血浆吸附系统治疗早中期重型肝炎的临床探讨

摘要

目的：探讨早中期重型肝炎采用离子交换树脂和中性大孔树脂双重血浆吸附系统治疗临床效果。方法：选取早中期重型肝炎患者40例，均为笔者所在医院2015年1月-2016年1月收治，采用双重血浆吸附系统治疗，对比治疗前后临床症状改善情况及肝功能指标等变化。结果：40例早中期重型肝炎病例，采用血浆吸附系统治疗后，临床症状均有程度不等的改善，表现为腹胀缓解、精神好转、食欲增加、乏力减轻，出血倾向不明显。相较治疗前，治疗后患者CHE明显升高，TBA、ALT、TB、AST指标明显下降，差异均有统计学意义(P<0.05)。ALB相对升高，但差异无统计意义(P>0.05)。相较治疗前，治疗后PTA升高，PT缩短，NH3降低，差异均有统计学意义(P<0.05)，外周PLT、Hb、WBC变化不明显(P>0.05)。不良反应中，因管路凝血治疗提前终止1例次，心率加快、血压下降1例次，调整血流速度后恢复。存活36例，占90%，死亡4例，占10%。其中因重症肺炎死亡1例，消化道出血死亡1例，肝性脑病死亡2例。结论：针对临床收治的早中期重型肝炎病例，采用血浆吸附系统治疗，可显著改善肝功能，且具较高临床安全性。%Objective:To investigate the clinical effect of dual plasma adsorption system of ion exchange resin and neutral macroporous resin in early and middle stage of severe hepatitis.Method:From January 2015 to January 2016,40 cases of early and middle stage severe hepatitis were selected from our hospital,they were treated with double plasma adsorption system,the improvement of clinical symptoms and liver function indexes were compared before and after treatment.Result:The patients with early and middle stage severe hepatitis were treated with plasma adsorption system,and the clinical symptoms were improved in different degree.Manifested as abdominal distension,mental improvement,increased appetite,fatigue,lack of bleeding tendency were not obvious. Compared with before treatment,after treatment,patients with CHE were significantly higher,TBA,ALT,TB,AST indicators were significantly decreased, there were statistical differences(P<0.05).ALB was relatively elevated,but there was no statistical significance(P>0.05).Compared with before treatment,PTA was increased after treatment,the PT was shortened,NH3 was decreased,there were statistically significant(P<0.05),peripheral PLT,WBC and Hb changed not significantly(P>0.05).Adverse reactions,due to the early termination of the pipeline coagulation treatment in 1 case,heart rate,blood pressure decreased by 1 time,the recovery after blood flow velocity adjustment.Survival of 36 cases,accounting for 90%,4 cases of death,accounting for 10%.Among them,1 case died of severe pneumonia,1 case died of gastrointestinal bleeding,2 cases died of hepatic encephalopathy.Conclusion:According to the clinical treatment of early and medium term severe hepatitis patients,plasma adsorption system treatment can significantly improve the liver function,and has a high clinical safety.