物理型和中间型人工肝对肝衰竭支持效果的比较研究

目的 :比较物理型 (血液灌流吸附 )及中间型 (血浆置换 )人工肝支持方法对肝衰竭患者肝功能的支持效果、安全性。方法 :4 1例重型肝炎肝衰竭患者分别进行血液灌流吸附 (2 4例 5 2例次 )和血浆置换 (17例 3 6例次 )治疗 ,观察治疗前后患者临床症状体征变化 ,比较治疗前后肝肾功能、血常规、PT变化。结果 :血液灌流吸附和血浆置换治疗后 ,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、直接胆红素下降均有显著性意义 (P <0 0 5或P <0 0 1) ,血浆置换治疗后凝血酶原时间、总蛋白下降 ,凝血酶原活动度升高均有显著性意义 (P <0 0 5或P <0 0 1) ,比较两种治疗方法的上述指标变化程度均无显著性意义 (P >0 1或P >0 2 5 )。两种治疗方法的不良反应均较轻。结论 :物理型、中间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 ,中间型人工肝的支持效果与物理型人工肝无显著差异。

Comparison study of physical and middle artificial liver in treatment of hepatic failure

Objective: To compare the efficacy and safety between physical artificial liver(hemoperfusion adsorption) and middle artificial liver(plasma exchange) in treatment of hepatic failure. Methods: Forty - one patients with hepatic failure were treated by hemoperfusion adsorption(24 cases conducted 52 time treatments) or plasma exchange(17 cases conducted 36 time treatments). The liver function, renal function, blood routine tests, prothrombin time(PT) and prothrombin activity(PTa) of two groups were examined before and after the treatment. Meanwhile, the changes of symptoms and signs of these subjects were observed closely. Results: Symptoms of all patients improved after the treatment. Compared with those before the treatment, the levels of serum aminotransferase, total bilirubin, direct bilurubin of two groups decreased after the treatment(p<0.05 or 0.01). In the plasma exchange group, the level of PT and serum proteins decreased significantly and PTa increased significantly after the treatment(p<0.05 or 0.01). There were not any significant differences of these changes between two groups(p>0.1 or 0.25). The side effects were light and limited in the all cases. Conclusion: Both artificial liver are effective in treatment of hepatic failure, and the support effects of middle artificial liver is similar to that of physical artificial liver.