CAJ | 학술논문

目的应用终末期肝病评分模型(MELD)评价血浆置换治疗肝衰竭的临床疗效.方法131例肝衰竭患者在内科综合治疗基础上进行血浆置换术(PE)治疗,观察治疗前后血常规、肝功能、肾功能、凝血指标和MELD计分的变化.结果在PE治疗前后丙氨酸氨基转移酶(406.2±591.6u/l和88.9±93.4u/l)、总胆红素(407.2±144.1μmol/l和287.6±150.4μmol/l)和凝血酶原时间(24.9±14.7s和19.7±7.1s)的变化有显著性统计学差异(P均<0.05);MELD计分小于40的患者经PE治疗后MEDL计分显著下降,差异有统计学意义(P<0.05),而MELD计分大于40的患者在治疗后MELD无显著性变化(P>0.05);入院时MELD计分在0~20分、20~30分、30~40分和大于40分的患者,其病死率分别为17.8%、37.3%、60.0%和100.0%.结论血浆置换治疗肝衰竭患者能有效改善血生化指标和MELD计分,MELD评分系统可用于对肝衰竭患者预后的判断.
목적응용종말기간병평분모형(MELD)평개혈장치환치료간쇠갈적림상료효.방법131례간쇠갈환자재내과종합치료기출상진행혈장치환술(PE)치료,관찰치료전후혈상규、간공능、신공능、응혈지표화MELD계분적변화.결과재PE치료전후병안산안기전이매(406.2±591.6u/l화88.9±93.4u/l)、총담홍소(407.2±144.1μmol/l화287.6±150.4μmol/l)화응혈매원시간(24.9±14.7s화19.7±7.1s)적변화유현저성통계학차이(P균<0.05);MELD계분소우40적환자경PE치료후MEDL계분현저하강,차이유통계학의의(P<0.05),이MELD계분대우40적환자재치료후MELD무현저성변화(P>0.05);입원시MELD계분재0~20분、20~30분、30~40분화대우40분적환자,기병사솔분별위17.8%、37.3%、60.0%화100.0%.결론혈장치환치료간쇠갈환자능유효개선혈생화지표화MELD계분,MELD평분계통가용우대간쇠갈환자예후적판단.
Objective To evaluate the model for end- stage liver disease (MELD) for predicting the clin-ical outcomes of patients with hepatic failure after plasma exchange (PE). Method 131 patients with hepatic failure were treated with plasma exchange. Blood routine,liver function, renal function and coagulation index were observed pre- and post-treatment, and the model for end-stage liver disease was also evaluated. Results There were obvious exchanges of ALT (406.2±591.6u/l vs. 88.9±93.4u/l),total serum bilirubin (407.2±144.1μmol/l vs. 287.6±150.4μmol/l) and prothrombin time (24.9±14.7s vs. 19.7±7.1s) in the 131 patients with liver failure before and after PE(P<0.05);The improvement was found in patients with MELD score less than 40(P<0.05);The fatali-ty rates in patients with MELD score at less than 20,20 to 30,30 to 40 and greater than 40 were 17.8%,37.3%, 60.0% and 100.0%,respectively. Conclusion Plasma exchange can significantly improve clinical outcomes of pa-tients with liver failure,especially in those at early to middle stage disease.