血浆置换联合连续性血液净化治疗肝衰竭患者短期疗效观察

doi:10.3969/j.issn.1672-5069.2018.03.042

实用肝脏病杂志 ›› 2018, Vol. 21 ›› Issue (3): 469-470.doi: 10.3969/j.issn.1672-5069.2018.03.042

血浆置换联合连续性血液净化治疗肝衰竭患者短期疗效观察

杨晓玲, 周强, 郑春华, 张怡芝, 李娜, 阮清芳, 张雪莲

444100 湖北省当阳市人民医院重症医学科

收稿日期:2017-09-20 出版日期:2018-05-10 发布日期:2018-05-25
作者简介:杨晓玲,女,43岁,医学硕士,副主任医师。E-mail:medttjx2003@163.com

Analysis of plasma exchange and continuous blood purification in treatment of patients with hepatitis B liver failure

Yang Xiaoling, Zhou Qiang, Zheng Chunhua, et al

ICU, People's Hospital,Dangyang444100,Hubei Province

Received:2017-09-20 Online:2018-05-10 Published:2018-05-25

摘要/Abstract

摘要： 目的探讨血浆置换联合连续性血液净化（CRRT）治疗肝衰竭患者的短期效果。方法在54例慢加急性乙型肝炎肝衰竭患者中,27例接受血浆置换治疗,另27例在此基础上联合CRRT治疗,观察短期疗效。结果在治疗3 w末,联合组血清总胆红素水平为（52.5±17.6）μmol/L,显著低于血浆置换组的（86.4±19.3）μmol/L,血浆白蛋白水平为（34.2±5.0）g/L,显著高于血浆置换组的（31.7±5.1）g/L（P<0.05）,两组INR无显著差异（P>0.05）;联合组不良反应发生率为25.9%,与血浆置换组的22.2%比,无显著性差异（P>0.05）;在治疗1 m时,血浆置换组死亡6例（22.2%）,联合组死亡2例（7.4%,P<0.05）。结论血浆置换联合CRRT治疗肝衰竭患者能短期改善肝功能指标,给进一步治疗赢得时间。

关键词: 肝衰竭, 血浆置换, 连续性血液净化, 治疗

Key words: Liver failure, Plasma exchange, Continuous blood purification, Therapy

杨晓玲, 周强, 郑春华, 张怡芝, 李娜, 阮清芳, 张雪莲. 血浆置换联合连续性血液净化治疗肝衰竭患者短期疗效观察[J]. 实用肝脏病杂志, 2018, 21(3): 469-470.

Yang Xiaoling, Zhou Qiang, Zheng Chunhua, et al. Analysis of plasma exchange and continuous blood purification in treatment of patients with hepatitis B liver failure[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(3): 469-470.

参考文献

[1] ABektas M,Idilman R,Soykan I,et al.Djuvant therapeutic plasma exchange in liver failure:assessments of clinical and laboratory parameters.J Clin Gastroenterol,2008,42(5):517-521.
[2] Jie J,Zhou F,Kang H,et al.Unexpected extrapyramidal symptoms and pulmonary aspergillosis in exertional heatstroke with fulminant liver failure:a case report. J Med Case Rep,2017,11(1):37.
[3] Akdogan M,Camci C,Gurakar A,et al.The effect of total plasma exchange on fulminant hepatic failure. J Clin Apher,2006,21(2):96-99.
[4] Du WB,Li LJ,Huang JR,et al.Effects of artificial liver support system on patients with acute or chronic liver failure. Transplant Proc,2005,37(10):4359-4364.
[5] Yu JW,Wang GQ,Zhao YH,et al.The MELD scoring system for predicting prognosis in patients with severe hepatitis after plasma exchange treatment. Hepatobiliary Pancreat Dis Int,2007,6(5):492-496.
[6] 中华医学会感染病学分会肝衰竭与人工肝学组和肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南.实用肝脏病杂志,2013,16(3):210-216.
[7] Kim JD,Choi JY,Park CH,et al.Clinical features of patients with fulminant hepatitis A requiring emergency liver transplantation:comparison with acute liver failure due to other causes.Korean J Hepatol,2010,16(1):19-28.
[8] Kaffarnik M F,Ahmadi N,Lock J F,et al.Correlation between plasma endothelin-1 levels and severity of septic liver failure quantified by maximal liver function capacity(LiMAx test). A prospective study.PLoS One,2017,12(5):e0178237.
[9] 范晶华,陈红英,王宏图,等. 血浆置换联合血浆灌流治疗肝衰竭患者临床疗效分析. 实用肝脏病杂志,2016,19(2):184-187.
[10] Li M,Wang Z,Wang Y,et al.Part of plasmapheresis with plasma filtration adsorption combined with continuous hemodiafiltration in the treatment of severe acute liver failure. Exp Ther Med,2016,12(4):2582-2584.
[11] Di C,Santoro MC,Gaspari R,et al.Catholic university experience with molecular adsorbent recycling system in patients with severe liver failure. Transplant Proc,2005,37(6):2547-2550.
[12] Yamamoto R,Nagasawa Y,Marubashi S,et al.Early plasma exchange for progressive liver failure in recipients of adult-to-adult living-related liver transplants. Blood Purif,2009,28(1):40-46.
[13] Annicchiarico BE,Avolio AW,Siciliano M,et al.Acute decompensation and absence of brain and kidney dysfunction predict long-term efficacy of plasma exchange in hyper-bilirubinemic cirrhotic patients awaiting liver transplantation.Transplant Proc,2008,40(6):1929-1931.
[14] 王朝旭,李叶宁,王文龙,等. 血浆置换联合胆红素吸附治疗慢加亚急性肝衰竭患者疗效及血清细胞因子水平变化. 实用肝脏病杂志,2017,20(4):492-493.
[15] Osada S,Saji S.The clinical significance of monitoring alkaline phosphatase level to estimate postoperative liver failure after hepatectomy. Hepatogastroenterology,2004,51(59):1434-1438.
[16] Tek I,Arslan O,Arat M,et al.Effects of replacement fluids used for therapeutic plasma exchange on plasma viscosity and plasma oncotic pressure.Transfus Apher Sci,2004,31(2):89-93.
[17] Udayakumar N,Subramaniam K,Umashankar L,et al.Predictors of mortality in hepatic encephalopathy in acute and chronic liver disease:a preliminary observation.J Clin Gastroenterol,2007,41(10):922-926.

