血液灌流与血浆置换联合抢救老年重度有机磷中毒的疗效

目的 探讨血液灌流与血浆置换联合抢救老年重度有机磷中毒的疗效.方法 对该院收治的老年有机磷中毒患者根据其治疗方法分为三组,其中灌流组30例采用血液灌流治疗,置换组30例采用血浆置换治疗,联合组30例采用血液灌流与血浆置换联合治疗.观察三组患者临床疗效、并发症发生率以及血清胆碱酯酶(h-CHE)、B－型钠尿肽(BNP)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平.结果 联合组患者治疗有效例数为27例,高于灌流组的21例以及置换组的23例,联合组患者住院时间、昏迷时间等均短于置换组以及灌流组(P＜0.05);联合组各项生化指标以及并发症发生率低于其他两组(P＜0.05).结论 血液灌流联合血浆置换对抢救老年重度有机磷中毒有良好疗效,可有效降低患者并发症发生率,提高患者预后.     

中间型和混合型人工肝对肝衰竭支持效果对比研究

目的　比较中间型 (血浆置换 )和混合型 (血浆置换加血液灌流吸附 )人工肝支持方法对肝衰竭患者肝功能的支持效果及安全性。方法　 1999- 0 1～ 2 0 0 2 - 0 2第三军医大学西南医院住院的 5 1例重型病毒性肝炎肝衰竭患者分别进行血浆置换 (17例 )和血浆置换加血液灌流吸附 (34例 )治疗 ,观察治疗前后患者临床症状变化 ,比较治疗前、后肝肾功能、血常规、凝血酶原时间变化。结果　血浆置换和血浆置换加血液灌流吸附治疗后 ,患者的临床症状均有不同程度改善。两种方法治疗后转氨酶、总胆红素、直接胆红素、凝血酶原时间、总蛋白、凝血酶原活动度的改善程度均差异有显著性 (P <0 0 5 ) ,但两种治疗方法间比较各项指标变化程度均差异无显著性。两种方法治疗的不良反应均较轻。结论　中间型、混合型人工肝对重型肝炎肝衰竭患者的肝功能均有肯定的支持效果。     

血液灌流联合血浆置换治疗重度有机磷中毒的临床研究

目的探讨血液灌流(HP)联合血浆置换治疗重度有机磷农药中毒的疗效。方法选取60例重度有机磷农药中毒患者,分为治疗组(HP联合血浆置换组)30例和对照组(非HP联合血浆置换组)30例,比较两组的观察指标(治愈率、昏迷至清醒时间、平均住院时间及胆碱酯酶活性恢复时间)。结果两组观察指标比较,差异均有统计学意义(P<0.05)。结论血浆置换与HP联合治疗能明显提高急性重度有机磷中毒的疗效。     

人工肝支持系统治疗的操作指南

一、人工肝支持系统治疗的操作方祛 国内应用的非生物型人工肝技术是一整套包含血浆置换、血液透析、血液滤过、血液/血浆灌流、分子吸附循环系统、连续性血液净化治疗等方法联合应用治疗重型肝炎的技术和治疗方法。临床医生根据患者病情选择单用或联合应用以上技术。 入院后重型肝炎患者均按常规检查和采用肝细胞生长素、甘利欣、苦黄、白蛋白、血浆等内科综合治疗。治疗组同时给予人工肝支持系统治疗,根据病情选用血浆置换、血液灌流、血液     

血浆置换联合持续血液滤过治疗28例急性药物性肝衰竭疗效观察

目的探讨血浆置换联合持续血液滤过在急性药物性肝衰竭治疗中的疗效。方法28例患者在给予常规治疗的基础上应用血浆置换联合持续血液滤过治疗,观察患者治疗前后的肝功能、肾功能、凝血功能变化。结果28例患者治疗后血清总胆红素由221.2±25.2μmol/L降至125.5±24.6μmol/L,P0.05;凝血酶原时间由36.2±9.3秒降至20.5±5.5秒,P0.05;谷丙转氨酶由1246±221U/L降至786±102U/L,P0.05;24例病情明显好转,生存率为85.7%。结论血浆置换联合持续血液滤过在急性药物性肝衰竭中有显著的治疗作用,可以明显改善肝肾功能。     

人工肝联合护肝药物治疗毒蕈中毒性肝炎3例报告

目的回顾毒蕈中毒性肝炎的综合救治经验。方法3例重度毒蕈中毒致中毒性肝炎患者在应用血液灌流、血浆置换及还原型谷胱甘肽治疗的基础上，加用复方甘草酸苷静脉滴注，每日一次，共用4周。结果3例患者均痊愈出院。结论人工肝联合护肝药物治疗毒蕈中毒性肝炎的效果好。     

