血浆吸附灌流联合血浆置换治疗肝衰竭和高胆红素血症的临床研究

目的观察血浆吸附灌流（plasma perfusion，PP）联合血浆置换（plasma exchange，PE）的组合型人工肝方法治疗肝衰竭和高胆红素血症的临床疗效。方法将PP和使用少量血浆的PE联合在1次治疗模式（联合组）中完成，治疗51例66例次肝衰竭和高胆红素血症患者，检测治疗前、结束时及治疗结束48h时患者血总胆红素、总胆汁酸、VIA、ALB及WBC水平，并观察不良反应发生情况，与同期进行的36例79例次单纯PE治疗患者（PE组）做对照。结果①联合组治疗的总有效率为60．87％，高于PE组的52．78％，但差异无统计学意义（P〉0．05）；②2组患者治疗结束及治疗结束48h时血清总胆红素均明显低于治疗前水平（P〈0．05），联合组治疗结束时血清总胆红素下降幅度高于PE组（P〈0．05）；③2组患者治疗结束时血清总胆汁酸均低于治疗前水平（P〈0．05），但2组间比较差异无统计学意义（P〉0．05）；④2组治疗结束时PTA值均高于治疗前水平（P〈0．05）；⑤同治疗前比较，联合组治疗结束时及治疗结束48h时血清ALB、GLO均无明显变化（P〉0．05）。而PE组则明显减少（P均〈0．05）；⑥同治疗前比，2组治疗结束时及治疗结束48h时血WBC总数均无明显变化（P〉0．05），丝且治疗结束时血Pn总数均明显减少（P均〈0105）；⑦联合组平均使用血浆量明显少于PE组；⑧未发生严重不良反应。结论本研究建立的PP联合PE的人工肝方法血浆用量少，治疗肝衰竭和高胆红素血症安全有效。

Combination therapy of plasma perfusion and plasma exchange in patients with liver failure and hyperbilirubinemia

Objects To evaluate the therapeutic efficacy of combination therapy of plasma perfusion(PP) and plasma exchange(PE) on patients with liver failure and hyperbilirubinemia.Methods Fifty-one patients(totally 66 person-times) with liver failure and hyperbilirubinemia received a combination therapy of PP and PE with a small amount of plasma.Serum TBIL,TBA,PTA,ALB and WBC were measured before treatment,at the end of treatment and at hour 48 post-treatment.Adverse reactions were closely observed.Thirty-six patient...