作　　者： (张舟）; (赖玉萍）; (梁燕娟）; (王婷婷）; (尤永森）;

机构地区： 佛山市顺德区第二人民医院内五科,广东佛山528305

出　　处： 《湖北科技学院学报（医学版）》 2017年第4期289-292,共4页

摘　　要： 目的探讨血液灌流与血液滤过治疗对急性肝衰竭(ALF)的临床疗效。方法选择我院住院的ALF患者58例,按治疗方法分成3组:血液灌流组24例,血液滤过组20例,内科治疗组14例。内科治疗组采用常规治疗,并给予醋酸保留灌肠,口服乳果糖,同时注意肝性脑病和脑水肿等并发症的防治;血液灌流组在内科治疗组的基础上进行血液灌流2~6次,每次2~3h,每次间隔2~4d。血液滤过组在内科治疗组的基础上进行血液滤过治疗2~6次,每次4h,每次间隔2~4d。入院后及治疗结束后分别抽取空腹静脉血,检测患者血清内毒素(LPS)、白细胞介素6(IL-6)、肿瘤坏死因子(TFN-α)、肝肾功能、电解质、凝血酶原活动度(PTA)、血氨、血常规的变化,3组之间进行疗效比较。结果血液灌流或血液滤过治疗后,患者临床症状得到明显改善,总胆红素、血氨、ALT、Scr、BUN、TFN-α、LPS、IL-6水平显著降低,PTA较治疗前显著升高,差异均有统计学意义(P<0.05);而内科治疗组只有血氨水平明显降低,治疗前后差异有统计学意义(P<0.05)。结论血液灌流及血液滤过能有效去除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,为肝细胞的自身再生创造条件,为肝移植赢取宝贵的时间,能明显提高患者的生存率。 Objective To investigate the clinical efficacy of hemoperfusion and hemofiltration in the treatment of acute liver failure（ ALF）. Methods 58 patients with ALF in our hospital were divided into hemoperfusion group（ n = 24）,hemofiltration group（ n = 20）,and medical treatment group（ n = 14）. The patients of medical treatment group were treated with conventional therapy. Blood perfusion group was treated with blood perfusion 2 ~ 6 times each time on the basis of medical treatment group,2 ~ 3h,2 ~ 4d at each interval.On the basis of the use of the medical treatment group,patients of hemoperfusion group were treated with hemoperfusion 2 ~ 6 times,2 ~ 3 hours each time,2 ~ 4 days each interval. On the basis of the use of the medical treatment group,patients of hemofiltration group were treated with hemofiltration 2 ~ 6 times,4h each time,2 ~4 days each interval. The fasting venous blood,serum endotoxin（ LPS）,interleukin 6（ IL-6）,tumor necrosis factor（ TFN-a）,liver and kidney function,prothrombin activity（ PTA）,the change of blood ammonia,blood routine and clinical symptoms were tested before the end of the treatment and after the end of the treatment. The curative effect was compared before and after treatment between the 3 groups. Results After treatment of hemoperfusion or hemofiltration,the clinical symptoms were improved. LPS,TNF-α,IL-6,serum（ TBIL）,blood ammonia and alanine aminotransferase（ ALT）,serum creatinine（ Scr）,urea nitrogen（ BUN） were significantly lower than those before treatment. Prothrombin activity（ PTA） was significantly higher than that before treatment,the difference was statistically significant（ P 0. 05）. The blood ammonia level in the medical treatment group was significantly lower than that before treatment,the difference was statistically significant（ P 0. 05）.Conclusion Hemoperfusion and hemofiltration can effectively remove LPS,TNF-α,IL-6,bilirubin,blood ammonia of blood in ALF patients,and also improve liver function and clinical

关 键 词： 血液灌流 血液滤过 肝功能衰竭 血清内毒素 肿瘤坏死因子 白细胞介素