三种人工肝支持方法对肝衰竭支持效果的比较

Effect comparison of three artificial liver support methods in treatment of hepatic failure

目的 :比较物理型 (血液灌流吸附 )、中间型 (血浆置换 )及组合型 (血浆置换 +血液灌流吸附 )人工肝支持方法对肝衰竭患者肝功能的支持效果、安全性 .方法 :75例重型肝炎肝衰竭患者分别进行血液灌流吸附 (2 4例 )、血浆置换 (1 7例 )和血浆置换 +血液灌流吸附 (34例 )治疗 ,观察治疗前后患者临床症状变化 ,比较治疗前后肝肾功能、血常规、凝血酶原时间 (PT)、凝血酶原活动度 (PTa)变化 .结果 :血液灌流吸附、血浆置换及血浆置换 +血液灌流吸附治疗后 ,患者的临床症状均有不同程度改善 .三种方法治疗后转氨酶、总胆红素(TB)、直接胆红素 (DB)下降均有显著性差异 (P <0 .0 5或P<0 .0 1 ) ,而血浆置换及血浆置换 +血液灌流吸附治疗后PT、总血清蛋白 (TSP)下降 ,PTa升高均有显著性差异 (P <0 .0 5或P <0 .0 1 ) .三种方法治疗的不良反应均较轻 .结论 :三种人工肝支持方法对重型肝炎肝衰竭患者的肝功能均有肯定的支持效果 。

AIM: Non bioartificial liver was applied to clinic early, but the reported efficacy were very different. The aim of this article is to compare the efficacy and safety of hemoperfusion adsorption, plasma exchange and plasma exchange plus hemoperfusion adsorption in treatment of severe viral hepatitis. METHODS: Seventy five patients with severe viral hepatitis were treated with hemoperfusion adsorption therapy (24 cases), plasma exchange therapy (17 cases) and plasma exchange plus hemoperfusion adsorption therapy (34 cases). The data of liver function, renal function, blood routine test, prothrombin time (PT), prothrombin activity (PTa) pre and post therapy were analyzed. RESULTS: Clinical symptoms of patients improved after treatment. The levels of aminotransferase, total bilirubin (TB), direct bilirubin (DB) decreased significantly after three therapies ( P <0.05 or P <0.01), PT, the level of total serum proteins (TSP) decreased significantly and PTa increased significantly after plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy ( P <0.05 or P <0.01). The side effects were light and limited in all patients. CONCLUSION: Three therapies were effective in the treatment of severe viral hepatitis. Plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy are better than hemoperfusion adsorption therapy.