共查询到18条相似文献,搜索用时 656 毫秒
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目的探讨人工肝血浆置换术治疗药物性亚急性肝功能衰竭患者的临床观察与并发症防范护理措施。方法回顾性分析2007年12月至2010年12月温州医学院附属第一医院收治的50例药物性亚急性肝功能衰竭患者的临床资料,所有患者均在护肝、降酶等综合治疗的基础上进行血浆置换治疗。分析治疗前后患者肝功能、凝血功能的变化和临床症状如乏力、食欲缺乏、腹胀等改善情况以及对人工肝治疗中出现的并发症情况,总结并发症的发生原因及预防护理措施。结果人工肝治疗后,多数患者临床症状明显改善,表现为精神好转,乏力、腹胀及消化道症状明显减轻;治疗后血清总胆红素、丙氨酸氨基转移酶明显下降,白蛋白、凝血指标升高。并发症发生率高低依次为血浆过敏反应(6人次)、低血压(2人次)、插管处出血(1人次)。结论人工肝血浆置换术治疗药物性亚急性肝功能衰竭,可以改善患者肝功能,提高早、中期患者救治成功率;提倡尽早予以人工肝治疗。规范、细致的临床护理是提高人工肝血浆置换术治疗药物性亚急性肝功能衰竭成功率的重要保证,正确预防处理并发症是提高治疗安全性的关键。 相似文献
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目的 探讨药物性亚急性肝衰竭患者人工肝血浆置换术治疗的成功率和对肝功能影响.方法 选取药物性亚急性肝衰竭患者300例,根据治疗方式分为治疗组(人工肝血浆置换术)和对照组(单纯内科综合治疗),每组150例.对照组采用常规性的内科综合治疗,包括—般性的支持治疗、针对性的对症处理、保护肝脏细胞和促进再生、防止并发症等治疗.治疗组在对照组的常规治疗基础上行人工肝血浆置换术.比较两组患者的救治成功率、肝功能改变情况.结果 治疗组救治成功率显著高于对照组(P<0.05),且早期患者成功率高于对照组(P<0.05);治疗组各项肝功能指标均显著改善(P<0.05).结论 人工肝血浆置换术对药物性亚急性肝衰竭早期患者救治成功率高,改善患者肝功能,值得临床推广. 相似文献
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目的 总结目前常用人工肝治疗方法:血浆置换(Plasma exchange)、血液灌流(Hemoperfusion)和分子吸附再循环系统(Molecular adsorbent recirculatint system)联合肝移植治疗慢性肝功能衰竭的经验。方法 对7例慢性肝脏功能衰竭患者分别应用上述三种人工肝方法治疗15人次,于治疗前后分别检测肝功能、凝血酶原活动度、血氨等指标,并观察临床症状、体征变化。人工肝支持治疗后接受原位肝移植治疗。结果 人工肝治疗后多数患者的乏力、纳差、腹胀等症状明显缓解,7例均顺利进行原位肝脏移植,其中6例成活。结论 人工肝可明显改善慢性肝功能衰竭患者术前状况,为肝移植赢得时间和创造条件。 相似文献
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《当代护士》2016,(9)
目的探讨采用无肝素血浆置换(PE)治疗肝功能衰竭患者的护理及安全性。方法采用血浆置换对72例肝功能衰竭患者进行治疗,随机分为2组,治疗组40例进行无肝素血浆置换治疗,共116人次,持续用注射泵进行生理盐水冲洗分离器及管路,对照组32例常规加用肝素进行血浆置换治疗,共90人次,观察2组患者治疗中及治疗后出凝血相关不良反应及并发症的发生情况。结果治疗组除PE治疗中常见的不良反应外,无1人次出现血浆分离器及管路凝血以及术中和术后出血等并发症,对照组发生出凝血相关性不良反应15人次,2组对照出凝血相关性不良反应发生情况差异有显著统计学意义(P0.01),护理干预后出凝血相关并发症情况差异无统计学意义(P0.05)。结论采用无肝素人工肝血浆置换(PE)治疗肝功能衰竭,出血及凝管的发生率低,操作简单,安全性较高,同时,做好术前心理护理、术中密切观察患者的生命体征并配合医生及时处理并发症,是无肝素血浆置换治疗顺利完成的基础。 相似文献
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【目的】探讨非生物组合型人工肝技术血浆吸附加血液透析滤过(PPA+HF)治疗急性肝衰竭(ALF)的临床疗效与护理要点。【方法】20例ALF患者采用单血泵、输液泵行PPA+HF人工肝技术进行48例次治疗,比较治疗前后患者生化、肾功能、肝功能、凝血指标、临床症状改善程度及治疗不良反应和安全性。严密监护,充分做好各个环节的护理【结果】患者在治疗后意识障碍、黄疸、恶心、呕吐、腹胀等症状明显改善,治疗后血清总胆红素(TB)、总胆红素、转氨酶、肾功能、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)较治疗前显著下降(P〈0.05)。血浆白蛋白、血白细胞、血小板及电解质水平无明显变化(P〉0.05)。【结论】PPA+HF人工肝技术可显著改善ALF患者临床症状及生化指标,安全性好,无明显不良反应,近期疗效显著。做好各机器管路间的串接,加强治疗中的各项护理工作,防止不良反应和并发症是治疗成功的重要保证。 相似文献
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舒适护理在人工肝支持系统治疗重症肝炎中的应用 总被引:1,自引:0,他引:1
目的:探讨人工肝血浆置换治疗重症肝炎的护理要点。方法:对88例重症患者行人工肝血浆置换治疗,比较治疗前后肝功能变化并进行护理总结。结果:人工肝血浆置换能明显改善重症肝炎患者的症状和体征,肝功能明显好转。结论:认真做好术前、术后临床监护及护理干预,严格无菌操作,防止并发症的发生,是保证人工肝血浆置换治疗成功的关键。 相似文献
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血浆置换、血液灌流在人工肝支持治疗中的比较 总被引:2,自引:0,他引:2
