连续性血浆透析滤过在肝衰竭患者中的应用

Continuous plasma dialysis filtration application in patients with liver failure

目的 探讨连续性血浆透析滤过（CPDF）在治疗肝衰竭患者中的疗效及预后影响因素.方法 回顾性分析2015年1月至2015年10月本院重症肝病科住院的69例肝衰竭患者的临床资料,按照治疗方法分为内科治疗联合CPDF的治疗组（28例）和单用内科治疗的对照组（41例）,其中CPDF治疗组根据患者28 d结局分为存活组（20例）和死亡组（8例）,记录相关临床数据,包括实验室指标以及终末期肝病模型（MELD）评分,比较治疗前后上述指标的改变,分析CPDF的疗效以及影响CPDF治疗肝衰竭患者预后的相关因素.结果 治疗组患者经3次CPDF治疗后48 h的ALT、AST、TBIL、Scr、MELD评分以及凝血酶原活动度（PTA）均较治疗前有明显改善,差异有统计学意义（P＜0.05）,其中TBIL、Scr、MELD评分以及PTA的改善明显高于对照组,差异有统计学意义（P＜0.05）.治疗组患者28d存活率（64.3％）明显高于对照组（41.5％）.CPDF治疗组中存活组与死亡组比较,存活组患者的年龄、3次CPDF治疗后48 h的TBIL、Scr及MELD评分明显低于死亡组,PTA明显高于死亡组,差异有统计学意义（P＜0.05）.而两组患者治疗前与3次CPDF治疗后48 h的差值△MELD评分、△TBIL、△Scr、△PTA的比较,差异有统计学意义（P＜0.05）.结论 CPDF联合内科治疗能显著改善肝衰竭患者的肝肾功能、凝血功能以及MELD评分,并提高了患者28 d存活率.多次CPDF治疗后,肝肾功能、凝血功能以及MELD评分较治疗前无改善甚至恶化的肝衰竭患者,预后不良.

Objective To investigate the effect and the prognostic related factor of patients with liver failure （LF） who were treated with continuous plasma dialysis filtration （CPDF）.Methods A retrospective analysis was performed on clinical data of 69 patients was carried out in the intensive care unit of our hospital,during January 2015 to October 2015.According to the treatment methods,the patients were divided into two groups,the medical treatment combined of CPDF in the treatment group （28 cases） and single use medical treatment in the control group （41 cases）.The patients in treatment group were divided into survival group （20 cases） and death group （8 cases）.The relevant clinical data was recorded,including laboratory indexes and the model for end-stage liver disease （MELD） score.The changes of the above indexes were compared before and after the treatments.The curative effect of CPDF and the related factors were analyzed which influenced the prognosis of patients with liver failure treated by CPDF were analyzed.Results In the treatment group,alanine aminotransferase （ALT）,asparate aminotransferase （AST）,total bilirubin （TBIL）,serum creatinine （Scr） levels,MELD scores,and prothrombin activity （PTA） were significantly improved at 48 h after 3 CPDF treatments than before treatment,the difference was statistically significant.The improvement of TBIL,Scr,MELD scores,and PTA was significantly higher than those in the control group,the difference was statistically significant.The survival rate （64.3%） of the treatment group was significantly higher than that of the control group at 28 days （41.5%）.In the survival group,the age of the patients,TBIL,Scr,and MELD score at 48 h after 3 CPDF treatments were significantly lower than those in the death group,PTA was significantly higher than that of the death group,and the difference was statistically significant.Between two groups,the differences of △MELD score,△TBIL,△Scr,and △ PTA before and at 48 hours after 3 CPDF treatments were statistically significant.Conclusions CPDF combined with medicine treatment can significantly improve the liver and kidney function,blood coagulation function and MELD score of the patients with liver failure,as well as the 28 days survival rate of the patients.If the patients with liver failure accepted CPDF whose liver and kidney function,blood coagulation function and MELD score at 48h after 3 CPDF treatments have no improvement and even continue to progress.The prognosis of the patient is poor.