中国血液净化

›› 2009, Vol. 8 ›› Issue (1): 49-52.

• 人工肝 • 上一篇    下一篇

两种人工肝支持系统治疗70例重症肝衰竭患者的安全性及有效性的比较

陈舜杰 陆 玮 季 刚 单剑萍 朱 淳 蒋更如   

  1. 上海交通大学医学院附属新华医院肾脏科
  • 收稿日期:2008-08-06 修回日期:1900-01-01 出版日期:2009-01-12 发布日期:2009-01-12
  • 通讯作者: 蒋更如

Comparison of efficacy and safety between two artificial liver supporting systems in the treatment of 70 cases with severe hepatic failure

CHEN Shun-jie, LU Wei, JI Gang, SHAN Jian-ping, ZHU Chun, JIANG Geng-ru   

  1. Gengru1 Department of Nephrology, Xin Hua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092
  • Received:2008-08-06 Revised:1900-01-01 Online:2009-01-12 Published:2009-01-12

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摘要： 【摘要】目的 比较血浆置换(PE)联合连续性静脉-静脉血液透析滤过(CVVHDF)，血液灌流(HP)联合CVVHDF在人工肝支持治疗中的有效性和安全性。方法 对70例重症肝衰竭患者随机分为两组，分别给予单次PE联合CVVHDF或单次HP联合CVVHDF的人工肝支持治疗，观察患者临床症状的变化，比较治疗前后电解质、肝肾功能、凝血酶原时间(PT)、部分凝血活酶时间(APTT)的变化。结果 经过上述两种模式治疗后，两组患者的临床症状均有不同程度改善，血清总胆红素（TB)、血清肌酐(Scr)、血清尿素氮(BUN)、谷丙转氨酶(AST)、谷草转氨酶(ALT)均明显下降(P＜0.01)；电解质恢复正常（P＜0.01)。与HP联合CVVHDF治疗组相比，PE联合CVVHDF组治疗结束时PT、APTT均明显下降（P＜0.01)，血清白蛋白(Alb)明显升高(P＜0.01)。二种模式治疗的不良反应均较轻。结论 两种治疗模式均能有效清除肝衰竭或者合并肾衰竭产生的各种有毒物质。两种治疗模式均能调节水电解质平衡。PE联合CVVHDF治疗后，患者血清白蛋白浓度明显提高，出凝血功能明显改善，优于HP联合CVVHDF治疗组。

关键词: 血浆置换, 血液灌流, 肝功能衰竭, 人工肝, 连续性静脉-静脉血液透析滤过

Abstract: 【Abstract】 Objective Non-bioartificial liver has been applied in clinical practice, but the efficacy was reported to be quite different. The aim of this study was to compare the efficacy and safety of plasma exchange (PE) plus continuous venovenous hemodiafiltration (CVVHDF) and hemoperfusion adsorption (HP) plus CVVHDF in the treatment of severe viral hepatitis. Methods Seventy patients with severe liver hepatitis were randomly divided into two groups: patients with single treatment of PE+CVVHDF (36 cases) and those with single treatment of HP+CVVHDF (34 cases). Clinical symptoms and signs, liver function, renal function, prothrombin time (PT), activated partial thromboplastin time (APTT) and electrolytes were analyzed. Results In the 2 groups after the treatment, clinical symptoms improved significantly, serum aminotransferases, total biliruin, urea nitrogen and creatinine decreased (P＜0.01), and serum electrolytes recovered to normal. In the PE+ CVVHDF group after treatment, PT and APTT decreased, and serum albumin increased significantly (P＜0.01), as compared with those of the HE+CVVHDF group. The side effects were mild in all patients in the 2 groups. Conclusion The two artificial liver supporting systems were effective in the treatments of patients with severe liver hepatitis. PE+CVVHDF was better than HP+CVVHDF in improvement of PT, APTT and serum albumin.

Key words: Hemoperfusion, Liver failure, Artificial liver, Continuous venovenous hemodiafiltration