中国血液净化

›› 2005, Vol. 4 ›› Issue (6): 306-309.

• 论著 • 上一篇    下一篇

以血浆作透析液的血液透析联合高容量血液滤过在高胆红素血症中的初步应用

刘宏宝 陈 威 李振江 窦科峰 宋振顺 徐月清 王汉民   

  1. 710032 西安， 第四军医大学西京医院肾内科(刘宏宝，陈威，李振江，徐月清，王汉民)，肝胆外科(窦科峰，宋振顺) 
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-06-12 发布日期:2005-06-12
  • 通讯作者: 陈威

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-06-12 Published:2005-06-12

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摘要：

目的 以人体新鲜冰冻血浆作透析液行血液透析（HD-PBD）后继续进行高容量血液滤过（HV- HF），观察其对高胆红素血症的治疗效果。方法 7例高胆红素血症患者行HD-PBD治疗6h后，应用同一滤器继续行HVHF治疗24h。另选取6例行MARS治疗6h的高胆红素血症患者作为对照。各组患者治疗前后测定血清胆红素水平，并监测动脉血气分析和电解质浓度的变化。结果 HD-PBD对胆红素的清除较HVHF明显（ P<0.05）， HVHF在纠正电解质和酸碱失衡方面比HD-PBD更显著（ P<0.05）。停止 HD-PBD后继续行HVHF治疗24h，胆红素仍有所下降（ P<0.05）；停止 MARS治疗后的1～2天内胆红素显著升高（P<0.05）。
结论 HD-PBD联合HVHF治疗高胆红素血症患者，结合了二者在清除肝源性毒素和调节电解质酸碱平衡紊乱方面的优势，并且安全、简便、易行和成本低廉，值得推广应用。

关键词: 高胆红素血症, 肝功能衰竭, 高容量血液滤过, 血浆透析

Abstract:

Objective We proposed a new blood purification modalityhemodialysis with plasma-based dialysate(HD-PBD) plus high volume hemofiltration(HVHF) for patients with hyperbilirubinemia,and evaluated the effect of this treatment on removal of serum bilirubin. Methods Seven patients with hyperbilirubinemia were included in this study.After HD-PBD for 6 hours,then treated with HVHF for 24 hours with the same filter. Six patients treated with molecular adsorbent recirculating system (MARS) were as controls. Serum total bilirubin(TB), direct bilirubin(DB) and indirect bilirubin(IB) were detected before and after treatment in all patients. Arterial blood gas analysis and the concentration of electrolytes in all patients were monitored before and after treatment. Results HD-PBD for 6 hours is more effective in the removal of serum bilirubin than HVHF for 24 hours（P<0.05）. There were no significant diffevence of arterial blood HCO-3, PCO2, PO2 and electrolyte before and after HD-PBD （P>0.05）, and aforementioned target is significanly different before and after HVHF （P<0.05）. The average level of serum bilirubin was significantly increased in 1 to 2 days after MARS, but there was a significant decrease after HVHF for 24hours following HD-PBD（P<0.05）. Conclusion HD-PBD plus HVHF, a newly proposed modality for patients with hyperbilirubinemia, Which combines the predominance in removal of serum bilirubin and excellent correction of electrolyte and acid-base disturbance, is a low-cost, safe, simple and convenient treatment, and deserve to be generalized in clinical application.

Key words: Hepatic failure, High volume hemofiltration, Plasma dialysis 

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