血浆灌流对肝衰竭患者凝血功能影响特点分析

Changes of blood coagulation function parameters after plasma perfusion in patients with liver failure

目的分析血浆灌流对肝衰竭患者凝血功能影响的特点。方法选取我院2014年1月~2015年6月收治的肝衰竭患者60例。所有患者给予常规治疗措施,且在常规治疗措施基础上实施血浆灌流治疗方案,结合患者情况,每例患者进行1~4次血浆灌流治疗。分析患者在血浆灌流前和第一次血浆灌流1 h后和血浆灌流2 h后凝血功能指标凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、凝血酶时间(TT)、血小板(PLT)以及D-二聚体(D-D)水平的变化。结果在血浆灌流1 h后和血浆灌流2 h后肝衰竭患者PTA水平分别为(28.41±3.09)%和(29.73±3.13)%,APTT水平分别为(32.79±5.80)s和(31.05±5.62)s,INR水平分别为(1.73±0.69)和(1.61±0.65),FIB水平分别为(3.15±0.90)g/L和(3.25±0.91)g/L,TT水平分别为(15.29±4.10)s和(14.86±4.12)s,与灌流前相比,差异均无显著性差异;在血浆灌流1 h后和血浆灌流2 h后患者外周血PLT计数分别为(101.59±24.92)×109/L和(119.84±25.16)×109/L,D-D水平分别为(1.63±0.29)mg/L和(1.75±0.30)mg/L,与治疗前相比,差异有统计学意义(P<0.05)。结论血浆灌流在吸附患者血液中不良因子的同时会降低PLT数量,对患者纤溶功能有一定的影响,应注意预防和及时处理。

Objective To investigate the changes of blood coagulation function parameters after plasma perfusion in patients with liver failure. Methods 60 patients with liver failure were enrolled in this study between January 2014 and June 2015. All patients received plasma perfusion at the base of conventional supporting treatment. 1 to 4 plasma perfusions were conducted in each patients according to their own disease circumstance. Coagulation function indexes,including blood PTA,APTT,INR, FIB,Tr,peripheral blood PLT counts and D-dimer,before the first plasma perfusion as well as 1 h and 2 h after plasma perfusion were recorded and compared. Results Blood PTA,AFTT,INR,FIB and Tr levels after plasma perfusion 1 h and 2 h had no difference with those before the plasma perfusion FPTA（28.41±3.09） % 1 h,（29.73±3.13） % 2 h vs. （28.57± 3.17）% before;APTr （32.79±5.80） s 1 h,（31.05±5.62） s 2 h vs. （32.68±5.75） s before;INR（1.73±0.69） 1 h, （1.61±0.65） 2 h vs. （1.69±0.65） before;FIB （3.15±0.90） g/L 1 h,（3.25±0.91） g/L 2 h vs. （3.18±0.92） g/L before and ＂IT （15.29±4.10） g/L 1 h,（14.86±4.12） g/L 2 h vs. （15.24±4.13） s beforeq;However,peripheral blood PLT counts and D-dimer levels after plasma perfusion 1 h and 2 h were significantly different from those before plasma perfusion EPLT count （101.59±24.92）×109/L 1 h,（119.84±25.16）×109/L 2 h vs. （185.43±31.0）×109/L before;D-dimer （1.63±0.29） mg/L 1 h,（1.75±0.30） mg/L 2 h vs.（0.67±0.25） mg/L before,P〈0.05]. Conclusion Plasma perfusion can absorb harmful substances in blood as a therapeutic approach for patients with liver failure, but we should take it into consideration that this therapy might reduce the platelet counts and interfere with the fibrinolytic function.