白蛋白透析联合血浆灌流治疗肝衰竭的临床观察

目的观察白蛋白透析联合血浆灌流治疗肝衰竭的安全性及疗效。方法在2010年1月至2012年4月期间,采用白蛋白透析联合血浆灌流治疗肝衰竭患者17例,每次治疗前后检测血常规、生化全套、血凝常规,并观察临床表现及生命体征。治疗前后均数比较采用配对t检验。结果治疗前后患者血红蛋白、血小板、纤维蛋白原等安全性指标均无显著变化(P均0.05)。治疗后患者临床症状均有不同程度的改善,乏力、纳差减轻,腹胀有所缓解,精神好转。单次治疗胆红素(t=12.74,P0.01)、肌酐(t=4.74,P0.01)及血氨(t=7.22,P0.01)水平显著下降。肝性脑病好转率71%,肝肾综合征好转率60%,出院时临床总有效率64.7%。结论白蛋白透析联合血浆灌流治疗肝衰竭是一种安全有效的方法,尤其适用于合并肝性脑病、肝肾综合征的肝衰竭患者。

Clinical effect of albumin dialysis combined with plasma perfusion in treatment of liver failure

Objective To evaluate the safety and clinical effect of albumin dialysis combined with plasma perfusion in the treatment of liver failure.Methods Seventeen patients with liver failure were treated with albumin dialysis combined with plasma perfusion from January 2010 to April 2012.The treatment outcomes were evaluated based on the changes in routine blood results,biochemical indices,and blood coagu-lation indices,as well as clinical manifestations and vital signs.Comparison of means before and after treatment was made by paired t-test. Results The patients showed no significant changes in levels of hemoglobin,platelet,and fibrinogen after treatment （P〉0.05 for all）. After treatment,all patients showed variable improvements in clinical symptoms including weakness,poor appetite,abdominal distension, and low spirit.The patients had significantly decreased levels of total bilirubin （t=12.74,P〈0.01 ）,creatinine （t=4.74,P〈0.01 ）, and blood ammonia （t=7.22,P〈0.01）after single treatment.Of the patients with hepatic encephalopathy,71%showed improvements, and 60% of patients with hepatorenal syndrome showed improvements.Among all patients,64.7% were cured or showed improvements when discharged.Conclusion Albumin dialysis combined with plasma perfusion is safe and effective in the treatment of liver failure,espe-cially for patients with hepatic encephalopathy and hepatorenal syndrome.