血浆置换联合连续性血液净化治疗肝衰竭患者短期疗效观察

Analysis of plasma exchange and continuous blood purification in treatment of patients with hepatitis B liver failure

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	鲍应军, 任伟新. 门静脉血栓介入治疗研究进展[J]. 实用肝脏病杂志, 2019, 22(6): 768-769.
[2]	中国研究型医院学会肝病专业委员会, 中国医师协会脂肪性肝病专家委员会. 脂肪性肝病诊疗规范化的专家建议（2019年修订版）[J]. 实用肝脏病杂志, 2019, 22(6): 787-792.
[3]	. 肝纤维化诊断及治疗共识（2019年）[J]. 实用肝脏病杂志, 2019, 22(6): 793-803.
[4]	石莹莹, 王元喜. 替比夫定联合阿德福韦酯治疗慢性乙型肝炎患者效果及其对肾功能的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 820-823.
[5]	邢欣, 魏重操, 周咪咪, 李小玲, 邓江, 鲁晓岚. 牛磺熊去氧胆酸与熊去氧胆酸治疗非酒精性脂肪性肝病患者疗效和安全性的Meta分析[J]. 实用肝脏病杂志, 2019, 22(6): 852-855.
[6]	段楚瑶, 陈庆山, 汪黎明, 贺晓琪. 熊去氧胆酸治疗妊娠期肝内胆汁淤积症患者疗效研究^*[J]. 实用肝脏病杂志, 2019, 22(6): 864-867.
[7]	陈梅梅, 段晓燕, 曹海霞, 丁雯瑾. 复方鳖甲软肝片治疗原发性胆汁性肝硬化患者疗效分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 880-883.
[8]	马雅琼, 李芝兰, 夏冰. 早期肠内营养联合微生态制剂治疗肝性脑病患者肠道菌群的改变^*[J]. 实用肝脏病杂志, 2019, 22(6): 892-895.
[9]	冯文广, 姜伟, 宋国军. PPV指导术中液体治疗对行肝部分切除术治疗的肝内胆管结石患者术后并发症发生的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 912-915.
[10]	黎秋曦, 贾健锋, 黄锐. 区段肝蒂肝切除术与B超引导下肝切除术治疗肝胆管结石患者临床价值分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 916-919.
[11]	李传杰, 徐静, 王亮亮, 潘劲劲, 刘波. 恩替卡韦治疗慢性乙型肝炎患者血清HBsAg变化与病毒学应答的相关性研究[J]. 实用肝脏病杂志, 2019, 22(6): 928-929.
[12]	张瑞, 王剑, 陈世耀. 肝硬化门脉高压症并发血栓形成机制和治疗研究进展^*[J]. 实用肝脏病杂志, 2019, 22(6): 930-933.
[13]	梁巨波, 苗琪, 马雄. 胆管细胞型胆汁淤积诊治进展[J]. 实用肝脏病杂志, 2019, 22(6): 941-943.
[14]	赵协山, 伍春瑢, 王春峰, 余积洁, 何青. 替诺福韦联合安络化纤丸治疗HBeAg阴性慢性乙型肝炎患者疗效及其血清肝纤维化指标的变化研究*[J]. 实用肝脏病杂志, 2019, 22(5): 644-647.
[15]	涂杰霞, 王安娜, 廖若汐. 干扰素α-2b与聚乙二醇干扰素α-2a治疗慢性乙型肝炎患者疗效比较研究*[J]. 实用肝脏病杂志, 2019, 22(5): 648-651.