不良反应对人工肝治疗即刻效应的影响

Effects of Adverse Reactions on Immediate Effects of Artificial Liver Therapy

目的观察在血浆置换(PE)和分子吸附再循环系统(MRAS)治疗过程的不良反应及其对治疗即刻效应的影响。方法选择住院且行人工肝治疗重型病毒性肝炎患者87例,根据治疗方法分为PE组47例(行人工肝治疗70例次)和MARS组40例(行人工肝治疗47例次),每组按是否发生不良反应分为有反应组和无反应组,观察治疗过程中发生的不良反应,记录患者人工肝前后各检测指标[血丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)、总蛋白(TP)、白蛋白(ALB)、血红蛋白(Hb)、白细胞计数(WBC)、红细胞计数(RBC)、血小板计数(PLT)、肌酐(Cr)、尿素氮(BUN)以及血电解质K^+、Na^+、Cl^-、Ca^(2+)]。结果1)PE和MARS均能有效降低ALT、TBIL、DBIL、Cr和Hb、PLT、RBC;PE对降低胆红素浓度的能力高于MARS,而清除Cr不如MARS。2)人工肝过程中不良反应发生率达53.00%,PE的不良反应率高于MARS(61.43%比40.43%,P<0.05);PE组低血钙反应最多,而MARS组的低血压反应最多(P<0.05)。3)不良反应的发生与治疗类型(PE或MARS)、治疗前患者Ca2+浓度以及RBC有关(P<0.05);不良反应对治疗前后TBIL、DBIL、Cr、K+、WBC值的变化有影响(P<0.05)。结论人工肝过程容易发生不良反应,不良反应对治疗前后TBIL、DBIL、Cr、K+、WBC值的变化有影响。

Objective To observe the adverse reactions in the treatment with plasma exchange(PE)and molecular adsorbent recirculating system(MRAS),and to investigate their influences on immediate effects.Methods Eighty-seven inpatients receiving artificial liver therapy for severe viral hepatitis were divided into PE group(47 patients,70 treatments)and MARS group(40 patients,47 treatments).Each group was further divided into adverse reaction group and non-adverse reaction group.The incidence of adverse reactions was recorded during the treatment.The alanine aminotransferase(ALT),total bilirubin(TBIL),direct bilirubin(DBIL),total protein(TP),albumin(ALB),hemoglobin(Hb),creatinine(Cr),urea nitrogen(BUN),K+,Na+,Cl-and Ca 2+levels,red blood cell(RBC)count,white blood cell count(WBC),and platelet(PLT)count were measured before and after treatment.Results Both PE and MARS effectively reduced the ALT,TBIL,DBIL,Cr and Hb levels,PLT count,and RBC count.However,PE was superior to MARS for decreasing bilirubin concentration but inferior to MARS for clearing Cr.The incidence of adverse reactions was 53.00%during artificial liver therapy,and that in PE group was higher than that in MARS group(61.43%vs 40.43%,P<0.05).The most frequent adverse reactions were hypocalcemia and hypotension in PE group and MARS group,respectively(P<0.05).The adverse reactions were related to the type of treatment(PE or MARS),Ca 2+concentration and RBC count(P<0.05),and had effects on the changes in TBIL,DBIL,Cr,K+and WBC count before and after treatment(P<0.05).Conclusion Adverse reactions are common in artificial liver therapy and exert effects on the changes in TBIL,DBIL,Cr,K+and WBC count before and after treatment.