双重血浆分子吸附模式人工肝在重症急性肝衰竭患者中的应用效果

Application Effect of Dual Plasma Molecular Adsorption System Artificial Liver in Patients with Severe Acute Liver Failure

目的观察双重血浆分子吸附(DPMAS)模式人工肝对入住重症监护室(ICU)的急性肝衰竭患者的疗效。方法选取2019年8月-2021年5月入住我院ICU的急性肝衰竭患者66例,根据治疗方法将其分为观察组(n=34)和对照组(n=32)。两组在综合内科保守治疗基础上,观察组患者接受DPMAS模式人工肝治疗,对照组患者采用血浆置换(PE)治疗。比较两组上机前后的血液检验参数(肝功能、凝血项、电解质、血常规、炎性指标、炎性介质)、临床疗效、不良反应、平均住院日和28 d生存率。结果观察组上机治疗后TBIL、ALT、AST、WBC、炎性指标和炎性介质均较上机前下降,差异有统计学意义(P<0.05);对照组上机治疗后肝功能指标、炎性指标和炎性介质均较上机前下降,PTA比上机前升高,差异有统计学意义(P<0.05);两组ALB、PTA上机前后的变化率比较,差异有统计学意义(P<0.05);两组总有效率、平均住院日和28 d生存率比较,差异无统计学意义(P>0.05);观察组不良反应总发生率低于对照组(8.82%vs 37.50%),差异有统计学意义(P<0.05)。结论DMPAS与PE对急性肝衰竭患者都具有较好的疗效,但DPMAS治疗能克服PE治疗的局限性,有效改善急性肝衰竭患者的症状,提升救治成功率,安全性良好,可作为在血浆紧张情况下的人工肝治疗的一种优先选择。

Objective To observe the effect of dual plasma molecular adsorption system(DPMAS)artificial liver on patients with acute liver failure in intensive care unit(ICU).Methods A total of 66 patients with acute liver failure admitted to ICU of our hospital from August 2019 to May 2021 were selected and divided into observation group(n=34)and control group(n=32)according to treatment methods.On the basis of comprehensive medical conservative treatment,patients in the observation group received DPMAS artificial liver treatment,while patients in the control group received plasma exchange(PE)treatment.The blood test parameters(liver function,coagulation,electrolyte,blood routine,inflammatory indexes,inflammatory mediators),clinical efficacy,adverse reactions,average hospitalization days and 28-day survival rate were compared between the two groups before and after operation.Results TBIL,ALT,AST,WBC,inflammatory indexes and inflammatory mediators in the observation group after treatment were lower than those before treatment,and the difference was statistically significant(P<0.05).The liver function indexes,inflammatory indexes and inflammatory mediators in the control group after treatment were lower than those before treatment,while PTA was higher than that before treatment,and the difference was statistically significant(P<0.05).There was statistically significant difference in the change rates of ALB and PTA between the two groups before and after commissioning(P<0.05).There was no significant difference in the total effective rate,average length of stay and 28-day survival rate between the two groups(P>0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group(8.82%vs 37.50%),and the difference was statistically significant(P<0.05).Conclusion Both DMPAS and PE have good curative effect on patients with acute liver failure,but DPMAS treatment can overcome the limitations of PE treatment,effectively improve the symptoms of patients with acute liver failure,improve the success rate of treatment,and has good safety,which can be used as a preferred choice for artificial liver treatment under plasma tension.