【摘要】 【目的】评估连续性血液净化治疗(CBP)在救治急诊外科术后肝功能衰竭合并肝性脑病中的作用和疗效。【方法】分析本院12例急诊外科术后合并肝性脑病患者56例次连续性静脉-静脉血液透析滤过(CVVHDF)加血浆置换(PE)临床资料,观察患者治疗前后肝肾功能、电解质、血氨、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)及血压心率的改变。【结果】治愈9例,死亡3例,清醒率83.3%。治疗后TB、TBA、NH3、BuN、Cr显著下降,电解质紊乱及酸中毒得以纠正。TNF-α、IL-6分别从治疗前(86.43±0.48)ng/L,(45.95±0.66)ng/L下降至治疗后(43.94±0.34)ng/L(P<0.05),(24.81±0.40)ng/L(P<0.05)。【结论】CBP设备简单,操作方便,能有效纠正危重患者体液平衡,纠正酸中毒和电解质紊乱,清除炎症介质,改善肝功能,是辅助治疗外科术后并发肝性脑病的有效方法。更多还原

【Abstract】 【Objective】To study the clinical effect of continuous blood purification(CBP)in treating patients with hepatic encephalopathy caused by severe liver function failure after emergent surgical operation.(【Methods】)The data of 12 patients treated with continuous vein-venous hemodiafiltration(CVVHDF) and plasma exchange(PE)were analyzed and then the changes of the functions of liver and kidney,electrolyte,blood ammonia,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),blood pressure and heart rate before and after the treatment were observed.【Results】Nine patients survived 83.3% at revival rate and 3 died,for hepatic encephalopathy.TB,TBA,NH3,BuN and Cr had been obviously reduced,the acidosis and electrolyte disorder were corrected after treatment.TNF-α,IL-6 reduced from(86.43 ±0.48)ng/L,(45.95 ± 0.66)ng/L respectively to(43.94±0.34) ng/L(P<0.01),(24.81±0.40)ng/L(P<0.01).【Conclusion】Being simple and convenient in operation,CBP is effective to treat patients with hepatic encephalopathy after emergent surgical operation and it is also effective in correcting the balance of body fluid,acidosis and electrolyte disorder of the critically-ill patients and in cleaning the inflammatory medium and improving the liver function.Besides,it is the effective adjuvant way to treat the complication of hepatic encephalopathy after the surgical operation.更多还原