补充不同置换液进行选择性血浆置换治疗重型肝炎患者的临床效果

目的观察补充不同置换液进行选择性血浆置换治疗重型肝炎的临床效果。方法选择在本院住院的41例成年重型肝炎患者，对其共进行人工肝选择性血浆置换（PPE）治疗75例次。治疗时根据不同的血浆供应条件，随机分为3组，均给予护肝、支持、对症等基本治疗，给予促肝细胞生长素、前列第尔、甘草酸胺、白蛋白、血浆等综合治疗，择期进行选择性血浆置换治疗。结果3组患者治疗后都有临床症状的明显改善，并且治疗后各组的肾功能和电解质变化不明显，肝功能指标均有明显的好转，各组的总胆红素、直接胆红素和总胆汁酸明显降低，总蛋白和白蛋白增高，胆碱脂酶和总胆固醇上升幅度略有差异，但是组内相互比较差异无显著性意义。结论选择性血浆置换治疗重型肝炎有很多的优点，少量血浆补充可以代替原来的单纯血浆置换。少用血浆，可以缓解血浆供应的矛盾，减少血浆反应的发生，减少输入血浆内尚不明确的潜在性病毒感染等危险。

Clinical Effect of Part Plasma Exchange by Different Fluid Replacement in the Treatment of Patients with Severe Hepatitis

Objective To observe the clinical effect of part plasma exchange by different displacement liquid in the treatment of patients with severe hepatitis. Methods 41 adult patients with severe hepatitis in our hospital were chosen, which were treated for 75 times by part plasma exchange （PPE）. According to different conditions of blood supply, the patients were randomly divided into three groups, which were given the liver, support, and symptomatic treatment, and hepatocyte growth promoting factor, glycyrrhizic acid amine, plasma albumin, the comprehensive treatment, then were treated by part plasma exchange at selective time. Results 3 groups of patients after treatment can significantly improve clinical symptoms, and no significant changes in renal function and electrolytes in each group; liver function indexes significantly improved; total biliruhin, direct bilirubin and total bile acid significantly decreased; total protein and albumin increased; cholinesterase and total cholesterol increased somewhat differently, without significant difference among the three groups. Conclusion Part plasma exchange in the treatment of severe hepatitis has many advantages. A small amount of plasma supplementation can replace the original simple plasma exchange, which can reduce contradictions of the blood supply, reduce the occurrence of plasma reaction, and reduce the risk on unclear and potential viral infection.