血浆置换联合血液灌流治疗肝衰竭的疗效观察

Combined plasma exchange and hemoperfusion in the treatment of liver failure

目的探讨血浆置换(PE)联合血液灌流对肝衰竭患者临床症状及血清生化指标的影响,并观察其临床疗效,评估其安全性。方法肝衰竭患者80例根据治疗方法不同分为3组,应用PE联合血液灌流35例(联合组),单纯应用PE治疗25例(PE组),仅予综合内科治疗20例(内科组),比较3组患者的临床症状及相关实验室血液生化指标包括血清总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、凝血酶原时间(PT)和凝血酶原活动度(PTA)之间的差异。结果治疗后3组患者临床症状均有不同程度改善;联合组有效率为60.0%(21/35)、PE组为52.0%(13/25)、内科组为30.0%(6/20),联合组、PE组分别与内科组相比差异有统计学意义(X^2=3.82、3.59,P均<0.05);联合组、PE组和内科组治疗后TBil、ALT、AST、PT和PTA等均有明显下降(t=6.72、7.05、6.43、7.98、4.37;t=6.04、4.37、5.82、6.19、5.85;t=3.11、2.08、2.75、2.32、3.33,P均<0.01);联合组和PE组相比差异无统计学意义(q=1.89、1.26、1.74、1.38、1.44,P均>0.05),但2组与内科组相比差异均有统计学意义(q=2.87、3.49、3.33、4.82、6.77;q=3.88、3.97、3.85、4.10、7.16,P均<0.01);联合组出现口周麻木、皮肤瘙痒等不良反应的发生率(21.55%、24.14%)低于PE组(41.84%、46.94%)(X^2=4.78、5.83,P均<0.01)。结论血浆置换联合血液灌流治疗肝衰竭,不仅能有效改善患者肝功能,而且能节省血浆用量,降低口周麻木、血浆过敏反应等不良反应的发生率,提高安全性,具有较好的临床应用价值。

Objective To investigate the effect of plasma exchange(PE) combined hemoperfusion on the clinical symptoms of liver failure and serum biochemical indicators,assessing its safety.Methods 80 cases of liver failure patients were divided into three groups,the joint application of PE hemoperfusion in 35 cases(combination group),simple application of the treatment in 25 cases of PE(PE group),only to comprehensive medical treatment in 20 cases(medical group),three groups of patients’ clinical symptoms and laboratory blood parameters related to serum total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),prothrombin time(PT) and prothrombin activity(PTA) were compared.Results After treatment,clinical symptoms of three groups of patients were improved;effective rate of joint group was60.0%(21/35),PE group was 52.0%(13/25),internal medicine group was 30.0%(6/20),the combined group,PE groups showed significant difference to the medical group(x^2=3.82,x^2=3.59,P<0.05);the combined group,PE group and the medical therapy group after treatment,TBil,ALT,AST,PT and PTA,etc.have decreased(t=6.72,t=7.05,t=6.43,t=7.98,t=4.37;t=6.04,t=4.37,t=5.82,t=6.19,t=5.85;t=3.11,t=2.08,t=2.75,t=2.32,t=3.33,P<0.01);the combination group and PE groups showed no significant difference(q=1.89,q=1.26,q=1.74,q=1.38,q=1.44,P>0.05),but the two groups to the medical group showed significant differences(q=2.87,q=3.49,q=3.33,q=4.82,q=6.77;q=3.88,q=3.97,q=3.85,q=4.10,q=7.16,P<0.01);combined group’s perioral numbness,itching and other adverse reactions incidence(21.55%,24.14%) lower than the PE group(41.84%,46.94%)(x^2=4.78,x^2=5.83,P<0.01).Conclusion Plasmapheresis combined hemoperfusion for treatment of liver failure,not only can effectively improve liver function,and also can save the amount of plasma,reduce the incidence of perioral numbness,plasma allergic reactions and other adverse reactions,improve security,has better clinical value.