血浆置换联合持续性血液透析滤过对慢性乙型重型肝炎近期预后及生化指标的影响

目的探讨血浆置换（plasma exchange，PE）联合持续性血液透析滤过（continuous hemodiafiltration，CHDF）治疗重型肝炎的近期疗效。方法2002年1月至2006年12月期间在我科住院的慢性乙型重型肝炎患者181例随机分2组，A组87例内科综合治疗＋PE＋CHDF，B组94例内科综合治疗＋PE，比较两组治疗后近期疗效及生存率，并观察两组治疗前后临床症状及实验室结果的改变。结果两组治疗后在近期有效率、意识转清率、改善电解质等方面有差异（P〈0．01），A组优于B组，在降低胆红素（TBIL）、改善凝血酶原活动度（PrA）及白蛋白（ALB）方面无差异（P〉0．05）。结论内科综合治疗＋PE＋CHDF能提高慢性乙型重型肝炎患者近期生存率和意识转清率，可有效纠正电解质紊乱，保持内环境平衡。

Impact of plasma exchange combined with continuous hemodiaflltration on short-term prognosis and biochemical indicator of patients with severe hepatitis

Objective To explore the short-term therapeutic effect of plasma exchange combined with continuous hemodiafiltration on patients with severe hepatitis. Methods 181 in patients in our department dur-ing Jan. 2002 to Dec. 2006 with chronic severe hepatitis caused by hepatitis B were randomly divided into two groups: Patients of group A (n=87) were treated with internal medicine supporting treatment combined with PE and CHDF,while patients of group B(n=94) were treated with internal medicine supporting treatment com-bined with PE. The short-term therapeutic effect and survival rate were compare and the clinical symptoms and the laboratory examination were determined before and after the treatment. Results There were significant difference between the two groups in short-term efficacy rate,improvement rate of consciousness and serum elee-trolure(P<0.01). There was no significant difference between the two groups in the total bilirubin decreasing,PTA improving and the albumin changing (P>0.05). Conclusion Internal medicine supporting treatment combined with PE and. CHDF can increase the recent survival rate and improve the consciousness of hepatic en-eephalopathy, and it also effectively redress electrolyte disturbance in serum and keep homeostatic equilibrium of patients; furthermore,this treatment is also convenience and safe, so it can be taken as the major method in treatment of severe hepatitis.