不同模式人工肝治疗对肝衰竭患者肝肾功能及凝血功能的影响

Effect of Different Modes of Artificial Liver Therapy on Liver and Kidney Function and Coagulation Function in Patients with Liver Failure

目的:分析对肝衰竭患者开展不同模式的人工肝治疗的影响。方法:选取2022年1—9月九江市第一人民医院收治的75例肝衰竭患者,经随机数字表法划分成A组、B组、C组,各25例,A组进行双重血浆分子吸附(DPMAS)+血浆置换(PE),B组进行血浆透析滤过(PDF),C组开展PE,比较三组症状改善效果、实验室指标、终末期肝病模型(MELD)评分的变化,并统计不良反应发生情况。结果:三组治疗后的有效率、不良反应发生率基本一致(P>0.05)。三组治疗前血清总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酐(Cr)、白蛋白(ALB)、国际标准化比值(INR)、凝血酶原活动度(PTA)、MELD评分差异均无统计学意义(P>0.05);治疗后,三组TBIL、ALT、AST、Cr、INR、MELD评分较治疗前均降低,C组ALB、PTA较治疗前均升高,A、B组ALB、PTA较治疗前均降低(P<0.05);三组间治疗后的TBIL、ALT、AST、Cr、INR、MELD评分比较,差异均无统计学意义(P>0.05),C组ALB、PTA均高于A、B组(P<0.05)。结论:肝衰竭患者中,将DPMAS+PE、PDF、PE进行灵活应用的疗效良好,无明显优劣,对临床症状的改善均有着较为理想的应用价值。

Objective:To analyze the effects of artificial liver treatment in patients with liver failure.Method:A total of 75 patients with liver failure in Jiujiang NO.1 People's Hospital from January to September 2022 were selected,they were divided into group A,B,C by random number table method,each 25 cases.Group A underwent dual plasma molecular adsorption(DPMAS)+plasma exchange(PE),group B underwent plasma dialysis filtration(PDF),and group C underwent PE.Symptom improvement,laboratory indicators and the end-stage liver disease model(MELD)scores changes of the three groups were compared,and adverse reactions was calculated.Result:The effective rate and adverse reactions incidence rate of the three groups were basically consistent(P>0.05).There were no statistically significant differences in serum total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Cr),albumin(ALB),international normalized ratio(INR),prothrombin activity(PTA),MELD score(P>0.05);after treatment,TBIL,ALT,AST,Cr,INR and MELD scores were decreased in all three groups compared with those before treatment,ALB and PTA were increased in group C compared with those before treatment,ALB and PTA were decreased in group A and group B compared with those before treatment(P<0.05);comparison of TBIL,ALT,AST,Cr,INR and MELD scores after treatment among three groups,the differences were not statistically significant(P>0.05);ALB and PTA were higher in group C than those in group A and group B(P<0.05).Conclusion:In patients with liver failure,the flexible application of DPMAS+PE,PDF and PE has good effect,with no obvious advantages or disadvantages,and has ideal application value for the improvement of clinical symptoms.