【作者】 陈幼明； 邓洪； 朱建芸； 江元森； 高志良；

【Author】 CHEN You-ming DENG Hong ZHU Jian-yun JIANG Yuan-sen GAO Zhi-liang~※ (The Third Affiliated Hospital,SUN Yat-sen University,Guangzhou,510630,China)

【机构】 中山大学附属第三医院；

【摘要】 目的:探讨人工肝支持系统(artificial liver support systerm,ALSS)血浆置换联合持续性血液透析滤过治疗重型肝炎的疗效及并发症。方法:用日产 KM-8800血浆交换仪行血浆置换(plasma exchange,PE),用 JUN-500血液透析滤过仪行持续性血液透析滤过(continuous hemodiafiltration,CHDF)。随机抽取2002年1月至2006年12月期间在我科住院的慢性乙型重型肝炎患者181例(重型肝炎诊断符合2000 年第10次全国传染病和寄生虫病学会议修订的诊断),将患者随机分2组,A 组87例,B 组94例。A 组内科综合治疗+PE+CHDF,B 组内科综合治疗+PE。治疗前两组在年龄、性别构成、分期、并发症等方面无差异 (P>0.05)。比较两组治疗后近期疗效及生存率,并观察两组治疗前后临床症状及实验室结果的改变。结果:人工肝治疗后,近期有效率:A 组80.5%,B 组48.9%;近期生存率:A 组48.3%,B 组30.9%;肝性脑病意识转清率:A 组54.5%(12/22),B 组20.0%(5/25);低血钾改善率:A 组80.5%(33/41),B 组7.1%(3/42); 低血钠改善率:A 组93.1%(27/29),4%(2/50)。两组治疗后在近期有效率、意识转清率、改善电解质等方面有差异(P<0.01=,在降低胆红素、改善凝血酶原活动度及对白蛋白的影响等方面无差异(P>0.05)。人工肝治疗的并发症以血浆过敏反应为多见,占10.8%,器械因素次之,占9.8%,两组间发生率无差异。结论:内科综合治疗+PE+CHDF 能提高重型肝炎患者近期生存率和意识转清率,可有效纠正电解质紊乱, 保持内环境平衡;且方便可行较为安全,可作为非生物型人工肝治疗重型肝炎的主要方法。更多还原

【Abstract】 Objectives To explore the therapeutic effects and complication about application of artificial liver support system(ALSS)of plasma exchange(PE)combined with continuous hemodiafiltration(CHDF)on patients with severe hepatitis.Methods 181 patients with chronic severe hepatitis caused by hepatitis B were randomized divided into two groups:A group and B group.Patients of A group(n=87)were treated with internal medicine supporting treatment combined with PE(KM-8800,Japan)and CHDF(JUN-500);Patients of B group(n=94) were treated with internal medicine supporting treatment combined with PE.There was no significant difference between two groups before treatment about age,sex,phases of disease and complication.The clinical symptoms and the laboratory examination were determined before and after the treatment.Results After treatment with ALSS,the clinical symptoms and signs of all patients improved in two groups.The recent efficacy rate,the improvement of consciousness of hepatic encephalopathy and the amelioration of electrolure in the A group was 80.5%,54.5%(12/22)and 80.5 %(33/41),while 48.9%,20.0%(5/25)and 7.1%(3/42)in the B group,there were significant difference between the two groups(P<0.01).there was no significant difference between the two groups about decreasing the total bilirubin,improving PTA and the change of albumin(P>0.05).The most common adverse reaction was plasma allergic reaction,the incidence of adverse reaction was no significant difference between two groups.Conclusions The treatment of internal medicine supporting treatment combined with PE and CHDF can increase the recent survival rate and improve the consciousness of hepatic encephalopathy, and can effectively redress electrolyte disturbance and keep homeostatic equilibrium of patients,This treatment is also convenience and safe,so this treatment can be taken as the major method for treatment severe hepatitis.更多还原