双重血浆分子吸附系统治疗肝衰竭患者发生血管迷走神经反应相关因素分析及其处理对策研究

Vasovagal reaction in patients with liver failure during double plasma molecular adsorption system treatment

目的探讨影响双重血浆分子吸附系统(DPMAS)治疗肝衰竭(LF)患者发生血管迷走神经反应(VVR)的相关因素和处理对策。方法2021年1月~2022年3月山西白求恩医院消化内科诊治的LF患者82例和LF前期患者17例,均接受DPMAS治疗。VVR诊断依据患者在仰卧位时出现心动过缓(HR<60次/分)和低收缩压(SBP<100 mmHg),并伴有恶心、出汗、腹部不适、视力模糊、胸闷、排便、头晕、晕厥等相关症状。结果在99例患者417例次的DPMAS治疗过程中,8例患者发生13例次(3.1%)VVR;在DPMAS治疗前,VVR组SBP、心率和静脉压分别为(105.7±8.7)mmHg、(71.3±11.2)bpm和(3.5±7.3)mmHg,均显著低于或慢于非VVR组【分别为(114.6±14.7)mmHg、(82.7±15.0)bpm和(14.7±16.5)mmHg,P<0.05】,而两组在舒张压、平均动脉压、动脉压和跨膜压方面,无显著性差异(P>0.05);在DPMAS治疗前SBP≤110 mmHg人群,VVR发生率为5.7%,占发生VVR例次的76.9%,在SBP>110 mmHg人群,VVR发生率为1.2%,占发生VVR例次的23.1%;在所有发生VVR的患者,停止分浆泵,给予羟乙基淀粉氯化钠注射液500 ml静脉滴注,均改善症状;对于SBP偏低(≤110mmHg)的患者,治疗前预防性给予羟乙基淀粉氯化钠注射液静脉滴注能有效降低VVR发生率。结论DPMAS治疗相关VVR是一种较为少见的并发症。治疗前SBP偏低是影响VVR发生的重要因素,给予羟乙基淀粉氯化钠注射液是预防VVR发生的主要措施。

Objective The aim of this study was to investigate vasovagal reaction(VVR)in patients with liver failure(LF)during double plasma molecular adsorption system(DPMAS)treatment.Methods 82 patients with LF and 17 patients with pre-LF were encountered in our hospital between January 2021 and March 2022,and all underwent DPMAS treatment.The VVR was defined as decreased blood pressure and slowed heart beats with concomitant symptoms.Results Out of the 99 patients with LF or pre-LF,the incidence of VVR was 3.1%in 417 times of DPMAS from 8 patients;before the DPMAS treatment,the systolic blood pressure,heart beats and venous pressure in patients with VVR were(105.7±8.7)mmHg,(71.3±11.2)bpm and(3.5±7.3)mmHg,all significantly lower or slower than[(114.6±14.7)mmHg,(82.7±15.0)bpm and(14.7±16.5)mmHg,respectively,P<0.05]in patients without VVR,while there were no significant differences as respect to the diastolic pressure,mean arterial pressure,arterial pressure and transmembrane pressure between the two groups(P>0.05);the incidence of VVR was 5.7%in patients with SBP≤110 mmHg before DPMAS,accounting for 76.9%of all,while the VVR was 1.2%in patients with SBP>110 mmHg,accounting for 23.1%of all;in all patients with VVR,the DPMAS was discontinued,administered with hydroxyethyl starch sodium chloride intravenously,and all recovered;the prophylactic infusion of hydroxyethyl starch sodium chloride intravenously in patients with SBP≤110 mmHg before DPMAS decreased the incidence of VVR.Conclusions The DPMAS treatment-related VVR is a relatively rare complication,and the decreased SBP and slow HR before treatment are the important factors impacting the occurrence of VVR.The intravenous infusion of hydroxyethyl starch sodium chloride is the main measure to prevent the occurrence of VVR.