目的:比较血浆置换、血液灌流在人工肝支持治疗中的有效性和安全性。方法:对70例重症肝功能衰竭患者予以血浆置换、血液灌流两种模式的人工肝支持治疗,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、部分凝血活酶时间的变化。结果:经过上述两种模式治疗后,患者的临床症状均有不同程度改善,血清总胆红素、血清肌酐、血清尿素氮、谷丙转氨酶、谷草转氨酶均明显下降(P〈0.01);血浆置换组治疗结束时凝血酶原时间、部分凝血活酶时间均明显下降(P〈0.01)、血清白蛋白明显升高(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功能衰竭或合并肾功能衰竭产生的各种有毒物质。血浆置换治疗能调节水电解质平衡,血浆置换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。 相似文献
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白建蓉 《实用医院临床杂志》2018,(2)
目的探讨人工肝血浆置换术对重型乙肝患者乙肝病毒脱氧核糖核酸(HBV-DNA)水平、炎症因子等的影响。方法我院接受人工肝血浆置换术治疗50例重型乙肝患者(观察组)和同期接受常规基础药物治疗50例重型乙肝患者(对照组),观察治疗前后两组炎性因子、凝血功能指标、HBV-DNA转阴率、肝功能指标及不良反应发生情况。结果治疗后两组IL-4、TNF-α、ALT、AST、TBi L明显降低,PT、APTT明显缩短,FIB明显升高,且观察组各项指标变化较对照组明显,差异有统计学意义(P0.05);观察组HBV-DNA转阴率明显高于对照组(P0.05),但两组不良反应发生率差异无统计学意义(P0.05)。结论人工肝血浆置换术可明显提高重型乙肝患者肝功能,作用机制可能与其可有效抑制炎性因子、调节凝血功能、降低HBV-DNA水平有关。 相似文献
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Plasma exchange has gained widespread acceptance as an effective mode of blood purification in patients suffering from acute hepatic failure. However, it is still undetermined whether a single use of plasma exchange is capable of removing inflammatory cytokines completely or of preventing the development of citrate toxicity inherent with fresh frozen plasma. To clarify these issues we developed combined plasma exchange and continuous hemodiafiltration (CHDF) modality in which CHDF is performed in an opposite direction to plasma exchange. This study was designed to assess the effectiveness of combined modality therapy. Fifteen patients with acute hepatic failure were treated with plasma exchange (plasma exchange group) or plasma exchange and CHDF (plasma exchange + CHDF group), and various biochemical parameters were determined before and after treatment. Although citrate levels increased significantly after treatment compared with pretreatment levels in both the plasma exchange group and the plasma exchange + CHDF group, the percentage of the increase in citrate levels was significantly higher in the plasma exchange group than in the plasma exchange + CHDF group. Bilirubin levels were significantly lower after treatment in both the plasma exchange and plasma exchange + CHDF groups. There were no significant differences in tumor necrosis factor-alpha levels before and after treatment in the plasma exchange group, but they were significantly lower after treatment in the plasma exchange + CHDF group. Interleukin-6 (IL-6) levels increased significantly after treatment in the plasma exchange group, but there were no significant differences in the IL-6 levels before and after treatment in the plasma exchange + CHDF group. Interleukin-8 levels increased significantly after treatment in the plasma exchange group while decreasing significantly after treatment in the plasma exchange + CHDF group. These results indicate that combining plasma exchange and CHDF in a parallel circuit is an effective modality for suppressing the elevation of blood citrate levels and for removing inflammatory cytokines. This finding may have important implications for the development of an effective treatment for patients with acute hepatic failure. 相似文献
