白蛋白透析联合胆红素吸附治疗心脏术后急性肝衰竭临床研究

Clinical study of albumin dialysis combined with bilirubin adsorption in the treatment of acute liver failure after cardiac surgery

目的研究白蛋白透析联合胆红素吸附对心脏术后急性肝衰竭治疗的安全性及有效性。方法回顾性分析阜外医院自2014年8月~2016年12月期间运用白蛋白透析联合胆红素吸附治疗的7例心脏术后急性肝衰竭患者数据。记录患者治疗前后肝功能及胆红素、凝血功能等指标。结果 7例患者全部肝功能好转并转出重症监护室,6例患者顺利出院,1例患者合并院内感染死亡。治疗前后患者谷丙转氨酶(alanine aminotransferase,ALT)及谷草转氨酶(aspartate aminotransferase,AST)分别由(632±197)U/L及(384±125)U/L下降至(516±149)U/L和(277±112)U/L,有统计学差异(t=4.692,P=0.017;t=3.012,P=0.033)。治疗前总胆红素(759±144)μmol/L,直接胆红素(544±115)μmol/L,治疗后总胆红素(441±97)μmol/L,直接胆红素(299±67)μmol/L(t=8.240,P<0.001;t=6.119,P=0.001)。治疗期间患者循环稳定,无严重并发症。结论白蛋白透析联合胆红素吸附对心脏术后急性肝衰竭患者是一种安全有效的方法。

Objective To evaluate the safety and efficacy of albumin dialysis combined with bilirubin adsorption in the treatment of acute liver failure after cardiac surgery. Methods Seven patients with acute liver failure after cardiac surgery treated in Fuwai Hospital between Aug. 2014 to Dec. 2016 were retrospec-tively analyzed. Results of liver enzymes, bilirubin and blood coagulation tests were recorded before and after treatment. Results Liver function recovered in all the 7 patients, of whom 6 discharged from hospital and one died of nosocomial infection. After the treatment, alanine aminotransferase （ALT） decreased from （632 ＆#177; 197） U/L to （516＆#177;149） U/L （t=4.692, P=0.017）, aspartate aminotransferase （AST） decreased from （384＆#177;125） U/L to （277 ＆#177; 112） U/L （t=3.012, P=0.033）, total bilirubin from （759 ＆#177; 144） μmol/L to （441 ＆#177; 97） μmol/L （t=8.240, P〈0.001）, and direct bilirubin from （544＆#177;115） μmol/L to 299＆#177;67 μmol/L （t=6.119, P=0.001）. Circula-tion status of the patients was stable during the treatment, and no serious complications happened. Conclu-sion Albumin dialysis combined with bilirubin adsorption is a safe and effective method for acute liver fail-ure after cardiac surgery.