血浆置换应用羟乙基淀粉替代部分血浆治疗肝衰竭的临床观察

Clinical observation of plasma exchange replacement of partial plasma with hydroxyethyl starch in the treatment of patients with liver failure

目的探讨羟乙基淀粉用于血浆置换(plasma exchange,PE)治疗肝衰竭患者的临床应用价值。方法回顾性分析在首都医科大学附属北京佑安医院住院并进行PE治疗的肝衰竭患者80例,根据置换量及置换液成分不同分为血浆组和代血浆组。血浆组共48例患者,共治疗70次。代血浆组共32例患者,共治疗55次。比较两组患者治疗前后生化指标、主要肝功能指标变化情况,比较两组患者治疗后24h、72h总胆红素(TBIL)下降率,比较两种方法对胆红素水平不同的肝衰竭患者治疗效果的影响。结果两组治疗后ALT、AST、TBIL、DBIL、GLO均较治疗前明显下降(P<0.05);血浆组ALB治疗前后差异无统计学意义(P>0.05),而代血浆组治疗后ALB较治疗前明显降低(P<0.05)。治疗后代血浆组TBIL、DBIL下降率均明显高于血浆组[(TBIL:(42.9±10.3)%vs(36.2±9.2)%,P<0.05;DBIL:(39.5±12.0)%vs(34.4±8.7)%,P<0.05)]。两组治疗后24h、72hTBIL下降率比较,差异均无统计学意义(P>0.05)。无论胆红素水平高低,血浆组与代血浆组治疗后24h、72hTBIL下降率比较,差异均无统计学意义(P>0.05)。结论与全部应用血浆作为置换液相比,在应用血浆的基础上加用羟乙基淀粉作为置换液进行PE治疗可以提高治疗后即刻胆红素的清除率,但不能降低治疗后胆红素的“反弹”幅度;当使用羟乙基淀粉部分替代血浆进行PE治疗后,应注意必要时白蛋白的补充。

Objective To investigate the clinical value of hydroxyethyl starch in plasma exchange (PE) for patients with liver failure. Methods Eighty cases of liver failure hospitalized in Beijing YouAn Hospital treated with PE were analyzed retrospectively.All the patients with liver failure were divided into plasma group and plasma substitute group according to replacement fluid and replacement volume.In plasma group,48 patients were treated with PE for 70 times;In plasma substitute group,32 patients were treated with PE for 55 times.The changes of main liver function indexes before and after treatment were compared between two groups.The decrease rates of TBIL 24 hours and 72 hours after treatment were compared between two groups,and the effects of two methods on the treatment of liver failure patients with different bilirubin levels were compared. Results After treatment,ALT,AST,TBIL,DBIL and GLO in two groups were significantly lower than before treatment ( P <0.05).There was no significant difference in ALB before and after treatment in those in plasma group ( P >0.05),but ALB in plasma substitute group was significantly lower after treatment than before treatment ( P < 0.05 ).The decrease rates of TBIL and DBIL in plasma substitute group were significantly higher than those in plasma group [(TBIL:(42.9±10.3)% vs (36.2±9.2)%,P <0.05;DBIL:( 39.5± 12.0 )% vs (34.4± 8.7 )%,P < 0.05 )].The decrease rates of TBIL in plasma group at 24 hours and 72 hours after treatment was higher than plasma substitute group,but there was no significant difference ( P >0.05).No matter the level of bilirubin,there was no significant difference in the decrease rate of TBIL between two groups at 24 hours and 72 hours after treatment ( P > 0.05). Conclusion Compared with used all plasma as replacement fluid,used hydroxyethyl starch partially replace plasma can improve the clearance rate of bilirubin after PE treatment,but it can not reduce the “rebound” of bilirubin.When hydroxyethyl starch is used partially replace plasma for PE,attention should be paid to albumin supplementation.