双重血浆分子吸附系统在酒精性肝衰竭患者治疗中的应用观察

Clinical observation of DPMAS in the treatment of alcoholic liver failure

目的:探讨双重血浆分子吸附系统(double plasma molecular absorb system,DPMAS)在酒精性肝衰竭患者治疗中的作用及出现的并发症,并给予对症处理,把控DPMAS环节,减少并发症的发生,为临床护理提供依据。方法:选取2019年5月-2022年1月酒精性肝衰竭患者56例,在进行内科综合治疗的基础上接受DPMAS治疗3次,同时医护人员对治疗全过程进行个案跟踪,对比DPMAS治疗的效果,并针对DPMAS应用过程中患者出现的并发症进行回顾性分析。结果:56例酒精肝衰竭患者行双重血浆分子吸附治疗168次,53例好转出院(94.64%),2例死亡(3.57%),1例因经济压力放弃治疗,自动出院;首次治疗前、治疗3次后患者肝功能各项指标对比均改善,谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP),总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)等明显降低(均P<0.001)、凝血酶原活动度(PTA)升高(P<0.001),差异有统计学意义。但在治疗过程中同时发现14例患者在DPMAS应用过程中出现了25次并发症,发生率为14.88%,其中电解质失衡8次、细菌性腹膜炎6次、低血糖4次、口腔真菌感染3次、肺部真菌感染3次、过敏性肺水肿1次。结论:DPMAS治疗酒精性肝衰竭患者效果较好,医护人员通过把控DPMAS前、中、后各环节,及时发现DPMAS使用过程中出现的并发症,并做到有效解决,能够降低患者的病死率,提高其治愈率。

Objective:To investigate the role of double plasma molecular adsorption system(DPMAS)in the treatment of alcoholic liver failure and its complications,as well as provide evidence to clinical nursing.Methods:A total of 56 patients with alcoholic liver failure in the Second Affiliated Hospital of Shandong First Medical University from May 2019 to January 2022 were selected and treated with DPMAS for 3 times based on the comprehensive medical treatment.Meanwhile,the whole treatment process of each case was followed-up by assigned medical staff.Finally,the effects of DPMAS treatment were compared,and the complications caused by DPMAS were retrospectively analyzed.Results:56 patients with liver failure were treated with DPMAS for 168 times,among which 53 patients(94.64%)were improved and discharged,2 patients(3.57%)died,1 patient gave up treatment due to economic pressure and discharged voluntarily.All liver function indexes were improved after the third treatment comparing with that before treatment,with significant decreasing of Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),Gamma-glutamyltranspeptidase(GGT),Alkaline phosphatase(ALP),Total bilirubin(TBIL),Directbilirubin(DBIL),Indirectbilirubin(IBIL)decreased significantly(P<0.001)and increased Prothrombin activity(PTA)(P<0.001).However,25cases(25%)of complications occurred in 14 patients during DPMAS treatment,including 8 cases of electrolyte imbalance,6 cases of bacterial peritonitis,4 cases of hypoglycemia,3 cases of oral fungal infection,3 cases of pulmonary fungal infection,and 1 case of allergic pulmonary edema.Conclusion:Better clinical efficacy could be by DPMAS in treating patients with alcoholic liver failure.However,medical staff should manage all procedures before,during and after DPMAS,timely found complications caused by DPMAS and effectively solve them to improve the cure rate of alcoholic liver failure.