血浆置换和血液灌流治疗重型肝炎临床对比研究.doc

血浆置换和血液灌流治疗重型肝炎临床对比研究 　　【摘要】 目的 对比研究人工肝治疗中血浆置换、血液灌流的临床疗效。方法 选择重型肝炎102例患者,在常规治疗的基础上随机分成两组,60例进行血浆置换治疗;42例进行血液灌流治疗,观察患者治疗前后TIB、ALB、PTA、NH?3、Na、K、Crea、Urea的变化及临床症状改善。 结果 两组表现在TIB、ALB、PTA、NH?3治疗前后有显著性差异(P0.05);两组治疗好转率比较:无显著性差异(P0.05)。结论 人工肝治疗中血浆置换、血液灌流的临床疗效无明显差异,主要并发症发生率有明显差异,因为血浆置换需大量血浆,治疗过程中患者总住院费用远远超过血液灌流。 　　【关键词】 重型肝炎; 血浆置换; 血液灌流 　　【Abstract】 Objective To compare the clinical efficacy of plasmapheresis with hemoperfusion. Both plasmapheresis and hemoperfusion have been proposed as treatment strategies for severe hepatitis to reduce the risk of death.Methods We collected 102 patients suffered from severe hepatitis,and they were randomized to treatment with plasmapheresis(60 cases) or hemoperfusion(62 cases).Biochemical and clinical symptoms changes were assessed before and after both plasmapheresis and hemoperfusion treatment.Results The values of Na?+,K?+,Crea,Urea were not modified by any treatment(P0.05),While significant differences in the values of TIB,ALB, PTA,NH?3 were found in both groups(P0.01).No significant differences were observed in the efficacy between plasmapheresis and hemoperfusion. Conclusion Plasmapheresis had the same efficacy with hemoperfusion as treatment strategy for severe hepatitis,but the incidences of chief complications were significantly different,and due to using lots of plasma in the process of plasmapheresis,making excessive cost of hospitalization,which was far beyond hemoperfusion. 　　【Key words】 　　Severe hepatitis; Plasmapheresis; Hemoperfusion 　　 　　作者单位:453000新乡市第一人民医院消化科 　　 　　重型肝炎是由各种因素如病毒、药物、酒精等引起肝细胞严重损害,导致其合成、解毒以及生物转化等功能发生严重障碍,出现以黄疸、凝血功能障碍、肝性脑病、腹水为主要表现的一种临床综合征,病死率高,内科保守治疗病死率高达60%～80%[1]。近年来,人工肝支持系统(artificial liver support system,ALSS)广泛应用于重型肝炎的治疗,已被证实为具有良好临床治疗效果[6],现将人工肝治疗中血浆置换与血液灌流临床疗效对比研究总结如下。 　　1 资料与方法 　　1.1 一般资料 全部病例均为我院2003年7月至2009年7月收治的重型肝炎进行人工肝治疗的102例患者,诊断符合2000年全国传染病与寄生虫病学会修订的标准[2]。随机分为两组:血浆置换组60例,男45例,女15例,年龄19～68岁.其中急性、亚急性重型肝炎12例,慢性重型肝炎48例。乙型肝炎48例,丙型肝炎5例,乙丙型肝炎2例,戊型肝炎1例,药物性肝炎2例,未分型2例。血液灌流组42例,男33例,女9例,年龄20