不同抗凝药物在双重胆红素吸附联合血浆置换对肝衰竭的治疗效果及安全性比较

Comparison of the efficacy and safety of different anticoagulant drugs in the treatment of liver failure with dual bilirubin adsorption combined with plasma exchange

目的观察不同抗凝药物在双重胆红素吸附联合血浆置换(Dual plasma molecule adsorption+Plasma exchange DPMAS+PE)治疗肝衰竭中抗凝疗效及安全性。方法收集新疆医科大学第一附属医院感染病肝病中心2020年9月30日—2021年3月31日收治的83例次各种疾病所导致的肝衰竭患者的临床资料,对使用普通肝素及低分子肝素钠抗凝进行双重胆红素吸附联合血浆置换的治疗进行回顾性分析。观察两组不同抗凝药物在人工肝治疗前后各项实验室指标及出血和血栓风险。结果两组不同抗凝模式的非生物型人工肝治疗肝衰竭均可以改善患者肝功能、纤维蛋白原及C-反应蛋白(CRP)(P<0.05)。普通肝素组较低分子肝素钠组更易形成血栓(P<0.05)。低分子肝素钠组较普通肝素组对于活化部分凝血活酶时间(APTT)延长时间改善变化差异有统计学意义(P<0.05),低分子肝素钠组较普通肝素组对于谷丙转氨酶(ALT)及谷草转氨酶(AST)下降水平改善明显(P<0.05)。普通肝素组下降较低分子肝素钠组对于CRP下降水平改善明显(P<0.05)。结论两组不同抗凝模式非生物型人工肝对肝衰竭治疗均有一定疗效,低分子肝素钠组较普通肝素组更能降低患者转氨酶水平。普通肝素组较低分子肝素钠组患者易导致血栓形成。

Objective To observe the anticoagulant efficacy and safety of different anticoagulant drugs in the treatment of liver failure with dual bilirubin adsorption combined with plasma exchange.Methods A collection of 83 samples of their clinical data with liver failure caused by various diseases from the Department of Infectious Diseases and Liver Diseases of the First Affiliated Hospital of Xinjiang Medical University from September 30, 2020 to March 31, 2021 were treated with unfractionated heparin and low molecular heparin sodium for anticoagulation. A retrospective analysis of dual bilirubin adsorption combined with plasma exchange treatment was performed. The various laboratory indicators and the risk of bleeding and thrombosis before and after artificial liver treatment with different anticoagulant drugs were observed and recorded in the two groups. Results The two groups of non-biological artificial livers with different anticoagulation modes can improve liver function, fibrinogen and C-reactive protein(CRP)(P<0.05). The lower molecular weight heparin sodium group was more likely to form thrombus compared with the unfractionated heparin group(P<0.05). Compared with the unfractionated heparin group, the low-molecular-weight heparin sodium group had a statistically significant difference in the improvement of activated partial thromboplastin time(APTT)prolongation time(P<0.05). Compared with the unfractionated heparin group, the low-molecular-weight heparin sodium group had a significant improvement in the decreased levels of alanine aminotransferase(ALT) and aspartate aminotransferase(AST)(P<0.05). The lower molecular weight heparin sodium group significantly improved the decreased level of C-reactive protein compared with the unfractionated heparin group(P<0.05). Conclusion The two groups of non-biological artificial livers with different anticoagulation modes have a certain effect on the treatment of liver failure. The low-molecular-weight heparin sodium group can reduce the patient’s transaminase level more than the unfractionated heparin group. Patients in the unfractionated heparin group and the lower molecular weight heparin sodium group are prone to thrombosis.