缓慢性血浆置换同步并联血液滤过治疗慢性乙型重型肝炎

目的 探讨缓慢性血浆置换(PE)同步并联静脉静脉血液滤过(CVVH)治疗慢性乙型重型肝炎患者的临床疗效.方法 104例患者随机分为3组,联合治疗组44例,PE治疗组30例,内科治疗组30例.联合治疗组在内科综合治疗基础上加用缓慢性PE同步并联CVVH治疗,PE治疗组在内科综合治疗基础上加用单纯PE治疗,内科治疗组仅予以内科综合治疗.观察3组治疗前后临床症状、体征、肝功能指标及近期有效率、生存率,并观察联合治疗组和PE治疗组治疗前后动脉血pH值、血钠浓度和肿瘤坏死因子及白细胞介素1、6、10等的变化情况.根据不同资料分别选择t检验、F检验或X2检验.结果 联合治疗组9例肝性脑病患者中7例意识转清,9例肝肾综合征患者中6例肾功能恢复,酸碱失平衡得以纠正,低钠血症改善,肿瘤坏死因子a下降,近期有效率81.82%,生存率56.82%;PE治疗组7例肝性脑病患者2例意识转清,5例肝肾综合征患者1例肾功能恢复,pH值、低钠血症及肿瘤坏死因子a无变化,近期有效率56.67%,生存率33.33%,两组患者白细胞介素1、6均降低,白细胞介素10升高.内科治疗组6例肝性脑病患者中1例意识转清醒,肝肾综合征患者肾功能均未恢复,近期有效率23.33%,生存率16.67%.结论 缓慢性PE同步并联CVVH是一种新型、安全、有效的非生物型人工肝治疗方法.

Combined slower plasma exchange and continuous veno-venous hemofiltration with a parallel circuit in the treatment of chronic severe viral hepatitis B patients

Objective To explore the clinical effects of combined slower plasma exchange(PE)and continuous veno-venous hemofiltration(CVVH)with a parallel circuit in the treatment of chronic severe viral hepatitis B patients.Methods 104 patients with chronic severe viral hepatitis B were divided into three groups:44 patients were treated with a parallel circuit of combined slower plasma exchange and continuous veno-venous hemofiltration(group A),30 patients were treated with plasma exchange(group B),and 30 patients received routine treatment(group C).Efficacy of treatment and survival rate in three groups were investigated.The levels of cytokine,plasma sodium concentration and pH value were examined before and after artificial liver support system treatment.Results In group A,7 of 9 patients in coma regained normal consciousness,6 of 9 patients with hepatorenal syndrome restored renal function,hyponatremia was improved,the balance of pH value was corrected,tumor necrosis factor(TNF)-alpha level was decreased,and the total survival rate was 56.82%.In group B,2 of 7 patients in coma regained normal consciousness,1 of 5 patients with hepatorenal syndrome restored renal function.Hyponatremia,pH value and TNF-alpha level were not changed;the total survival rate was 33.33%.Both IL-1 and IL-6 levels were significantly decreased after treatment in group A.IL-10 level was increased in both group A and group B.In group C,1 of 6 patients regained normal consciousness from coma,none of them restored renal function,and the total survival rate was 16.67%.Conclusions Combined slower PE and CVVH with a parallel circuit iS fl new.safe and effective non-biological artificial liver in the treatment for chronic severe viral hepatitis B patients.