双重血浆分子吸附系统对急性肝衰竭临床疗效研究

The observational study on the clinical effect of double plasma molecular adsorbent system in patients with acute liver failure

目的:研究双重血浆分子吸附系统对严重肝衰竭患者的治疗效果。方法:回顾性分析急性肝功能衰竭行双重血浆分子吸附系统(DPMAS)治疗患者45例的临床资料,观察临床疗效,治疗前后患者临床症状、胆红素水平、凝血功能、凝血酶原活动度(PTA)、血常规、乳酸、其他肝功能及电解质指标。结果:45例患者行DPMAS治疗共73次,显效12例,有效22例,无效11例,总有效率75.56%。DPMAS治疗后总胆红素193.29±109.26μmol/L,直接胆红素148.19±83.49μmol/L,分别低于治疗前的271.95±147.92μmol/L(P=0.0004)和201.24±98.66μmol/L(P=0.0006),差异均有统计学意义。治疗前12小时PT及APTT分别为18.24±9.59 s,65.49±57.64 s,治疗后12小时PT及APTT分别为21.63±11.63 s,79.68±34.83 s,较治疗前有所延长,但差异均无统计学意义(P>0.05)。治疗前12小时PTA(51.46±22.12)%,治疗后12小时为(46.25±22.46)%,较治疗前有所下降,但差异无统计学意义(P>0.05)。第一次DPMAS治疗前PTA(49.11±20.22)%,完成最后一次DPMAS治疗后PTA为(57.69±19.57)%,较治疗前升高,差异有统计学意义(P<0.05)。DPMAS治疗后患者AST、ALT较前下降,但差异均无统计学意义(P>0.05)。治疗后TBA、ALB及球蛋白(GLB)较前明显下降,差异均有统计学意义(P<0.05)。发生不良反应13例次(17.8%),包括轻度皮肤瘙痒、皮疹、发热、呕吐、胸闷,经对症处理后缓解。结论:DPMAS对急性肝功能衰竭治疗效果良好,对内环境影响较小,不良反应轻,值得临床推广。

Objective:To investigate the therapeutic effect of double plasma molecular adsorbent system in patients with acute liver failure.Methods:A retrospective study of 45 patients diagnosed as acute hepatic failure and treated with double plasma molecular adsorbent system(DPMAS)was made.Data of liver function,blood routine,blood lactate concentration,electrolyte,coagulation functions and prothrombin activity(PTA)within 12 hours before and after the treatment of DPMAS were collected.The clinical symptoms,blood bilirubin level,coagulation function,prothrombin activity,blood routine,blood lactate concentration,other liver functions and electrolyte parameters were observed and compared before and after DPMAS treatment.Results:Forty-five patients were treated with DPMAS for 73 times.The total effective rate was 75.56%,12 cases were improved significantly,22 cases were effective,and 11 cases had poor therapeutic effect.The symptoms of most patients were improved to different degrees after the treatment of DPMAS.The parameters of total bilirubin(193.29±109.26μmol/L)and direct bilirubin(148.19±83.49μmol/L)were significantly decreased after DPMAS treatment each time(P<0.01).Compared with 12 hours before DPMAS treatment,PT(21.63±11.63 s)and APTT(79.68±34.83 s)were prolonged and prothrombin activity(PTA)was decreased at 12 hours after DPMAS treatment,but there was no significant difference(P>0.05).After the completion of all DPMAS treatments,the prothrombin activity(PTA)of the patients(57.69±19.57)%after the last DP-MAS treatment increased significantly compared with that before the first DP-MAS treatment(P<0.05).The parameters of glutamic oxaloacetic transaminase(AST)and alanine transaminase(ALT)decreased after DPMAS treatment,and there was no significant difference(P>0.05).Total bile acid concentration(TBA),albumin(ALB)and globulin(GLB)were significantly declined after DPMAS treatment(P<0.05).The leucocyte count of blood routine increased after treatment,and the difference was statistically significant(P<0.05).There were no significant changes in levels of erythrocyte,hemoglobin,platelet,blood lactate concentration,serum sodium and potassium after DPMAS treatment(P>0.05).During DPMAS treatment,13 cases had treatment-related side effects.The incidence of adverse reactions was 17.8%.The side effects were mild,no local bleeding or active bleeding was found after DPMAS treatments.Conclusion:DPMAS has a favorable therapeutic effect on acute liver failure,and the clinical effect is accurate.It has less impact on internal environment and less side effects.The DPMAS treatment is safe,and worthy of promotion and application.