高原地区肝衰竭患者血浆置换与双重血浆分子吸附联合血浆置换治疗12周临床疗效研究

Clinical Curative Effect Research of Plasma Exchange and Dual Plasma Molecular Adsorption Combined with Plasma Exchange Therapy for Liver Failure Patients at High Altitude for 12 Weeks

目的探索高原地区血浆置换(PE)与双血浆分子吸附系统(DPMAS)联合PE治疗肝衰竭后12周疗效分析。方法回顾性分析96例肝功能衰竭患者的临床数据,按不同的治疗方法分为对照组(n=46)和观察组(n=50),分别对患者实施PE、DPMAS+PE治疗,对比两组治疗前后的临床症状、肝功能变化、凝血功能变化,所有患者随访12周。结果经人工肝治疗,96例病人生存率达84.37%;其中,观察组死亡率22%;对照组死亡率为15.22%。治疗后4周疗效分析,两组组内治疗后总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)较治疗前均降低,观察组降低幅度更大;白蛋白(ALB)、凝血酶原活动度(PTA)较治疗前均升高(P<0.05),观察组升高幅度更大;两组组间降低及升高幅度比较差异有统计学意义(P<0.01)。结论PE、PMASPE+PE两种人工肝治疗模式治疗肝衰竭均有效,PMASPE+PE治疗在改善凝血功能及ALB水平方面效果优于PE治疗。

Objective To explore effect of plasma exchange(PE)and dual plasma molecular adsorption system(DPMAS)combined with PE in treatment of liver failure at high altitude for 12 weeks.Methods The paper reviewed and analyzed clinical data of 96 liver failure patients,and divided them into control group(n=46)and observation group(n=50)according to different treatment methods,treated with PE and DPMAS+PE respectively.Clinical symptoms,liver function changes and coagulation function changes were compared between two groups before and after treatment.All patients were followed up for 12 weeks.Results After artificial liver treatment,survival rate of 96 patients reached 84.37%;among them,mortality rate in observation group was 22%,that in control group was 15.22%.After 4 weeks of treatment,effect analysis showed,total bilirubin(TBIL)and alanine aminotransferase(ALT)levels in both groups were lower than before treatment,with higher decrease in observation group.Albumin(ALB)and prothrombin activity(PTA)levels were higher than before treatment(P<0.05),with higher increase in observation group,there was statistically significant difference in decrease and increase magnitude between two groups(P<0.01).Conclusion Both PE and PMASPE+PE artificial liver treatment modes are effective in treatment of liver failure,and PMASPE+PE treatment can achieve better effect than PE treatment in improving coagulation function and ALB levels.