配对血浆分离吸附联合血液滤过治疗多器官功能障碍综合征的实验及临床研究

目的探讨配对血浆分离吸附法（CPFA）联合连续性静-静脉血液滤过（CVVH）治疗多器官功能障碍综合征（MODS）伴急性肝功能衰竭（ALF）患者的临床疗效和安全性。方法应用CPFA＋CVVH技术对重症加强治疗病房（ICU）中11例MODS伴ALF患者进行38例次治疗，比较患者治疗前后的平均动脉压（MAP）、氧合指数（Pa02／FiO2）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、IL-6、IL-8、肝功能、肾功能、全身炎症反应综合征（SIRS）评分、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及临床症状改善程度，同时观察治疗的不良反应，并进行治疗安全性评价。结果患者治疗后尿量较治疗前增多，黄疽减轻，发热、乏力、腹胀、食欲明显改善，精神好转，意识转清。治疗后MAP较治疗前上升了12mmHg（1mmHg=0．133kPa），PaO2／FiO2上升了40mmHg（P均＜0．05）；TNF-α、IL-1β、IL-6、IL-8均较治疗前明显降低（P均＜0．05），血清总胆红素、直接胆红素、血氨、血尿素氮、肌酐均明显下降（P均＜20．05）；SIRS、APACHEⅡ评分均较治疗前有不同程度的下降（P均＜0．05）。11例患者存活5例，存活率为45．5％；未发生出血、休克、过敏等并发症，患者耐受好。结论CPFA联合CVVH能有效清除炎症介质，改善MODS伴ALF患者的预后，且无明显不良反应。

Efficacy and safety of coupled plasma filtration adsorption combined with continuous veno-venous hemofiltration for multiple organ dysfunction syndrome patients with acute liver failure

OBJECTIVE: To evaluate efficacy and safety of coupled plasma filtration adsorption (CPFA) combined with continuous veno-venous hemofiltration (CVVH) for the treatment of multiple organ dysfunction syndrome (MODS) patients with acute liver failure (ALF), and to evaluate the effect of CPFA plus CVVF on inflammatory mediators in these patients. METHODS: A total of 38 cases of 11 MODS patients with ALF (male 6, female 5) were treated with CPFA plus CVVH, and the following clinical indicators including changes in mean arterial pressure (MAP), oxygen index (PaO(2)/FiO(2)), tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-6, IL-8, biochemical parameters of liver and kidney function, parameters of systemic inflammatory response syndrome (SIRS) score, and acute physiology and chronic health evaluation II (APACHEII) score were determined before and after the treatment. The degree of improvement in clinical symptoms, feasibility, tolerance toward CPFA plus CVVH, therapy-related adverse reactions and security were simultaneously evaluated. RESULTS: MAP increased by 12 mmHg (1 mmHg=0.133 kPa), and PaO(2)/FiO(2) increased by 40 mmHg after the application of CPFA plus CVVH (both P<0.05), along with significant decrease in TNF-alpha, IL-1beta, IL-6, IL-8 and markedly lowered levels of serum total bilirubin (IBIL), direct bilirubin (DBIL), blood urea nitrogen (BUN), serum creatinine (SCr) and blood ammonia (all P<0.05). Besides, clinical symptoms, including urinary volume, mental disturbance, jaundice, debility, nausea, vomiting, fever, abdominal distention, anepithymia, and SIRS, APACHEII scores were improved significantly after the CPFA plus CVVH (all P<0.05). No therapy-related adverse reactions, including severe haemorrhage, shock, hypersensitivity, were noted, and patients tolerated well toward CPFA plus CVVH. The total survival rate of patients was 45.5% (5/11 cases) at the end of the treatment. CONCLUSION: Our data indicate that CPFA combined with CVVH is an effective and safe method to improve the prognosis of MODS patients with ALF, the mechanism of which may be related to its effective removal of inflammatory cytokines.