血浆置换并联或串联血液滤过治疗肝衰竭疗效比较

目的 比较血浆置换(PE)并联或串联血液滤过(HF)治疗慢加亚急性肝衰竭的疗效.方法 将2006年1月-2007年8月住院的77例肝衰竭患者随机分为单纯PE组(39例)以及PE并联或串联HF组(PE+HF组,38例),并与同期住院未行人工肝支持治疗的患者(对照组,41例)进行对照,比较3组患者的存活率和生化指标改善情况.结果 3组患者治疗前生化指标比较差异均无统计学意义.PE组和PE+HF组治疗后血白蛋白(Alb)、胆碱脂酶(ChE)、凝血酶原活性(PTA)均升高,总胆红素(TBIL)、丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)均下降(P＜0.05或P＜0.01),提示生化指标均改善明显.PE组存活率为48.7%(19/39),PE+HF组为68.4%(26/38),对照组为29.3%(12/41),其中PE+HF组存活率显著高于对照组,差异有统计学意义(X2=12.11,P＜0.01).且PE+HF组治疗后肝性脑病患者意识转清率明显高于PE组(42.8%比0,P＜0.05).PE+HF组内环境紊乱纠正比例(19/23)较PE组(0/21)高(P＜0.05).结论 PE并联或串联HF治疗肝衰竭的疗效优于单用PE治疗.

Comparison of curative effect of low flow rate plasma exchange combined with hemofiltration for treatment of liver failure

Objective To investigate the effect of plasma exchange(PE)combined with hemofiltration (HF)on liver failure.Methods Seventy-seven inpatients with liver failure admitted during January 2006 to August 2007 were randomly assigned to receive PE combined with HF(PE+HF group,38 cases),or PE alone(PE group,39 cases).Forty-one inpatients with liver failure who had not received artificial liver support treatment were assigned to serve as control group.The survival rates and biochemical parameters of three groups were compared.Results There was no significant difference in biochemical parameters before treatment among three groups.Compared with pre-treatment values,albumin(Alb),cholinesterase(ChE) and prothrombin activity(PTA)of both PE group and PE+HF group were significantly increased after treatment,and total bilirubin(TBIL),alanine transaninase(ALT),aspartate transaminase(AST)of both PE group and PE+HF group were significantly decreased after treatment(P＜0.05 or P＜0.01).The survival rate of PE group,PE+HF group and control group was 48.7%(19/39),68.4%(26/38),and 29.3%(12/41)respectively.The survival rate of PE+HF group was significantly higher than that of control group(X2=12.11,P＜:0.01).The rate of recovery of consciousness of patients with hepatic encephalopathy in PE+HF group was higher than that of PE group(42.8%vs.0,P＜0.05).Compared with PE alone,the result was better when it was combined with HF in correction of electrolyte disturbance and acid-base imbalance(19/23 vs.0/21,P＜0.05).Conclusion Treatment of liver failure by PE combined with HF is safe and effective,and its efficacy is higher than PE alone.