血浆置换联合连续性血液净化技术治疗伴有急性肝衰竭多器官功能障碍综合征的临床观察

目的　研究血浆置换 (PE)联合连续性血液净化 (CBP)治疗伴有急性肝衰竭 (ALF)多器官功能障碍综合征 (MODS)的疗效。方法　 16例伴有急性肝衰竭的MODS患者除经内科常规治疗外 ,行PE联合连续性静脉 -静脉血液滤过 (CVVH)治疗 ,在治疗前、PE后、CVVH结束时 ,分别抽血测肝肾功能、血氨、TNF -α及IL- 6的水平 ,并进行ICU监护。结果　在治疗过程中 ,血流动力学稳定 ,血浆置换后血氨、ALT、TBIL、TBA、TNF -α、IL - 6明显下降 (P <0 0 5 ) ,而BUN、Cr下降不明显 ,CVVH治疗后血氨、BUN、Cr、TNF -α、IL - 6呈进行性下降 ,与治疗前相比差异显著 (P <0 0 5 ) ,而TBIL、TBA变化不明显 ,SIRS积分从 2 7分± 0 5分降到1 3分± 0 3分 (P <0 0 5 )。APACHEⅡ评分从 19 6± 5 3下降到 13 2± 2 6 (P <0 0 1) ,存活率为 4 3 75 %(7/16 )。结论　PE联合CVVH治疗能有效清除伴有急性肝衰竭MODS患者炎性介质TNF -α、IL - 6水平 ,改善肝肾功能 ,有效改善MODS的预后

Clinical Observation on MODS with Acute Liver Failure Treated with Continuous Blood Purification and Plasma Exchange

Objective To evaluate clinical efficacy of plasma exchange (PE) and continuous blood purification (CBP) in patient with MODS including acute liver failure (ALF). Methods 16 patients with MODS including ALF were treated with PE and CBP except general management, various biochemical parameters and serum TNF-α, IL-6 were determined before and after treatment. Results All the patient tolerated the treatment of PE and CBP. The data showed that serum NH3, ALT, TBIL, TBA, TNF-α, IL-6 were decreased but BUN, Cr had no significant differences following PE, NH, TNF-α, IL-6, BUN and Cr were lower but TBIL and TBA had no significant difference after CBP (P<0.01). SIRS score decreased significantly (pre-PE+CBP 2.7±0.5vs post-PE+CBP1.3±0.3, P<0.05), so did the APACHE Ⅱ score (pre-PE+CBP 19.6±5.3vs post-PE+CBP13.2±2.6, P<0.05). The survival rate of patient was 43.75%.Conclusion The data indicated that PE with CBP was an effective method for removing serum inflammatory cytokines and improving hepatic and renal function in the patient with MODS. It might be of clinical benefit to the prognosis of patient with MODS including ALF.