人工肝血浆置换治疗肝功能衰竭患者对其凝血功能和肝功能指标的影响

The Effect of Artificial Liver Plasma Exchange on Coagulation Function and Liver Function Indexes in Patients with Liver Failure

目的探讨人工肝血浆置换治疗肝功能衰竭患者对其凝血功能和肝功能指标的影响。方法选择我院2017年1月至2018年1月收治的50例肝功能衰竭患者。所有患者实施人工肝血浆置换治疗,采用颈内静脉置管或股静脉置管作为血管通路,并用血浆交换机作为机器,通过血浆置换器引出血液,分离血浆及细胞成分,将血浆致病物质、自身免疫毒物和抗体以及代谢产物去除,并给予等量血浆替代品和细胞成分输回到体内,每周治疗1~2次,共治疗2~3次。分析患者治疗后病情改善时间;治疗前后凝血功能和肝功能指标;不良反应发生率。结果患者治疗后凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、国际标准化比值、总胆红素、天冬氨酸转氨酶、丙氨酸转氨酶水平均明显优于治疗前,P<0.05。患者治疗后病情改善时间是5~6 d,平均病情改善时间是(5.50±0.25)d。患者经治疗后,未出现明显不良反应,仅有5例出现皮肤瘙痒,1例出现手足痉挛。结论肝功能衰竭患者经人工肝血浆置换治疗后,凝血功能和肝功能指标均得到一定程度的改善,效果确切,安全性高。

Objective To investigate the effect of artificial liver plasma exchange on the coagulation function and liver function indexes in patients with liver failure.Methods 50 patients with liver failure admitted to our hospital from January 2017 to January 2018 were selected.All patients are treated with artificial liver plasma exchange treatment.The internal jugular vein or femoral vein catheter is used as the vascular access,and the plasma exchanger is used as a machine,to draw blood through the plasma exchanger,separate plasma and cellular components,and pathogenic substances from the plasma,autoimmune poison,antibodies,and metabolites are removed,and equal amounts of plasma substitutes and cell components are infused back into the body.Treatment is 1 to 2 times a week,for a total of 2 to 3 treatments.Analyze the improvement time after treatment;coagulation function and liver function indexes before and after treatment;the incidence of adverse events of patients.Results After treatment,the prothrombin time,activated partial thromboplastin time,thrombin time,international normalized ratio,levels of total bilirubin,aspartate aminotransferase and alanine aminotransferase were significantly better than before treatment,P<0.05.The improvement time of patients after treatment is 5 to 6 days,and the average improvement time is(5.50±0.25)days.After treatment,the patient had no obvious adverse reactions,only 5 cases had skin itching,and 1 case had hand and foot cramps.Conclusion After the artificial liver plasma exchange treatment in patients with liver failure,the coagulation function and liver function indexes have been improved to a certain extent,the effect is accurate and the safety is high.