痰热清注射液联合甘利欣治疗药物性肝炎的临床观察

目的观察痰热清注射液联合甘利欣治疗药物性肝损害的临床疗效。方法将40例药物性肝损害患者随机分成两组,分别给予痰热清注射液联合甘利欣和单用甘利欣治疗,治疗6～8周。结果20例联合用药患者临床症状改善率和肝功能复常率明显优于单用甘利欣组,差异有显著意义(P0.05)。结论痰热清注射液联合甘利欣治疗药物性肝损害疗效显著,优于单用甘利欣治疗。     

序贯血液净化治疗毒蕈中毒并多脏器功能损害疗效观察

目的 观察和评价序贯血液净化治疗毒蕈中毒并多脏器功能损害(MODS)的疗效.方法 收集本院2000～2007年救治的56例急性毒蕈中毒并发中毒性肝炎、急性肾衰竭、中毒性脑病等患者的临床资料,将56例患者分为治疗组和对照组,治疗组30例,采用血浆置换联合血液灌流﹢血液透析,隔日血浆置换与血液灌流﹢血液透析交替使用;对照组26例,单用血液灌流﹢血液透析,透析4 小时串联灌流2小时,每日1次,疗程7～10天.两组基础治疗相同.结果 治疗组患者黄疸、意识障碍、少尿或无尿等明显改善,血清酶水平均明显下降,优于对照组.治疗组死亡6例,死亡率为20.0%;对照组死亡15例,死亡率为57.7%.两组死亡率比较,差异有显著性(P＜0.01).结论 序贯血液净化治疗较单纯血液灌流﹢血液透析能明显降低毒蕈中毒并多脏器功能损害患者的死亡率.     

配对血浆置换滤过吸附治疗慢性乙型重型肝炎的疗效

近年来,血液净化技术广泛应用于肝功能衰竭的治疗,并被定义为非生物型人工肝支持系统.临床常用的方法有血浆置换(plasma exchange,PE)、血液灌流、血浆吸附、血液透析滤过、血液滤过及上述方法的联合等,其中国内尤以PE最为常用.     

血浆置换治疗甲状腺功能亢进合并戊型病毒性肝炎三例临床分析

甲状腺功能亢进症(简称甲亢)患者较多合并肝损害,包括甲亢性肝损害、病毒性肝损害、药物性肝损害及非酒精性脂肪性肝炎等,症状多较严重,治疗棘手.在其合并病毒性肝损害中,以合并戊型病毒性肝炎(简称戊肝)多见.当甲亢合并严重肝损害时,抗甲状腺药物、手术及131I治疗均有一定的局限性,而血液净化已在治疗中显示一定的价值[1].现对我院2000～2011年收治的12例甲亢合并戊型肝炎患者的临床资料进行回顾性分析,总结其中2例合并重型肝炎及1例胆汁淤积严重患者采用血浆置换治疗的临床疗效.     

血液透析与血液灌流联合抢救急性重症毒物中毒分析

目的分析血液透析联合血液灌流术在抢救急性重症中毒患者中的治疗效果。方法对23例急性重症中毒患者采用血液透析联合血液灌流术的治疗观察,并与同期随机选择的非血液灌流内科综合治疗的30例急性重症中毒患者做疗效对照观察。结果血液透析联合血液灌流能有效清除体内有毒物质,治疗组患者全部治愈出院。结论血液透析联合血液灌流是抢救急性重症中毒的快速而有效的重要治疗方法。     

Artificial liver support system in China: a review over the last 30 years

Severe viral hepatitis with high mortality is the most common cause of liver failure in China. Treatment of severe viral hepatitis by hemoperfusion was initially adopted in the late 1970s and early 1980s. Following 10 years of development in China, a plasma exchange (PE)-centered artificial liver support system (ALSS), principally dependent on PE technology was developed. Based on the condition and symptoms of each patient, PE was given alone, or combined with hemodialysis, hemofiltration, hemodiafiltration, hemoperfusion, or plasma perfusion. In the late 1990s, training courses for ALSS were developed, and ALSS began to be carried out across China. Guidelines for artificial liver therapy were formulated and published by the Artificial Liver and Liver Failure Group of the Chinese Society of Infection. In recent years, new methods have been attempted, including small pore-size plasma separators, a molecular adsorbent-based recirculating system (MARS), and a continuous albumin purification system (CAPS). According to a retrospective analysis published in 2004, ALSS therapy significantly (P < 0.001) improved the survival rate of patients with severe hepatitis compared with patients who received only medicines (43.4%, 157/362 vs. 15.4%, 55/358 in chronic patients and 78.9%, 30/38 vs. 11.9%, 5/42 in acute and subacute patients). Furthermore, ALSS has also proved valuable as a bridge to liver transplantation in the treatment of patients with end-stage severe hepatitis in China. More recently, ALSS has been used in the treatment of drug-induced liver failure, acute fatty liver during pregnancy, and other difficult-to-treat disorders in China.     

