树脂吸附结合光照清除腹水胆红素的临床观察

目的观察树脂吸附结合光照清除腹水中胆红素的安全性及临床效果，解决临床肝硬化合并黄疸腹水问题。方法肝硬化合并黄疸腹水患者21例，其中男性17例，女性4例，年龄50-72岁，平均年龄60．2岁。将经过预处理的HB—H-6树脂装入特制灌流器，高压蒸汽灭菌；按常规方法行腹腔穿刺引流腹水，用树脂吸附结合蓝光照射60min：分别于灌流前后取样测定腹水中蛋白、细胞总数、密度和渗透浓度；将处理后腹水进行静脉回输，密切观察患者一般情况及体温、心率、尿量等变化；分别取灌流前后树脂进行透射电子显微镜观察。树脂吸附加光照后腹水静脉回输25例次。结果①处理后腹水外观颜色明显变浅。②处理前后比较，腹水中总胆红素下降40％-50％，结合胆红素下降33％～50％，未结合胆红素最多可下降80％，腹水中蛋白和细胞总数略有下降，腹水密度、渗透浓度未见明显变化。③电镜观察可见树脂呈网状骨架结构，灌流后树脂骨架中散在分布电子致密度大的不整形块状、条索状物，为胆红素。④25例次腹水回输后除1例患者出现发热，其余均无不适，腹水回输后患者尿量增多，部分患者血胆红素降低。结论采用树脂吸附结合光照处理腹水中胆红素，为肝硬化顽固性腹水的治疗带来新方法，

Clinical observation of ascites bilirubin clearing by resin adsorption combined with phototherapy

Objective To investigate the effect and security of bilirubin clearing by phototherapy combied with resin adsorption in order to solve the aseites reinfusion in liver cirrhosis patients with jaundice and ascites. Methods Twenty-one liver cirrhosis patients with jaundice and ascites （male 17,female 4,aged 50 - 72 years,mean age 60.2 years ） were enrolled in this study. Paracentesis was performed. The ascites was drained into a sterile infusion bag which was connected with adsorption cartridge, pipeline and pump, then treated with phototherapy and HB-H-6 resin adsorption for 60 minutes, taken samples before and at different time and the concentration of bilirubin of ascites were tested routinely. The ascites was reinfused after treatment. The resin was observed by electron microscope before-after-perfusion. Results The concentration of bilirubin decreased after treatment whereas the concentration change of protein,cell count and osmotic pressure were not changed obviously. After reinfusion,the general condition of patients were stable and their urine output increased. Under electron microscope observation bilirubin was adhered on the framework of resin. Conclusion The treatment of phototherapy combined with resin adsorption could clear ascites bilirubin effectively and safely.