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目的探讨血浆置换治疗肝衰竭患者的临床效果。方法收集32例肝衰竭患者,在综合治疗的基础上,采用血浆置换技术对其进行治疗。分别于治疗前、后检测患者临床生化指标:天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、清蛋白(ALB)、总胆红素(TBil)、直接胆红素(DBil)、凝血酶原时间(PT)、肌酐(Cr)、国际标准化比率(INR)、总胆汁酸(TBA)。结果本组患者血浆置换治疗总有效率为78.13%。早期肝衰竭患者有效率94.73%,中期肝衰竭患者有效率70.00%,晚期肝衰竭患者全部无效死亡。生化指标AST、ALT、ALB、TBil、DBil、PT、Cr、INR、TBA治疗后较治疗前均有明显改善(P<0.05)。结论血浆置换治疗肝衰竭患者效果较好,越早治疗效果越好。 相似文献
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目的探讨人工肝血浆置换术治疗肝衰竭的护理措施。方法对本科2008年1月~2009年11月收治的80例肝衰竭患者分成观察组和对照组,观察组40例在内科支持治疗的基础上行人工肝血浆置换术。对照组40例未行人工肝血浆置换术,观察两种治疗方法平均住院日、好转率。结果行人工肝血浆置换术治疗后临床症状及生化指标均有不同程度的改善,缩短了平均住院日,治愈好转率达到77.5%。结论血浆置换为主的人工肝支持系统是治疗肝衰竭的有效手段。患者的术前准备、术中监测、观察、处理和术后护理是保证治疗成功的重要基础。 相似文献
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Efficacy and limitation of apheresis therapy in critical care. 总被引:4,自引:0,他引:4
H Hirasawa T Sugai S Oda H Shiga K Matsuda H Ueno T Sadahiro 《Therapeutic apheresis》1997,1(3):228-232
Apheresis therapy such as plasma exchange and plasma adsorption has become therapeutic tools in critical care. The indications for apheresis therapy in ICU patients include fulminant hepatic failure, thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), autoimmune disease, and sepsis. During the past 11 years, 150 patients with various kinds of critical illnesses were treated with apheresis therapy in our ICU, and the overall survival rate was 50%. Apheresis therapy is especially useful in the treatment of a patient with fulminant hepatic failure because liver transplantation is seldom performed in Japan; therefore, the patient should be treated with artificial liver support. When plasma exchange is performed on the critically ill, continuous hemodiafiltration should be performed simultaneously to overcome the adverse effects of plasma exchange such as hypernatremia, metabolic alkalosis, and abrupt changes in colloid osmotic pressure and to enhance the removal rate of the causative middle molecular weight substances of hepatic failure or hepatic coma. 相似文献
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BACKGROUNDImmune checkpoint inhibitors (ICIs) can lead to immune-related hepatitis (IRH) and severe liver damage, which is life-threatening in the absence of specific treatment.CASE SUMMARYA 75-year-old man was admitted to our hospital complaining of loss of appetite, yellow urine, and abnormal liver function for the past 2 wk. Three months prior to admission, he was treated with two rounds of capecitabine in combination with camrelizumab for