CAJ | 학술논문

目的探讨血液灌流治疗急性肝功能衰竭(ALF)的临床疗效.方法选择我院感染科2007年1月-2009年5月住院的ALF患者26例,将其随机分成血液灌流组(16例)和常规治疗组10例.常规治疗组患者采用绝对卧床休息,给予高碳水化合物、低脂、适量蛋白质饮食,醋酸保留灌肠,适当补充清蛋白或新鲜血浆,静脉滴注还原型谷胱甘肽、甘草酸二胺、多烯磷酰酯胆碱,根据病情适当应用抗生素、凝血因子、免疫调节治疗、抗内毒素治疗等,积极防治肝性脑病、脑水肿等并发症.血液灌流组在常规治疗的基础上,应用HA330-Ⅱ型树脂血液灌流器进行血液灌流2～6次,每次间隔2～4 d.治疗前及末次治疗结束后次日晨分别抽取空腹静脉血,检测患者血清内毒素(LPS)、肿瘤坏死因子-α(TNF-α)、IL-6、肝肾功能、电解质、凝血酶原活动度(PTA)、血氨、血常规及临床症状的变化,并与常规治疗组进行比较.结果血液灌流治疗后,患者临床症状得到明显改善,血清总胆红素(TBIL)、ALT、血氨、尿素氯(BUN)、血肌酐(Scr)、血小板计数(PLT)、LPS、TNF-α、IL-6水平均较治疗前显著降低,PTA较治疗前显著升高,差异有统计学意义(P<0.05);常规治疗组患者仅血氨水平较治疗前显著降低,差异有统计学意义(P<0.05).结论血液灌流能吸附ALF患者血液中的LPS、TNF-α、IL-6、胆红素、血氨等,改善肝肾功能及临床症状,是抢救ALF安全、有效的方法.
목적 탐토혈액관류치료급성간공능쇠갈(ALF)적림상료효.방법 선택아원감염과2007년1월-2009년5월주원적ALF환자26례,장기수궤분성혈액관류조(16례)화상규치료조10례.상규치료조환자채용절대와상휴식,급여고탄수화합물、저지、괄량단백질음식,작산보류관장,괄당보충청단백혹신선혈장,정맥적주환원형곡광감태、감초산이알、다희린선지담감,근거병정괄당응용항생소、응혈인자、면역조절치료、항내독소치료등,적겁방치간성뇌병、뇌수종등병발증.혈액관류조재상규치료적기출상,응용HA330-Ⅱ형수지혈액관류기진행혈액관류2～6차,매차간격2～4 d.치료전급말차치료결속후차일신분별추취공복정맥혈,검측환자혈청내독소(LPS)、종류배사인자-α(TNF-α)、IL-6、간신공능、전해질、응혈매원활동도(PTA)、혈안、혈상규급림상증상적변화,병여상규치료조진행비교.결과 혈액관류치료후,환자림상증상득도명현개선,혈청총담홍소(TBIL)、ALT、혈안、뇨소록(BUN)、혈기항(Scr)、혈소판계수(PLT)、LPS、TNF-α、IL-6수평균교치료전현저강저,PTA교치료전현저승고,차이유통계학의의(P<0.05);상규치료조환자부혈안수평교치료전현저강저,차이유통계학의의(P<0.05).결론 혈액관류능흡부ALF환자혈액중적LPS、TNF-α、IL-6、담홍소、혈안등,개선간신공능급림상증상,시창구ALF안전、유효적방법.
Objective To discuss the clinical effect of hemoperfusion on acute liver failure (ALF).Methods Twenty-six ALF patients were randomized into groups A (n=16) and B (n=10).Group B were asked to rest in bed absolutely and given a high-carbohydrate,low-fat and adequate protein diet,acetic acid retention enema,appropriate addition of albumin or fresh plasma,intravenous infusion of GSH,glycyrrhizic acid diamine and polyene phosphatidylcholine,proper use of antibiotics,coagulation factors,immune regulation and anti-endotoxin based on patients′ conditions,to prevent positively such complications as hepatic encephalopathy and cerebral edema.Group A,besides conventional treatment,given additional hemoperfusion,2～6 times,every 2～4 d.Before treatment and next morning after,fasting venous blood were collected to determine serum endotoxin,TNF-α,IL-6,liver and kidney function,electrolytes,prothrombin activity (PTA),ammonia,blood routine examination and changes of clinical symptoms.Results After hemoperfusion treatment,the clinical symptoms of patients were improved remarkably,and the levels of TBIL,ALT,ammonia,BUN,Scr,PLT,LPS,TNF-α,IL-6 lowered and PTA increased as compared with pretreatment,but only ammonia level lowered in group B,the difference was significant (P<0.05).Conclusion Hemoperfusion,absorbing LPS,TNF-α,IL-6,bilirubin,ammonia,etc.and improving liver and kidney function and clinical symptoms,is a safe and effective method of rescuing ALF.