血浆置换联合连续性静脉-静脉血液透析滤过治疗妊娠期急性脂肪肝伴急性肝肾功能衰竭

目的探讨血浆置换(PE)联合连续性静脉-静脉血液透析滤过(CVVHDF)治疗妊娠期急性脂肪肝(AFLP)伴急性肝肾功能衰竭的疗效。方法回顾性分析第四军医大学西京医院2012年1月至2015年1月收治的11例AFLP伴急性肝肾功能衰竭患者的临床资料。本组患者均接受PE联合CVVHDF治疗,观察治疗前后患者的症状、体征、肝肾功能、血氨、凝血系列、血常规等生化指标的变化。结果经对症支持以及PE联合CVVHDF治疗,11例患者存活9例,死亡2例。存活患者治疗前后总胆红素、直接胆红素、血氨均明显下降,凝血酶原时间缩短,纤维蛋白原含量升高,尿素氮、血肌酐等肾功能指标明显下降(P<0.05),肝性脑病缓解、病情好转、转普通病房康复。随访1年,7例患者接受随访,其中1例进展为慢性肾脏病,无患者进展至慢性肝衰竭。结论 PE联合CVVHDF治疗妊娠期急性脂肪肝伴急性肝肾功能衰竭,可取得良好临床效果。

A clinical study of plasma exchange combined with continuous veno-venous hemodiafiltration in acute fatty liver of pregnant with acute liver and renal failure

Objective To explore the effect of plasma exchange(PE)combined with continuous veno-venous hemodiafiltration(CV-VHDF)on acute fatty liver of pregnant(AFLP)with acute liver and renal failure. Methods A retrospective study was performed on 11 cases of AFLP patients with acute liver and renal failure received in the Xijing Hospital of Fourth Military Medical University from January 2012 to January 2015. Patients were treated in PE combined with CVVHDF,the clinical index such as symptoms,signs,liver and kidney function,blood ammonia series and the routine blood coagulation were observed before and after treatment. Results Based on symptomatic supportive treatment,after PE combined with CVVHDF,among 11 cases,9 cases survived and 2 cases died. After the treatment,the total bilirubin,direct bilirubin,blood ammonia,prothrombin time,fibrinogen content,urea nitrogen,serum creatinine and kidney function index improved obviously(P < 0. 05),hepatic encephalopathy was reliefed,patients got better and transferred to ordi-nary ward until rehabilitation. There were 7 patients received follow-up of 1 year,one patient progress to chronic kidney disease (CKD),no patient progressed to chronic liver failure. Conclusion PE combined with CVVHDF treatment in acute fatty liver of preg-nant with acute liver and renal failure can achieve good clinical effect.