| 王临旭,高禄化,刘 浩,李 沛,黄长形.双重血浆分子吸附联合低置换量血浆置换术与全量血浆置换术治疗肝衰竭的疗效比较[J].,2021,(13):2474-2478 |
| 双重血浆分子吸附联合低置换量血浆置换术与全量血浆置换术治疗肝衰竭的疗效比较 |
| Comparison of the Efficacy of Double Plasma Molecular Absorb System Combined with Low-volume Exchange Plasma Exchange and Full-volume Plasma Exchange in the Treatment of Liver Failure |
| 投稿时间：2021-01-07 修订日期：2021-01-30 |
| DOI：10.13241/j.cnki.pmb.2021.13.015 |
| 中文关键词: 双重血浆分子吸附术 低置换量血浆置换术 肝衰竭 |
| 英文关键词: Double plasma molecular absorb system Low-volume exchange plasma exchange Liver failure |
| 基金项目:国家卫生计生委医药卫生科技发展研究中心研究项目（W2014HB013）；陕西省自然科学基金项目（2014JM2-8151） |
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| 中文摘要: |
| 摘要 目的：探讨双重血浆分子吸附术（DPMAS）联合低置换量血浆置换术（LPE）与全量血浆置换术（PE）治疗肝衰竭的临床疗效差异。方法：回顾性分析2019年6月至2020年10月在空军军医大学第二附属医院感染科治疗的101例肝衰竭患者的临床资料，分为双重血浆分子吸附联合低置换量血浆置换术（DPMAS+ LPE）治疗组51例和全量血浆置换术（PE）治疗组50例。对首次治疗前及治疗后24 h的肝功能、凝血系列、血小板等实验室指标、不良反应等进行对比分析。结果：DPMAS+LPE组与PE组治疗后两组血清总胆红素（TBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）较治疗前均明显下降（P<0.05），DPMAS+LPE组对胆红素清除效果优于PE组，两组TBIL下降率分别为36.5±17.1% vs 25.2±19.5%，差异有统计学意义（P<0.01）。DPMAS+LPE组治疗后凝血酶原时间（PT）、凝血酶原活动度（PTA）、活化部分凝血活酶时间（APTT）较治疗前无明显变化（P>0.05），纤维蛋白原（FIB）、血浆白蛋白（ALB）较前有所降低（P<0.0001），PE组治疗后PT、PTA、APTT较治疗前有所改善（P<0.05），纤维蛋白原（FIB）、血浆白蛋白（ALB）较治疗前无明显变化（P>0.05）。两组血小板计数(PLT)较治疗前均有所降低（P<0.05），但两组PLT下降率无统计学意义（P>0.05）。两组治疗中及治疗后均未见明显不良反应。结论：双重血浆分子吸附联合低置换量血浆置换术，与全量血浆置换术比较，不仅在清除血清胆红素方面更有优势，且对凝血功能无明显影响，无明显不良反应，可节约血浆用量，是治疗肝衰竭有效、安全的方式，值得推广。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical efficacy of double plasma molecular absorb system (DPMAS) combined with low-volume exchange plasma exchange(LPE) and full-volume plasma exchange (PE) in the treatment of liver failure. Methods: The clinical data of 101 patients with liver failure treated in the Department of Infectious Diseases, Second Affiliated Hospital of Air Force Military Medical University from June 2019 to October 2020 were retrospectively analyzed. Patients were divided into(DPMAS + LPE) treatment group with 51 cases and PE treatment group with 50 cases. The liver function, coagulation function, platelet parameters, and adverse reactions before the first treatment and 24 h after the treatment were compared and analyzed. Results: After treatment, the serum total bilirubin (TBIL), alanine aminotransferase(ALT) and aspartate transaminase (AST) in the DPMAS+LPE group and the PE group were significantly lower than before treatment(P<0.05). And the bilirubin clearance effect of DPMAS+LPE group was better than that of PE group (P<0.05). The reduction rate of TBIL in the two groups was (36.5±17.1)% vs (25.2±19.5)%, and the difference was statistically significant (P<0.01). After treatment, the prothrombin time (PT), prothrombin time activity(PTA), and activated partial thromboplastin time (APTT) in the DPMAS+LPE group had no significant changes compared with those before treatment (P>0.05), and fibrinogen (FIB) and plasma albumin (ALB) were lower than before treatment (P<0.0001). After treatment, the PT, PTA, and APTT of the PE group were improved compared with those before treatment(P<0.05), and FIB and ALB had no significant changes compared with before treatment (P>0.05). The platelet counts (PLT) of the two groups were lower than before treatment(P<0.05), but the PLT reduction rate of the two groups was not statistically significant (P>0.05). There were no obvious adverse reactions during and after treatment in the two groups. Conclusion: Compared with PE, DPMAS combined with LPE has more advantages in clearing serum bilirubin, and it has no obvious effect on blood coagulation function and no obvious adverse reactions. At the same time, the amount of plasma can be saved, which is an effective and safe way to treat liver failure and is worthy of promotion. |
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