血浆透析滤过治疗重症肝衰竭的临床研究

Clinical research of plasma diafiltration in the treatment of severe liver failure

目的研究血浆透析滤过治疗重症肝衰竭的临床效果。方法回顾性选择南华大学附属长沙中心医院2019年1月至2021年1月收治的64例重症肝衰竭患者的临床资料,其中对照组(n=32)采用血浆置换治疗,观察组(n=32)采用血浆透析滤过治疗,对比两组的临床治疗效果。结果观察组的治疗总有效率为96.88%(31/32),与对照组(78.13%,25/32)比较差异有统计学意义(P<0.05);治疗后观察组与对照组总胆红素、直接胆红素水平比较差异无统计学意义(均P>0.05),但观察组谷丙转氨酶[(94.02±31.31)U/L]显著低于对照组[(160.79±53.55)U/L](P<0.05);观察组治疗后的血清肌酐[(87.80±10.7)μmoI/L]、血氨[(56.80±4.73)μmol/L]水平明显低于对照组[(101.57±25.34)μmoI/L、(101.87±10.34)μmol/L](均P<0.05);观察组血浆用量[(1582.25±125.15)ml]明显少于对照组[(2262.50±208.29)ml](P<0.05);观察组的不良反应发生率[3.13%(1/32)]明显低于对照组[25.00%(8/32)],差异有统计学意义(P<0.05)。结论与血浆置换相比,血浆透析滤过治疗重症肝衰竭可有效改善患者肝功能,对小分子毒素的清除效果明显优于血浆置换,而且血浆用量更少,安全性更高,具有较好的临床应用价值。

Objective To study the clinical effect of plasma diafiltration in severe liver failure.Methods The clinical data of 64 patients with severe liver failure treated in Changsha Central Hospital Affiliated to Nanhua University from January 2019 to January 2021 were retrospectively analyzed.The control group(n=32)was treated with plasma exchange;The observation group(n=32)was treated with plasma dialysis and filtration,and the clinical therapeutic effects of the two groups were compared.Results The total effective rate of observation group was 96.88%(31/32),which was significantly higher than that of control group(78.13%,25/32)(P<0.05).After treatment,there was no significant difference in total bilirubin and direct bilirubin between the observation group and the control group(all P>0.05),but the alanine aminotransferase[(94.02±31.31)U/L]in the observation group was significantly lower than that in the control group[(160.79±53.55)U/L](P<0.05).After treatment,the serum creatinine[(87.80±10.7)μmol/L]and ammonia[(56.80±4.73)μmol/L]in the observation group were significantly lower than those in the control group[(101.57±25.34)μmol/L,(101.87±10.34)μmol/L,all P<0.05].The plasma consumption of observation group[(1582.25±125.15)ml]was significantly less than that of control group[(2262.50±208.29)ml](P<0.05).The incidence of adverse reactions in the observation group was 3.13%(1/32),which was significantly lower than that in the control group[25.00%(8/32)],with statistically significant difference(P<0.05).Conclusions Compared with plasma exchange,plasma dialysis and filtration in the treatment of severe liver failure can effectively improve the liver function of patients,with better clearance of small molecule toxins.Moreover,plasma dialysis and filtration has less amount of plasma use,higher safety,and better clinical application value.