摘要
目的：探讨人工肝支持系统（ＡＬＳＳ）治疗重症肝炎（重肝）的疗效和血浆置换（ＰＥ）、血浆吸附（ＰＰ）、血液灌流（ＤＨＰ）治疗重肝的适应证。方法：治疗组６４ 例，对照组６０ 例。２ 组病例内科基础治疗相同，治疗组加用ＡＬＳＳ治疗，其中ＰＥ每次置换４０～６０ ｍ ｌ／ｋｇ 异体同型等量血浆；ＰＰ每次交换１００～１５０ ｍ ｌ／ｋｇ 血浆；ＤＨＰ每次交换１７０～２５０ ｍ ｌ／ｋｇ 全血量，２～７ 日治疗１ 次，直到病情稳定好转。结果：治疗组共计治疗１６８ 例次，平均２．６ 次，存活４４ 例，存活率６８．７５％ ；对照组存活２８ 例，存活率４６．６７％ （Ｐ＜ ０．０１）。治疗组早、中、晚期存活率分别为８５．７１％ 、７６．４７％ 和５２．１７％ ，ＰＥ、ＰＰ和ＤＨＰ治疗存活率分别为７３．８１％ 、６６．６７％ 和５０．００％ 。结果显示ＰＥ适合中毒症状严重的各型重肝，ＰＰ宜用于严重胆汁淤积的重肝，ＤＨＰ以降低ＮＨ３ 为主，适宜高氨血症和肝性脑病的治疗。治疗过程中发生不良反应２４ 例次（１５．５８％ ），经对症处理不良反应均能缓解。结论：ＡＬＳＳ治疗重症肝炎能有效清除体内病理成分，包括血清总胆红素、血氨、肿瘤坏死因子和内毒素等，提高存活率，降低?
Objective:To observe the clinical curative effects of artificial liver support system(ALSS) and the application of plasma exchange(PE),plasma perfusion(PP) and direct hemoperfusion(DHP) in the treatment of fatal hepatitis.Methods:64 cases served as treatment group and 60 cases as control group,both groups were similar in basic medical treatment,but an additional ALSS was used in the treatment group.PE was to replace each time with the heterogenous,but homeotypical plasma at an equivalent amount of 40 to 60 ml/kg;PP was to replace each time with 100 to 150 ml/kg of plasma;DHP was to replace each time with 170 to 250 ml/kg of the whole blood volume,once every 2 or 7 days until the patient′s condition was improved.Results:168 times of treatment were performed in the treatment group,2 6 times averagely.44 cases survived in the treatment gorup,and the total survival rate was 68 75%;However,in the control group,28 cases survived and the total survival rate was 46 67%.In the treatment group,the survival rate during the early,intermediate and late stages of fatal hepatitis cases respectively were 85 71%,76 47% and 52 17%.PE was applicable in the treatment of various acute toxipathic hepatitis,PP was applicable in the treatment of acute cholestatic hepatitis and DHP was available to reduce NH 3 on the whole,applicable in the treatment of hyperammonemia and hepatic encephalopathy.During the process of treatment,24 times of side effects were found(15 58%),but they were relieved after expectant treatment.Conclusions:The ALSS treatment will effectively remove the pathological compositions,including total bilirubin(TBIL),NH 3,tumor necrosis factorα and endotoxin,out of the liver associated with fatal hepatitis,and it is available to improve the survival rate and reduce the mortality rate in patients with fatal hepatitis.
出处
《中国危重病急救医学》
CAS
CSCD
2000年第2期105-108,共4页
Chinese Critical Care Medicine
基金
江西省科委重点科技计划项目!(1998 109)
关键词
病毒性肝炎
人工肝支持系统
血浆置换
治疗
fatal hepatitis
artificial liver support system
plasma exchange
plasma perfusion
direct hemoperfusion
