CAJ | 학술논문

目的探讨血浆置换(plasma exchange,PE)联合持续静静脉血液透析滤过(continuous veno-venous hemodialysis filtration,CVVHDF)治疗儿童急性肝功能衰竭(acute liver failure,ALE)的应用价值.方法中国医科大学附属盛京医院PICU 2008年8月至2014年1月收治39例符合ALF诊断患儿,行PE联合CVVHDF治疗,治疗方法为PE后立即进行CVVHDF,每次PE+ CVVHDF历时24～72h,治疗前后采集患儿凝血酶原时间、血氨、谷丙转氨酶、谷草转氨酶、血氨总胆红素、直接胆红素等指标,并对35例存在肝性脑病患儿治疗前后进行Glasgow昏迷评分.结果 39例患几经PE+ CVVHDF治疗后20例ALF患儿(51.3％)肝功能恢复正常出院,7例治疗过程中死亡,12例因个人原因治疗过程中放弃治疗,后电话随访死亡.经PE+ CVVHDF治疗后,患儿总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶分别较治疗前下降[(128.8 ±82.6) μmol/L vs (73.2±92.4) μmol/L;(90.2±71.5)μmol/L vs (55.1±42.6)μmol/L;(3 024.1±2457.0)U/L vs(1 256.8 ±757.8)U/L;(3 420.6±2216.3)U/L vs (579.4±338.6)U/L] (P ＜0.05);治疗后凝血酶原时间较治疗前缩短[(40.4±23.0)s vs(22.8±9.4)s](P＜0.0l),临床出血倾向明显减轻;Glasgow昏迷评分明显升高[(9.5±3.1)分vs (12.1±2.9)分](P＜0.01).结论 PE联合CVVHDF治疗小儿ALF可明显改善临床症状及生化指标,安全性好,无明显不良反应.
목적 탐토혈장치환(plasma exchange,PE)연합지속정정맥혈액투석려과(continuous veno-venous hemodialysis filtration,CVVHDF)치료인동급성간공능쇠갈(acute liver failure,ALE)적응용개치.방법 중국의과대학부속성경의원PICU 2008년8월지2014년1월수치39례부합ALF진단환인,행PE연합CVVHDF치료,치료방법위PE후립즉진행CVVHDF,매차PE+ CVVHDF력시24～72h,치료전후채집환인응혈매원시간、혈안、곡병전안매、곡초전안매、혈안총담홍소、직접담홍소등지표,병대35례존재간성뇌병환인치료전후진행Glasgow혼미평분.결과 39례환궤경PE+ CVVHDF치료후20례ALF환인(51.3％)간공능회복정상출원,7례치료과정중사망,12례인개인원인치료과정중방기치료,후전화수방사망.경PE+ CVVHDF치료후,환인총담홍소、직접담홍소、곡병전안매、곡초전안매분별교치료전하강[(128.8 ±82.6) μmol/L vs (73.2±92.4) μmol/L;(90.2±71.5)μmol/L vs (55.1±42.6)μmol/L;(3 024.1±2457.0)U/L vs(1 256.8 ±757.8)U/L;(3 420.6±2216.3)U/L vs (579.4±338.6)U/L] (P ＜0.05);치료후응혈매원시간교치료전축단[(40.4±23.0)s vs(22.8±9.4)s](P＜0.0l),림상출혈경향명현감경;Glasgow혼미평분명현승고[(9.5±3.1)분vs (12.1±2.9)분](P＜0.01).결론 PE연합CVVHDF치료소인ALF가명현개선림상증상급생화지표,안전성호,무명현불량반응.
Objective To observe the clinical effect of plasma exchange(PE) combined with continuous veno-venous hemodialysis filtration(CVVHDF) in children with acute liver failure.Methods Thirty-nine cases with acute liver failure admitted to pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from August 2008 to January 2014 were treated with PE combined with CVVHDF.CVVHDF was performed after PE immediately,each PE + CVVHDF lasted 24 ～ 72 hours.Prothrombin time,blood ammonia,alanine transaminase,aspartate transaminase,serum total bilirubin,conjugated bilirubin were detected before and after PE + CVVHDF treatment.Glasgow Coma Scale were assessed before and after PE +CVVHDF in the thirty-five cases with hepatic encephalopathy.Results After the treatment of PE + CVVHDF,20 children were clinical recover,7 died,12 abandoned the treatment and the results of follow-up were death.PE + CVVHDF was effective in the treatment by decreasing serum total bilirubin,conjugated bilirubin,alanine transaminase,aspartate transaminase [(128.8 ± 82.6) μmol/L vs (73.2 ± 92.4) μmol/L; (90.2 ±71.5) μmol/L vs (55.1 ± 42.6) μmol/L; (3 024.1 ± 2 457.0) U/L vs (1 256.8 ± 757.8) U/L; (3 420.6 ±2 216.3) U/L v s (579.4 ± 338.6) U/L] (P ＜ 0.05),increasing Glasgow Coma Scale (9.5 ± 3.1 vs 12.1 ±2.9) (P ＜0.01),shortening prothrombin time[(40.4 ± 23.0) s vs (22.8 ±9.4) s] (P ＜0.01),in association with the improvement of hemorrhage tendency.Conclusion PE + CVVHDF significantly improves clinical symptoms and biochemical abnormalities in children with acute liver failure.Security of PE + CVVHDF is good and with no obvious adverse reactions.