血浆置换频次对早期慢加急性肝衰竭患者临床疗效的影响

The influence of the frequency of plasma exchange on the clinical efficacy of patients with early acute-on-chronic liver failure

目的:探讨血浆置换频次对早期慢加急性肝衰竭(ACLF)患者临床疗效的影响。方法:2018年3月-2020年2月收治ACLF患者50例,所有患者进行1~5次的血浆置换治疗,记录所有患者置换频次的治疗情况,采用终末期肝病模型(MELD)进行治疗前后的预后评价;记录不同频次血浆置换治疗后的肝功能指标水平,记录患者血浆置换频次及置换量、不良反应发生情况。结果:50例患者治疗后MELD评分低于治疗前,差异有统计学意义(P<0.05)。第5次置换治疗后,碱性磷酸酶(ALT)、总胆红素(TBil)水平明显改善,差异有统计学意义(P<0.05);白蛋白(ALB)、总胆汁酸(TBA)水平无明显变化,差异无统计学意义(P>0.05);50例患者血浆置换平均频次为(3.21±1.67)次;补充血浆量平均为(2311.78±278.55)mL/次;50例患者血浆置换172次,皮疹发生率为13.95%,畏冷发生率为1.74%,发热反应发生率为5.23%,静脉穿刺血肿发生率为2.32%。结论:对早期ACLF患者进行连续多次血浆置换,可持续改善肝功能;评估患者病情状况,及时调整血浆置换频次,以适应患者实现准确输血。

Objective:To investigate the effect of plasma exchange frequency on the clinical efficacy of patients with early acute-on-chronic liver failure(ACLF).Methods:From March 2018 to February 2020,50 ACLF patients were selected.All patients received 1 to 5 plasma exchange treatments.The treatment situation of replacement frequency in all patients was recorded.The end-stage liver disease model(MELD)was used to evaluate the prognosis before and after treatment.We recorded the liver function index levels after different frequency plasma exchange treatments,recorded the patient's plasma exchange frequency and exchange volume,and the occurrence of adverse reactions.Results:The MELD score of 50 patients after treatment was significantly lower than that before treatment,the difference was statistically significant(P<0.05).After the fifth replacement therapy,ALT and TBil levels were significantly improved,the difference was statistically significant(P<0.05).The ALB and TBA levels did not change significantly,the difference was not statistically significant(P>0.05).The average frequency of plasma exchange in 50 patients was(3.21±1.67)times.The average amount of supplemented plasma was(2311.78±278.55)mL/time.50 patients had plasma exchanges for 172 times,the incidence of rash was 13.95%,the incidence of chills was 1.74%,and the incidence of febrile reactions was 5.23%,and the incidence of venipuncture hematoma was 2.32%.Conclusion:Perform multiple plasma exchanges in patients with early ACLF can continuously improve liver function.Evaluate the patient's condition and adjust the frequency of plasma exchange in time to adapt to the patient to achieve accurate blood transfusion.