双重血浆分子吸附联合血浆置换治疗慢加急性肝衰竭的疗效分析

目的 观察双重血浆分子吸附系统（DPMAS）联合血浆置换（PE）治疗慢加急性肝衰竭（ACLF）的疗效及安全性。方法 回顾性分析2016年1月至2018年12月我科收治并行人工肝治疗的乙型肝炎ACLF患者69例，其中DPMAS联合PE组32例，单纯PE组37例。观察两组治疗前后血清生化指标、凝血指标和血小板（PLT）的变化，观察疗效及不良反应。结果 两组4周总有效率和12周生存率差异无统计学意义。两组治疗后总胆红素（TBil）、白蛋白（ALB）、总胆汁酸（TBA）差异有统计学意义。两组治疗后与治疗前比较，肝功能及凝血功能均明显好转，差异有统计学意义；联合组PLT治疗前后差异有统计学意义。两组不良反应发生率差异无统计学意义（P＞0.05）。结论 DPMAS联合PE治疗ACLF疗效确切，能减少血浆用量，安全性较高。

Clinical effect of double plasma absorption combined with plasma exchange therapy in acute on chronic liver failure

Objective To investigate the efficacy and safety of double plasma absorption(DPMAS) combined with plasma exchange (PE) in the treatment of acute on chronic liver failure.Methods Totally 69 cases of acute on chronic liver failure treated with artificial liver treatment were retrospectively analyzed since January 2016 to December 2018. The patients were divided into combination group with 32 patients(DPMAS combined with PE)and control group with 37 patients(PE alone). Changes in laboratory tests, clinical effection and adverse reaction before and after different modes of treatment were compared. Results The two groups showed no significant differences in the effectiveness and 12 week survival rate. After treatment, the levels of TBil, ALB and TBA in combination group were significantly improved than those of control group. There were significant differences in liver function and blood coagulation function before and after treatment between two groups. Conclusion The treatment of DPMAS combined with PE can improve liver function and blood coagulation function in comparison with simple PE.