简易血液灌流在突发急性重症中毒事件救治中的应用（附58例分析）

目的探讨简易血液灌流在突发急性重症中毒事件救治中的应用价值，提高急性中毒急救成功率。方法对58例重度急性中毒患者，在基础治疗的同时，采用单纯血泵、血透穿刺针、血透动静脉管路建立体外循环，用HA230型树脂血液灌流器，进行床边简易血液灌流。结果28例中毒患者病情稳定留在原医院继续治疗，病情稳定后向有条件的医院转诊深化治疗26例，现场抢救无效死亡4例。最终抢救存活52人，死亡6人，抢救成功率89．66％。结论血液灌流是临床上极为有效的急性中毒的救治方式，对于重症毒物中毒的现场急救，简易血液灌流可迅速在病人床边实施，有着广泛的推广及应用价值。     

百草枯中毒22例的血液净化治疗

目的：研究百草枯中毒诊疗方法及疗效。方法：在常规治疗的基础上应用血液净化（血液灌流、血液透析、血液滤过）抢救百草枯中毒患者22例。部分患者重复血液净化治疗。结果：22例患者中12例患者治愈或好转出院，10例患者因病重放弃治疗自动出院。结论：在内科综合治疗的基础上，早期反复的血液净化治疗能挽救部分患者的生命。     

Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column

The aim of this study is to evaluate the impact of neutral microporous resin hemoperfusion on hemodynamic improvement, removal of inflammatory cytokines, and mortality in critical care patients with severe sepsis. Forty-four patients with severe sepsis or septic shock were randomized to HA type hemoperfusion treatment (N=24) or standard therapy (N=20). Those undergoing hemoperfusion treatment received HA330 hemoperfusion. We measured the plasma concentrations of IL-6 and IL-8 at the start of every hemoperfusion treatment, and the following parameters were compared between the control group and the hemoperfusion group on days 3, 7, and 14: hemodynamics (cardiac index, systemic vascular resistance index, heart rate, and mean arterial pressure); change of hematology and coagulation function; organ function; and the sequential organ failure assessment (SOFA) score. Hospital, 28-day, and ICU mortality were also observed. Patients treated with HA hemoperfusion showed a significant removal of plasma IL-6 and IL-8 over time while in the study. Patients in the HA group also demonstrated significant increases in cardiac index, systemic vascular resistant index, fast withdrawal of vasoactive agents and decreases in heart rate compared with the controls at days 3 and 7. Although there was no significant difference between the groups in organ dysfunction as assessed by SOFA scores from day 0 (baseline) to day 7, significant improvement can be demonstrated in the hemoperfusion group at day 14. There was no significant difference between the groups in 28-day mortality, hospital mortality, or length of hospital stay, but ICU mortality and the length of ICU stay in the HA group were markedly reduced. Hemoperfusion treatment using the HA type cartridge in sepsis is safe and it may improve organ dysfunction, ICU mortality, and shorten the length of ICU stay. Clinical significant removal of inflammatory cytokines such as IL-6 and IL-8 from circulation by hemoperfusion may contribute to improving a patient's outcome in an ICU.     

Effects of hemoperfusion adsorption and／or plasma exchange in treatment of severe viral hepatitis： A comparative study

AIM: Non-bioartificial liver has been applied to clinic for quite a long time, but the reported efficacy has been very different. The aim of this study was to compare the efficacy and safety of hemoperfusion adsorption, plasma exchange and plasma exchange plus hemoperfusion adsorption in treatment of severe viral hepatitis. METHODS: Seventy-five patients with severe viral hepatitis were treated with hemoperfusion adsorption therapy (24 cases), plasma exchange therapy (17 cases) and plasma exchange plus hemoperfusion adsorption therapy (34 cases). The data of liver function, renal function, blood routine test, prothrombin time (PT) and prothrombin activity (PTa) pre- and post-therapy were analyzed. RESULTS: Clinical symptoms of patients improved after treatment. The levels of aminotransferase, total bilirubin, direct bilirubin decreased significantly after 3 therapies (P<0.05 or P<0.01). PT, the level of total serum protein decreased significantly and PTa increased significantly after plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy (P<0.05 or P<0.01). The side effects were few and mild in all patients. CONCLUSION: Three therapies were effective in the treatment of severe viral hepatitis. Plasma exchange therapy and plasma exchange plus hemoperfusion adsorption therapy are better than hemoperfusion adsorption therapy.     

