多种血液净化方法治疗160例肝功能衰竭疗效观察

目的：探讨不同血液净化方法治疗肝功能衰竭的疗效。方法：将273例肝功能衰竭患者随机分成治疗组（160例）和对照组（113例）。治疗组在常规内科治疗的基础上加用多种血液净化方法治疗，包括血浆置换、血浆置换联合连续性静一静脉血液滤过、血浆置换联合血液透析滤过、血浆置换联合血浆吸附和分子吸附再循环系统等；对照组仅予常规内科治疗。观察两组治疗前后临床症状、体征及肝功能指标的变化，以及预后情况。结果：与治疗前比较．治疗组治疗后总胆红索（TB）、白蛋白（ALB）、总胆汁酸（TBA）、丙氨酸转氨酶（ALT）、前白蛋白（PALB）、胆碱酯酶（CHE）和凝血酶原活动度（PTA）均明显改善（P均〈0．01），但球蛋白（GLB）有所下降。对照组TB、TBA、ALT和PTA也有所改善，但治疗组较对照组肝功能指标改善明显，差异均有显著性（P〈0．05或P〈0．01）。治疗组中肝性脑病患者意识转清率为78．95％（15／19例）、存活率为63．13％（101／160例）；均较对照组的38．46％（5／13例）和47．79%（54／113例）显著增高，差异均有显著性（P均〈50．05）。结论：内科综合疗法加用多种血液净化方法治疗肝功能衰竭能改善临床症状及肝功能指标，可提高存活率。

Therapeutic effects of blood purification in 160 cases with liver failure

Objective: To evaluate the clinical efficacy of various methods of blood purification in the treatment of patients with liver failure.Methods: Two hundred and seventy-three patients suffering from liver failure were randomly divided into two groups.On the base of medical routine treatment,160 patients were additionally treated with various methods of blood purification treatment group,including plasma exchange,plasma exchange associated with continuously venovenous hemofiltration,plasma exchange associated with hemodiafiltration,plasma exchange associated with plasma absorption,molecular absorbents recycling(system) and so on.While the other 113 patients received medical routine treatment only(control group).The efficacy of treatment and prognosis in the two groups were then observed and compared.Results: In the treatment group,the total bilirubin(TB),albumin(ALB),total bile acid(TBA),alanine aminotransferase(ALT),pre-albumin(PALB),cholinesterase(CHE) and prothrombin activity(PTA) after the treatment were better compared with those before the treatment(all P<0.01),but globulin(GLB) was lower after treatment.TB,TBA,ALT and PTA in the control group were also improved,but liver function indexes were better in(treatment) group than those in control group,the differences being significant(P<0.05 or P<0.01).Fifteen of 19 cases(78.95%) regained consciousness from hepatic encephalopathy and the survival rate was 63.13%(101/160 cases) in the treatment group,both of which were significantly higher than those in the control group (38.46%(5/13 cases) and 47.79%(54/113 cases),both P<0.05).The comparisons of therapeutic effects between two groups had significant differences(both P<0.05).Conclusion: The medical treatment with the addition of various methods of blood purification can improve the symptoms and the indexes of liver function and increase the survival rate in the patients with liver failure.