CAJ | 학술논문

目的回顾性分析南京医科大学附属南京儿童医院2年来使用治疗性血浆置换联合连续静-静脉血液滤过+透析方法在16例急性肝衰竭儿童中的应用,探讨非生物型人工肝支持系统对儿童急性肝衰竭的治疗作用.方法收集201 1年4月至2013年3月南京医科大学附属南京儿童医院PICU住院治疗的急性肝衰竭患儿16例,自入院开始,按需要给予降酶、退黄、抗感染、机械通气、血管活性药物等内科综合治疗;符合急性肝衰竭诊断标准后,立即给予非生物型人工肝治疗,以开始血液净化治疗作为0点,在0、1、2、3、5和7d时点抽取静脉血行血生化、凝血常规检查,比较其在不同时点的谷丙转氨酶(ALT)的水平,总胆红素(TBIL)、凝血酶原时间(PT)、尿素氮(BUN)、肌酐(Cr),在治疗的0d、3d二个时点抽取静脉血行甲胎蛋白(AFP)检测.计量资料采用均数±标准差(x±s)表示,治疗前后组内两均数间进行方差分析.结果 16例患儿均行非生物型人工肝治疗,血浆置换时间(7.25±2.25)h,连续血液滤过(+透析)时间(120.75 ±33.45)h.其中治愈出院12例,死亡2例,自动出院2例.治疗2dALT水平明显下降、凝血酶原活动度(PTA)明显上升,3dPT明显改善,Cr、TBIL水平明显下降,5 d BUN水平明显下降.结论与传统内科保守治疗相比,治疗性血浆置换联合连续静-静脉血液透析+滤过的非生物型人工肝支持系统能明显改善急性肝衰竭患儿的肝肾功能及凝血功能,改善预后.
목적 회고성분석남경의과대학부속남경인동의원2년래사용치료성혈장치환연합련속정-정맥혈액려과+투석방법재16례급성간쇠갈인동중적응용,탐토비생물형인공간지지계통대인동급성간쇠갈적치료작용.방법 수집201 1년4월지2013년3월남경의과대학부속남경인동의원PICU주원치료적급성간쇠갈환인16례,자입원개시,안수요급여강매、퇴황、항감염、궤계통기、혈관활성약물등내과종합치료;부합급성간쇠갈진단표준후,립즉급여비생물형인공간치료,이개시혈액정화치료작위0점,재0、1、2、3、5화7d시점추취정맥혈행혈생화、응혈상규검사,비교기재불동시점적곡병전안매(ALT)적수평,총담홍소(TBIL)、응혈매원시간(PT)、뇨소담(BUN)、기항(Cr),재치료적0d、3d이개시점추취정맥혈행갑태단백(AFP)검측.계량자료채용균수±표준차(x±s)표시,치료전후조내량균수간진행방차분석.결과 16례환인균행비생물형인공간치료,혈장치환시간(7.25±2.25)h,련속혈액려과(+투석)시간(120.75 ±33.45)h.기중치유출원12례,사망2례,자동출원2례.치료2dALT수평명현하강、응혈매원활동도(PTA)명현상승,3dPT명현개선,Cr、TBIL수평명현하강,5 d BUN수평명현하강.결론 여전통내과보수치료상비,치료성혈장치환연합련속정-정맥혈액투석+려과적비생물형인공간지지계통능명현개선급성간쇠갈환인적간신공능급응혈공능,개선예후.
Objective To explore the therapeutic effect of non-biotype artificial liver support system (NBALSS) in acute liver failure (ALF) of children by analyzing the data of 16 children with ALF treated with plasma exchange (PE) and continuous venovenous hemodiafiltration (CVVHDF) in the past 2 years.Methods A total of 16 children with ALF in PICU admitted from April 2011 to March 2013 were enrolled in this study.After admission,they were treated for lowering transaminase,removing jaundice,antiinfection,maintaining respiration with mechanic ventilation support and maintaining blood pressure with vasoactive drugs.When patients met the criteria of ALF,the NBALSS was initiated.The CVVHDF were scheduled on the day of admission,and blood chemistry and routine coagulation were checked on the day of admission,day 1,2,3,5 and 7 after NBALSS.The levels of alanine aminotransferase (ALT),total bilirubin (TBIL),prothrombin time (PT),blood urea nitrogen (BUN) and creatinine (Cr) were compared between before and after NBALSS.Alpha-fetoprotein (AFP) was checked on day of admission and 3 days after NBALSS.The data was expressed with Y ± s,and analysis of variance was used for data analysis before and after treatment.Results In 16 ALF children treated with NBALSS,PE time was (7.25 ± 2.25) h,and CVVHDF time was (120.75 ± 33.45) h.On day 2,ALT levels significantly decreased and prothrombin activity (PTA) significantly improved.From day 3,PT significantly shortened,and Cr and TBIL level significantly decreased.On day 5,BUN level decreased significantly.Of them,12 children survived,2 chindren died and 2 children got off from hospital by their own parent decision.Conclusions Compared with conventionally conservative treatment,non-biotype artificial liver support system can improve liver and kidney function and coagulation of ALF children more efficiently,thereby improving the outcome of patients.