血液透析滤过联合血液灌流治疗重度鱼胆中毒15例分析

目的 探讨血液透析滤过(HDF)联合血液灌流(HP)治疗重度鱼胆中毒的疗效.方法 15例鱼胆中毒患者常规内科治疗后,均在中毒后前2天应用HDF串联HP,2d后继续HDF治疗,对其疗效进行分析.结果 经治疗中毒临床症状完全消失,肝、肾功能等各项临床指标均正常,15例患者均痊愈.结论 HDF联合HP治疗重度鱼胆中毒效果可靠、抢救成功率高.     

血液净化治疗蜂螫伤合并多器官功能障碍综合征的临床观察

目的：探讨血液净化治疗对蜂螫伤合并多器官功能障碍综合征（MODS）的急性肾衰竭的疗效。方法：回顾性分析29例蜂螫伤合并MODS并接受血液净化治疗患者的临床病历资料,根据接受血液净化方式分为血液灌流联合血液透析滤过组（HP＋HDF）、血液透析滤过组（HDF）、血液透析组（HD）,比较3组的疗效。结果：HP＋HDF组少尿期短,住院天数、透析次数均较HDF组、HD组少;24h内接受血液净化的患者病死率高。结论：HP＋HDF治疗蜂螫伤合并MODS在缩短病程方面优于HDF和HD;早期血液净化治疗并不能降低病死率。     

Contribution of hepatic immunoglobulin A deposits to the diagnosis of alcoholic hepatopathy

BACKGROUND: Alcoholic hepatic disease is a severe and frequent disease and its diagnosis is not always an easy task. AIM: To assess the contribution of immunoglobulin A (IgA) in the hepatic sinusoids for diagnosis of alcoholic hepatopathy. PATIENTS AND METHODS: The presence of IgA was studied through direct immunofluorescence in 59 patients submitted to hepatic needle biopsy, indicated by clinical or in vitro changes suggestive of chronic hepatopathy. RESULTS: A significant deposition of IgA was found in alcoholic patients as compared to non-alcoholic patients, with 76% sensitivity (95% CI: 54.5-89.8) and 73.5% specificity (95% CI: 55.3-86.5). In individuals who present only alcohol as the etiological agent of hepatopathy, compared with the subgroup of B or C virus carriers, the results were even more significant, with 85.7% sensitivity (95% CI: 56.2-97.5) and 89.5% specificity (95% CI: 65.5-98.2). CONCLUSION: The deposition of IgA in the hepatic sinusoids present sensitivity and specificity for the diagnosis of an alcohol-induced hepatic lesion. This resource can be particularly useful when conventional histology can not be define a specific cause for the change found.     

Is hemoperfusion effective in the treatment of digoxin intoxication? (author's transl)]

Digitalis therapy is frequently accompanied by adverse drug reactions. Severe digitalis intoxications are still a problem. Therapeutical methods, which could be used in the case of a life threatening digoxin intoxication, are known, but not yet generally available. Hemodialysis has only a minor effect on digoxin excretion. This study was planned to test the hypothesis that hemoperfusion across dextran-cocoated charcoal or the resin Amberlite XAD 4 could be more effective in the therapy of digoxin intoxications. The ability of hemoperfusion to eliminate digoxin was tested in a patient who had to undergo treatment beacuse of a severe bromcarbamide intoxication. Additionally we compared the effect of several modifications on this method in 12 dogs, which had received 0.05 mg/kg body weight per day for three days prior to the experiment. Although hemoperfusion across Amberlite XAD 4 may eliminate as much digoxin as normal human kidneys during the few hours of treatment, the amount of digoxin removed after all is only a small percentage of the total body pool. Thus compared to the risks of hemoperfusion as an invasive treatment its effect is small. According to our results, hemoperfusion cannot be recommended as a standard therapy of severe digoxin intoxications.