulation,blood routine,electrolytes,blood ammonia,endotoxin changes and adverse reactions were investigated before and after treatment;clinical efficacy and safety were evaluated.Results The clinical symptoms of the patients after treatment improved and liver function improved obviously.Compared with before treatment,the levels of alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,total bilirubin（TB）and total bile acid（TBA）were significantly reduced;the levels of cholinesterase（CHE）,prothrombin time（PT）and prothrombin activity（PTA）were significantly increased;the level of plasma ammonia was significantly reduced（P〈0.05）.Endotoxin was negative before and after treatment.Compared with before treatment,blood routine,renal function and electrolytes had no obvious change.38 out of 40 cases of double plasma molecular adsorption system combined with PE achieved complete success,one case was terminated early because of pipeline coagulation,one case was interrupted because of decreased blood pressure,and then,continued after treatment.Conclusion Double plasma molecular adsorption system combined with PE is safe and effective in treating severe hepatitis B with less adverse reactions and higher security.