无肝素化CRRT治疗肝硬化并肝性脑病的疗效观察

Clinical Observation of Non-Heparin CRRT in Treatment of Liver Cirrhosis Complicated with Hepatic Encephalopathy

目的观察无肝素化连续性肾脏替代(CRRT)对肝硬化并肝性脑病患者血氨、IL-6、IL-10、TNF-α水平及预后的影响。方法选取60例肝硬化并肝性脑病患者,随机分为对照组32例和观察组28例。对照组仅给予常规护肝、抗肝昏迷治疗。观察组在常规护肝、抗肝昏迷治疗基础上加用无肝素化连续性肾脏替代(CRRT)治疗。比较两组患者血氨、白介素-6、白介素-10、TNF-α水平、凝血酶原时间的变化以及神志转清的时间和死亡率。结果观察组患者血氨、白介素-6、白介素-10、TNF-α水平较对照组明显下降(P<0.05),凝血酶原时间变化无显著差异(P>0.05),而且神志转清时间显著短于对照组,死亡率明显低于对照组,差异有统计学意义(P<0.05)。结论无肝素化CRRT用于治疗肝硬化并肝性脑病患者可以有效降低患者血氨、炎性介质白介素-6、白介素-10、TNF-α水平,可以缩短神志转清时间,显著降低死亡率,且对患者凝血酶原时间无影响,是治疗肝硬化并肝性脑病的一个比较安全、有效的方法。

Objective To observe the effect of non-heparinized continuous renal replacement(CRRT)on serum ammonia,IL-6,IL-10,TNF-alpha levels and prognosis in patients with cirrhosis and hepatic encephalopathy.Methods 60 patients with cirrhosis and hepatic encephalopathy were randomly divided into two groups,the conventional treatment group(control group)and the non-heparinized CRRT treatment group(observation group).The control group wasonly given routine liver protection and anti-hepatic coma treatment,while the observation group was given routine liver protection and anti-hepatic coma treatment,heparinized continuous renal replacement(CRRT)was added.After treatment,blood ammonia,plasma IL-6,IL-10,TNF-alpha concentration and prothrombin time were measured by venous blood sampling at admission and 24 hours after admission.The levels of blood ammonia,interleukin-6,interleukin-10,TNF-alpha,prothrombin time and the time of being in one's right mind and mortality were compared between the two groups.Results The levels of serum ammonia,interleukin-6,interleukin-10 and TNF-alpha in the observation group were significantly lower than those in the control grou(P<0.05).There was no significant difference in prothrombin time,and the time of being in one's right mind was significantly shorter than that in the control group(P>0.05).The mortality rate was significantly lower than that in the control group.The difference between the two groups was statistically significant(P<0.05).Conclusion Non-heparinized CRRT can effectively reduce the levels of serum ammonia,inflammatory mediators interleukin-6,interleukin-10 and TNF-alpha in patients with liver cirrhosis and hepatic encephalopathy.It can short the time of being in one's right mind and significantly reduce mortality,and have no effect on prothrombin time.It is one of safe and effective methodsfor hepatic cirrhosis and hepatic encephalopathy.