摘要
目的观察不同人工肝支持系统治疗急性重症肝衰竭伴多器官功能障碍综合征(MODS)的临床疗效及安全性。方法选取2014年5月--2019年3月百色市人民医院收治的急性重症肝衰竭伴MODS患者168例为研究对象,采用随机数字表法将其分为观察组、对照组,各84例,对照组予以血浆置换联合血浆胆红素吸附系统(PE+PBA)治疗,观察组采用血浆置换联合双重血浆分子吸附系统(PE+DPMAS)治疗,比较两组治疗有效率,分析其治疗前后肝功能[血清总胆红素(TBIL),直接胆红素(DBIL),丙氨酸氨基转移酶(ALT),门冬氨酸氨基转移酶(AST),谷.氨酰转肽酶(GGT)]、电解质(K^+,Na^+,Ca^2+,CI)、凝血功能[凝血酶原时间(PT),凝血酶原活动度(PTA),纤维蛋白原(FIB),活化部分凝血活酶时间(APTT)]、炎症因子[肿瘤坏死因子-a(TNF-α),白介素-6(IL-6),C反应蛋白(CRP)]、不良反应发生率、临床结局。结果两组治疗有效率比较差异无统计学意义(P>0.05);治疗后两组TBIL、DBILALT、AST、GGT均下降,且观察组治疗后TBILDBIL、ALT低于对照组(P<0.05);治疗后两组K^+、Na^+均升高,而Ca^2+CI水平均下降,且观察组治疗后Ca2+高于对照组(P<0.05);治疗后两组PT均缩短,PTA、FIB、APTT均上升,且观察组治疗后PT较对照组缩短,观察组FIB高于对照组(P<0.05);观察组治疗后血清TNF-α、IL-6、CRP水平较对照组低(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05);观察组入院8周后死亡率低于对照组(P<0.05)。结论采用PE+DPMAS治疗急性重症肝衰竭伴MODS患者可明显改善其肝功能,对凝血功能、电解质水平影响小,能较好下调机体炎症因子水平,改善患者临床结局,且安全可靠,值得在临床推广实践。
Objective To observe the clinical efficacy and safety of different artificial liver support systems in the treat-ment of acute severe liver failure with multiple organ dysfunction syndrome(MODS).Methods 168 patients with acute severe liver failure and MODS admitted to our hospital from May 2014 to March 2019 were selected as the research objects.They were divided into observation group and control group with 84 cases each by random number table method The control group was treated with plasma exchange combined with plasma bilirubin adsorption system(PE+PBA).The observation group was treated with plasma exchange combined with double therapy.The therapeutic efficacy was compared between the two groups.The liver function [total bilirubin(TBIL),direct bilirubin(DBIL),alanine aminotransfer ase(ALT),aspartate aminotransferase(ASI),glutamic alanine aminotransferase(GGT)],electrolyte(K^+,Na^+,Ca^2+;CIr),coagulation funetion[prothrombin time(PT),prothrombin activity(PTA),fibrinogen(FTB),aclivated partial thromboplastin time(APTT)],inflammalory factors[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)],incidence of adverse reactions,and clinical outcomes were analyzed before and after treatment.Results Therc was no significant difference in the effective rate between the lwo groups(P>0.05).After treatment,TBIL,DBIL,ALT.AST and CGT in the Lwo groups decreased,and TBIL,DBIL and ALT in the observation group were lower than those ir the control group(P<0.05),After treatment,the levels of K^+,Nat in the two groups increased,Ca^2+,Ci in the two groups decreased,and Ca^2+in the observation group was higher than that in the control group(P<0.05).After treatment,PT shortened in both groups,PTA,FIB and APTT increased in both groups,and PT in the observation group was shorten than that in the control group,FIB in the observation group was higher than that in the control group(P<0.05)serum levels of TNF-α、IL-6 and CRP in the observation group were lower than those in the control group(P<0.05)there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05);The mortality rate of the observation group was lower than that of the control group 8 weeks after admission(P<0.05).Conclusion PE+DPMAS can significantly improve the liver function of patients with acute severe liver failure and MODS,and has little effect on coagulation function and electrolyte function.It is safe and reliable to lower the level of inflammatory factors,and it is worth popularizing in clinical practice.
作者
黄辉权
HUANG Huiquan(Department of eritical mnedicine,Baise people's Hospital,Baise Guangxi 533000,China)
出处
《中国急救复苏与灾害医学杂志》
2020年第2期187-191,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
