持续缓慢血液透析滤过联合血浆置换治疗重型肝炎脑病的研究

Study of Treatment on Severe Hepatitis and Hepatic Encephalopathy with Continuous Hemodiafiltration Plus Plasma Exchange

目的 :探讨人工肝辅助装置持续缓慢血液透析滤过 (CHDF)联合血浆置换 (PE)治疗中、晚期慢性重型肝炎肝性脑病的疗效及作用机制。方法 :治疗组 5 3例 ,中期 2 5例 ,晚期 2 8例 ;对照组 4 8例 ,中期 2 1例 ,晚期 2 7例。两组病例均合并有不同程度的并发症。在相同内科治疗的基础上 ,治疗组加用日产 KM- 880 0血浆交换仪并联用 JUN- 5 0 0血液透析滤过仪进行人工肝治疗 ,观察治疗的情况。结果 :治疗组的 5 3例患者中 30例治愈或好转 ,另有 7例经治疗后维持到接受肝移植手术 ,总有效率为 6 9.8% ,肝性脑病经治疗后清醒率为 86 .2 % ;对照组 4 8例中11例治愈或好转 ,另有 1例接受肝移植手术 ,有效率 2 5 .0 %。结果显示 CHDF+ PE治疗有效改善了中、晚期慢性重型肝炎患者的预后。在 85例次治疗过程中发生不良反应 13例次 (15 .3% ) ,经对症处理后不良反应均能缓解。结论 :在内科综合治疗的基础上联合 CHDF+ PE治疗对中、晚期慢性重型肝炎安全有效 。

Objective:To study the clinical efficacy and its mechanism of artificial liver support system(ALSS) about continuous hemodiafiltration(CHDF) plus plasma exchange(PE) in treatment of patients with chronic severe hepatitis and even with hepatic encephalopathy at intermediate or late stage . Methods:53 cases served as treatment group and 48 cases served as control group. In the treatment group, 25 cases were at the intermediate stage and 28 cases were at late stage. In the control group, the cases during the intermediate and late stages respectively were 21,27. All patients were suffering from chronic severe hepatitis and various complications . At the base of treatment of medicine, an additional artificial liver support system of KM 880 Plasma exchange device made in Japan together with JUN 500 hemodiafiltration device were used in treatment group. The effect was observed and investigated. Results:Of 53 patients in the treatment group,30 cases were cured or improved after treatment and 7 cases were maintained by artificial liver system till an operation of liver transplantation was received .The total survival rate was 69.8%.After treatment the rate of regaining consciousness is 86.2% . However, in the control group, 11 cases survived and 1 case was performed with liver transplantation.The total survival rate was 25.0%.These results show that treating with CHDF plus PE can effectively improve the prognosis of the patients with chronic severe hepatitis during the intermediate and late stages. During the process of treatment , 13 times of side effects were found(15.3%),but they were relieved after expectant treatment. Conclusion:At the base of treatment of medicine ,CHDF plus PE have been proved safely and effectively in treating the patients with chronic severe hepatitis at intermediate or late stage, and they can improve the survival rate of the patients.