血浆置换联合持续性血液滤过透析对慢性重型乙型病毒性肝炎临床症状及生化指标的影响——附87例报告

目的:探讨血浆置换联合持续性血液滤过透析治疗对慢性重型乙型病毒性肝炎(慢重肝)临床症状及生化指标的影响.方法:记录87例慢重肝患者(A组)在应用血浆置换及持续性血液滤过透析联合内科综合治疗前后临床症状和生化指标的改善情况,并与94例行血浆置换联合内科综合治疗的慢重肝患者(B组)进行对比.结果:治疗后,A组临床症状改善100%(87/87),低钾血症复常率为80%(33/41)、低钠血症复常率为93%(27/29),肝性脑病清醒率55%(12/22);B组则相应为48%(45/94)、7%(3/42)、7%(2/30)和20%(5/25),2组上述各项指标比较差异均有统计学意义(均为P＜0.05).A组近期有效率、近期生存率分别为80%、48%,B组为47%、31%,2组比较差异均有统计学意义(均为P＜0.05).不良反应以血浆过敏反应为主,均未发生低血压、肺水肿等严重不良反应.结论:血浆置换及持续性血液滤过透析联合内科综合治疗可有效纠正慢重肝患者的电解质紊乱,保持内环境平衡,且能提高其近期生存率和肝性脑病清醒率,为慢重肝的治疗提供了新的选择.

Therapeutic effects of plasma exchange combined with continuous hemodiafiltration on chronic severe hepatitis B——a report of 87 cases

Objective:To study the therapeutic effects of artificial liver support system(ALSS)of plasma exchange(PE)combined with continuous hemodiafiltration(CHDF)on severe chronic hepatitis B.Methods:87 chronic severe hepatitis B patients(group A)were treated by PE combined with CHDF based on medical supporting treatment.Their therapeutic effects on clinical symptoms and biochemical indicators were observed and compared with 94 severe chronic hepatitis B patients(group B),who were treated only by PE without CHDF.Results:The recent improvement rate of clinical symptoms,hypokalemia,hyponatremia and consciousness rate of hepatic encephalopathy in group A were 100%(87/87),80%(33/41),93%(27/29)and 55%(12/22)respectively,while 48%(45/94),7%(3/42),7%(2/30)and 20%(5/25)respectively in group B.There were significant differences between two groups(P<0.05).The effective power and survival rate in the near future in group A(80% and 48%)were much higher than those in group B(47% and 31%)(P<0.05).The most common adverse reaction was plasma allergic reaction.Severe adverse reaction such as hypotension and pulmonary edema were not found.Conclusion:Based on medical supporting treatment,PE combined with CHDF can increase the recent survival rate and the consciousness rate of hepatic encephalopathy,nomalize electrolyte disturbance.It can be a new choice of the treatments for severe chronic hepatitis B patients.