连续性肾替代治疗脑病型重型肝炎的临床研究

目的 探讨连续性肾脏替代疗法(CRRT)治疗肝性脑病型重型肝炎临床疗效,并研究其机制。方法 47例肝性脑病型重肝炎患者随机分成三组:CRRT治疗组、PE(血浆置换)+CRRT治疗组和基础疗法组,前二组在基础疗法组基础上分别予CRRT或PE+CRRT治疗。治疗前后检测肝肾功能、血氨、TNFα和IL-6等。结果 CRRT治疗组、PE+CRRT治疗组和基础疗法组患者的清醒率分别为75.0％、86.7％、31.3％;存活率25.0％、46.7％、6.25％(P<0.05),CRRT治疗后血清尿素氮、肌酐、氨、TNFα、IL-6比基础疗法组明显下降,(P<0.05)。血清胆红素、TBA下降和基础疗法组比较无显著变化(P>0.05)。CRRT治疗过程中,血液动力学稳定,并发症少。CRRT治疗组、PE+CRRT治疗组肝性脑病Ⅰ～Ⅱ期患者存活率分别为44.4％、62.5％,明显高于Ⅲ～Ⅳ期患者的存活率0％、28.6％(P<0.05)。结论 CRRT是辅助治疗肝性脑病型重型肝炎的有效方法;早期联合PE治疗能进一步提高疗效。

The clinical study of treatment with continuous renal replacement therapy in severe hepatitis with hepatic encephalopathy

Objective To evaluate the clinically value and to investigate therapeutic mechanising of the treatment with continuous renal replacement therapy in severe hepatitis with hepatic encephalopathy.Metfaod Forty - seven cases were randomly allocated into three groups: CRRT group ^PE( plasma exchange) -I- CRRT group and basic treatment group.The former two groups were respectively operated by CRRT or PE + CRRT with basic treatment.Serum biochemical tests,amirKK TNFa and IL- 6 were detemined before and after treatment with CRRT.Result 75.0% patients in CRRT group and 86.7% patients in PE + CRRT group regained normal consciousness,but in basic treatment group31.3% achieved a normal neurologic recovery (P< 0.05).The survival rate of patients in CRRT group^PE + CRRT group and basic treatment group were respectively 25.0% ,46.7% and 6.25%(P<0.05).It showed that renal function and serum amino were significantly improved after treatment with CRRT,serum TNFa and EL - 6 decreased ( P < 0.05).There were no changes in levels of serum bilirubin and total bile acid.The hemodynamic function was kept stable and there were no complications during the CRRT therapy.The survival rate of patients was associated with the degree of hepatic encephalopathy in CRRT group and PE + CRRT group ( P < 0.05).Conclusion Our results showed that CRRT is an efifective means in treating severe hepatitis with hepatic encephalopathy and obviously increase the survival rate if it combined with PE in early hepatic encephalopathy.