人工肝血浆置换治疗肝衰竭的临床观察

目的观察血浆置换术(PE)治疗肝衰竭的疗效。方法回顾性分析2012年1月至2013年6月收治的肝衰竭患者的临床资料,PE组33例肝衰竭患者在内科综合治疗基础上加用血浆置换治疗,对照组30例肝衰竭患者予内科综合治疗,观察两组患者治疗2周后临床症状、并发症发生情况、肝功能生化指标的变化等,随访治疗后3个月内病情转归情况并分析影响疗效的因素。实验检测数据用均数±标准差(x±s)表示,计量资料用t检验进行比较,计数资料采用χ2检验或Fisher确切概率法。结果予血浆置换治疗后,患者乏力、纳差、腹胀等临床症状明显改善,血清中ALT、TBil水平较治疗前降低(390.48±536.52)U/L vs(81.03±47.58)U/L;(479.27±130.01)μmol/L vs(244.64±151.05)μmol/L,P值均0.01],Alb、胆固醇(CHO)、凝血酶原活动度(PTA)水平较治疗前升高(33.06±5.42)g/L vs(35.24±3.68)g/L;(2.50±1.24)mmol/L vs(3.59±0.86)mmol/L;(34.16±5.33)%vs(73.98±27.23)%,P值均0.01],对照组治疗后ALT、TBil、Alb、CHO、PTA水平较治疗前差异无统计学意义(P0.05);PE组患者好转率明显高于对照组(χ2=8.276,P0.01),而病死率低于对照组(χ2=13.258,P0.01);PE治疗效果与治疗前TBil水平、并发症、胆酶分离、年龄≥40岁有关(P0.05),TBil、胆酶分离是影响PE疗效的独立危险因素(P0.05,OR值分别为1.01、8.75);术中共发生不良反应8例次,予对症处理后均可好转并完成治疗。结论 PE治疗肝衰竭安全有效,有临床推广价值。TBil、胆酶分离是影响PE疗效的独立危险因素。

Clinical efficacy of plasma exchange therapy in treatment of liver failure

Objective To investigate the clinical efficacy of plasma exchange （PE） in the treatment of liver failure. Methods A retro- spective analysis was performed on the clinical data of patients with liver failure who were treated from January 2012 to June 2013 in our hos- pital. Thirty - three patients in PE group received PE in addition to medical comprehensive treatment, and 30 patients in control group were treated with medical comprehensive treatment. Clinical symptoms, complications, and the changes in biochemical markers of liver function were observed after 2 weeks of treatment, post - treatment outcomes were evaluated by 3 - month followed - up, and the influential factors for efficacy were analyzed. Experimental data were expressed as mean ± standard deviation, continuous data were compared by t test, and cate- gorical data were analyzed by chi - square test or Fisher＇s exact test. Results Symptoms such as fatigue, poor appetite, and abdominal dis- tension were significantly relieved after PE. Post -treatment serum alanine aminotransferase （ALT） and total bilirubin （TBil） levels were significantly lower compared with pre - treatment levels （ 390.48 ± 536.52 U/L vs 81.03 ± 47.58 U/L and 479.27 ± 130.01 Ixmol/L vs 244.64 ± 151.05 μmol/L, P 〈 0.005 ） , whereas post - treatment levels of albumin （Alb） and cholesterol （CHO） and prothrombin activity （PTA） were significantly higher than those measured before the treatment （33.06 ± 5.42 g/L vs 35.24 ＋ 3.68 g/L, 2.50 ± 1.24 mmol/L vs 3.59 ± 0.86 mmol/L, and 34.16% ± 5.33% vs 73.98% ± 27.23%, P 〈 0. 005 ）. No significant differences were identified between pre - and post - treatment levels of ALT, TBil , Alb, CHO, and PTA （ P 〉 0.05 ）. Patients in PE group .had a significantly higher improve- ment rate （2,2 = 8. 276, P 〈 O. 005 ） and a significantly lower mortality rate （2-2 = 13. 258, P 〈 0.005） compared with the control group. The efficacy of PE was found to be correlated with pre -treatment TBil lev