人工肝脏在急性肝衰围手术期的合理选择与运用

目的　结合我科肝移植围手术期应用的生物透析吸附系统和血浆置换技术,对其围手术期应用价值进行探讨。方法　对22例急性肝功能衰竭病人应用生物透析吸附系统和血浆置换人工肝技术支持前后的生化指标、凝血酶原国际标化比值、肝移植手术过程的失血量、输血量、无肝期时间、手术时间、以及住院日数、住院经费等进行比较。结果　生物透析吸附系统组和血浆置换组的性别组成、平均年龄及疾病组成无差异;应用人工肝支持后两组的谷丙转氨酶、谷草转氨酶、总胆红素及直接胆红素均较支持前显著下降(P<0 05),而凝血酶原国际标化比值在 Biologic DT组支持前后无差异(P>0 05),但血浆置换组则显著下降(P<0 01);两组间比较谷丙转氨酶、谷草转氨酶、总胆红素及直接胆红素下降率两组无差异,但凝血酶原国际标化比值改善程度血浆置换组明显高于 Biolog ic DT组(P<0 01);肝移植手术过程中失血量、输血量、无肝期时间、手术时间血浆置换组明显少于Biologic DT组(P<0 05),住院日数、住院经费血浆置换组也低于 Biologic DT组(P<0 05)。结论　肝移植围手术期的支持血浆置换技术优于生物透析吸附系统。应用血浆置换可以改善病人的凝血功能及凝血状态,有利于减少手术过程中的失血量、输血量,病人恢复更加顺利,住院日数及住院费用

Appropriate use of artificial livers in pre-liver-transplantation period in acute liver failure

Objective To determine the values of different kinds of artificial livers (biological DT and plasma exchange) in pre liver transplantation period in acute liver failure (ALF). Methods Twenty two patients with ALF were subsequently experienced biological DT/plasma exchange treatment and modified piggyback liver transplantation. The biochemical parameters of pre and post artificial liver supporting were determined. The volume of blood loss, volume of blood infusion, non hepatic time, operating time, hospitalization duration and hospitalization cost were also evaluated. Results No differences in sex distinction, mean age and disease distribution were found between the biological DT group and plasma exchange group. The levels lf alanine aminotransferase, glutamic oxaloacetic transaminase, total bilirubin index and direct bilirubin index were significantly decreased in both groups (P<0 05). The prothrombin time INR did not improve in the biological DT group (P>0 05) but significantly decreased in plasma exchange group (P<0 01). The decreasing rate of alanine aminotransferase, glutamic oxaloacetic transaminase, total bilirubin index and direct bilirubin index showed no difference between the 2 groups. However, the improving rate of prothrombin time INR was markedly higher in the plasma exchange group than in the biological DT group (P<0 01). The volume of blood loss, volume of blood infusion, non hepatic time, operating time, hospitalization duration and hospitalization cost were remarkably lower in the plasma exchange group than in the biological DT group (P<0 05). Conclusions The value of plasma exchange is superior to that of biological DT in the pre liver transplantation supporting period of ALF.