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目的探讨目前临床常用人工肝支持治疗方法血浆置换(PE)、血浆胆红素吸附(PA)、活性炭血液灌流(HP)和组合型生物人工肝(HBL)对慢性重型肝炎肝脏功能衰竭的临床疗效、安全性及可行性。方法对28例慢性重型肝炎肝衰竭患者各分别应用上述人工肝方法进行治疗61次,通过比较治疗前后患者临床症状、肝功能、凝血酶元活动度(PTA)、血氨等指标判断临床疗效,观察治疗相关的不良反应及患者耐受情况判断安全性及可行性。另有30例病情相近患者作为对照。结果与对照组比较,人工肝治疗者组乏力、腹胀、纳差等症状明显缓解率达89.7%,血清胆红素平均降低33.26%,PTA上升10.28%,2月存活率比对照组高19.03%(P<0.05)。其中以血浆置换效果最为明显。治疗组血压下降、过敏等不良反应发生率16.39%,主要以PE治疗血浆过敏居多,未发生大出血、休克等即该严重并发症及应用血制品引起的重叠感染,患者耐受良好。结论PE、PA、HP和HBL可显著改善慢性重得型肝炎肝脏功能衰竭患者临床症状及生化指称、提高近期存话率,且安全可行,值得国内推广应用。
Objective To investigate the clinical efficacy of commonly used artificial liver support therapy in patients with chronic severe hepatitis and liver failure. Methods Plasma exchange (PE), plasma bilirubin (PA), activated carbon hemoperfusion (HP) and combined bioartificial liver (HBL) , Safety and feasibility. Methods Twenty-eight patients with chronic severe hepatitis and liver failure were treated with the above-mentioned artificial liver method for 61 times respectively. Clinical symptoms, liver function, activity of thrombin (PTA) and blood ammonia were compared before and after treatment to determine the clinical effect, Observe the treatment-related adverse reactions and patient tolerance to determine the safety and feasibility. Another 30 patients with similar disease as a control. Results Compared with the control group, the alleviation rate of fatigue, bloating and anorexia were 89.7%, the serum bilirubin was reduced by 33.26% on average, the PTA was increased by 10.28%, and the survival rate in February was 19.03% higher than that of the control group (P <0.05). One of the most obvious plasma exchange. In the treatment group, the incidence of adverse reactions such as the decrease of blood pressure and allergy was 16.39%. Most of the patients were mainly treated with PE for the treatment of plasma hypersensitivity. No major bleeding, shock, or serious complications were found. The patients were well tolerated. Conclusion PE, PA, HP and HBL can significantly improve the clinical symptoms and biochemical indicators of liver failure patients with chronic severe hepatitis, improve the rate of recent stowage, and safe and feasible, it is worth popularizing and applying.