lymph node metastasis of esophageal cancer. Although liver function was normal before treatment, abnormal liver function appeared at week 5. Capecitabine and camrelizumab were discontinued. Ursodeoxycholic acid and methylprednisolone 40 mg daily were administered. Liver function continued to deteriorate. Prothrombin time and international normalized ratio were 19 s and 1.8, respectively. The patient was diagnosed with acute liver failure. A pathological analysis of liver biopsy indicated a strongly positive immunohistochemical staining of T8+ cells, thereby suggesting that drug-induced liver injury was related to IRH caused by camrelizumab. Subsequently, we performed sequential dual-molecule plasma adsorption system (DPMAS) treatment with plasma exchange (PE). After two rounds of treatment, the patient''s appetite significantly improved, the yellow color of urine reduced, and liver function improved (total bilirubin level decreased) after five rounds of treatment. Liver function normalized 4 wk after discharge.CONCLUSIONThe use of sequential DPMAS with PE can reduce liver injury and systemic toxic reactions by clearing inflammatory mediators and harmful substances from blood, and regulate immune cell activity, which may be effective in the treatment of severe ICI-induced IRH. 相似文献
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目的 观察双重血浆分子吸附系统(DPMAS)联合血浆置换(PE)治疗慢加急性肝衰竭(ACLF)的疗效及安全性。方法 回顾性分析2016年1月至2018年12月我科收治并行人工肝治疗的乙型肝炎ACLF患者69例,其中DPMAS联合PE组32例,单纯PE组37例。观察两组治疗前后血清生化指标、凝血指标和血小板(PLT)的变化,观察疗效及不良反应。结果 两组4周总有效率和12周生存率差异无统计学意义。两组治疗后总胆红素(TBil)、白蛋白(ALB)、总胆汁酸(TBA)差异有统计学意义。两组治疗后与治疗前比较,肝功能及凝血功能均明显好转,差异有统计学意义;联合组PLT治疗前后差异有统计学意义。两组不良反应发生率差异无统计学意义(P>0.05)。结论 DPMAS联合PE治疗ACLF疗效确切,能减少血浆用量,安全性较高。 相似文献
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王爱莉 《中华临床医师杂志(电子版)》2014,(6):1056-1059
目的探讨戊型肝炎患者利用人工肝支持系统血浆置换治疗前后血液生化指标的变化及其临床意义。方法将147例患者分为两组,其中60例为对照组,只进行一般内科治疗,87例为试验组,进行一般内科治疗同时进行人工肝支持系统血浆置换治疗。分别测定两组治疗前后戊肝患者的血液生化指标变化,包括血清丙氨酸氨基移换酶(ALT)、门冬氨酸氨基移换酶(AST)、谷氨酰基移换酶(GGT)、碱性磷酸酶(AKP)、总胆固醇(CHO)、胆碱酯酶(chE)、总胆红素(TBil)、直接胆红素(DBil)、前白蛋白(PA)、血氨(NH3)、总胆汁酸(TBA)、总蛋白(TP)、白蛋白(ALB)、尿素氮(BUN)、肌酐(Cr),并对结果进行分析和统计学处理。结果试验组人工肝支持系统血浆置换治疗后ALT、AST、ALP、GGT、TBil、DBil、TBA和NH3明显降低,各指标前后差值与对照组差值比较有统计学差异(P<0.01,P<0.05);PA,TP、ALB,chE和CHO明显升高,与对照组比较有统计学差异(P<0.01,P<0.05);而BUN、Cr无明显变化,与对照组比较无统计学差异(P>0.05)。结论人工肝支持系统血浆置换后肝脏功能明显改善,是临床治疗戊型肝炎安全而有效措施之一,值得推广,特别是对老年戊型肝炎患者的肝细胞再生赢得时间。 相似文献
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目的:探讨人工肝辅助装置血浆置换(PE)联合连续性静-静脉血液滤过(CVVH)治疗重型肝炎肝衰竭的疗效、安全性及可行性。方法:对25例重型肝炎肝衰竭患者应用上述人工肝方法进行治疗70次,通过比较治疗前后患者临床症状、肝功能、凝血酶原活动度(PTA)、血氨、胆碱酯酶等指标判断临床疗效,观察治疗相关的不良反应及患者耐受情况,判断安全性及可行性。结果:患者意识模糊、黄疸、乏力、腹胀、纳差等症状均明显缓解,血清总胆红素治疗后较治疗前降低,PTA上升,治疗后近期有效率达72%,不良反应主要以血浆过敏居多,未发生大出血、休克等严重并发症,患者耐受良好。结论:在内科综合治疗的基础上PE联合CVVH可显著改善重型肝炎肝衰竭患者临床症状及生化指标,提高近期存活率,且安全可行,值得在国内推广应用。 相似文献