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目的分析血浆灌流对肝衰竭患者凝血功能影响的特点。方法选取我院2014年1月~2015年6月收治的肝衰竭患者60例。所有患者给予常规治疗措施,且在常规治疗措施基础上实施血浆灌流治疗方案,结合患者情况,每例患者进行1~4次血浆灌流治疗。分析患者在血浆灌流前和第一次血浆灌流1 h后和血浆灌流2 h后凝血功能指标凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、凝血酶时间(TT)、血小板(PLT)以及D-二聚体(D-D)水平的变化。结果在血浆灌流1 h后和血浆灌流2 h后肝衰竭患者PTA水平分别为(28.41±3.09)%和(29.73±3.13)%,APTT水平分别为(32.79±5.80)s和(31.05±5.62)s,INR水平分别为(1.73±0.69)和(1.61±0.65),FIB水平分别为(3.15±0.90)g/L和(3.25±0.91)g/L,TT水平分别为(15.29±4.10)s和(14.86±4.12)s,与灌流前相比,差异均无显著性差异;在血浆灌流1 h后和血浆灌流2 h后患者外周血PLT计数分别为(101.59±24.92)×109/L和(119.84±25.16)×109/L,D-D水平分别为(1.63±0.29)mg/L和(1.75±0.30)mg/L,与治疗前相比,差异有统计学意义(P<0.05)。结论血浆灌流在吸附患者血液中不良因子的同时会降低PLT数量,对患者纤溶功能有一定的影响,应注意预防和及时处理。
Objective To analyze the effect of plasma perfusion on the coagulation function in patients with liver failure. Methods Sixty patients with liver failure admitted to our hospital from January 2014 to June 2015 were selected. All patients were given routine treatment measures, and in the conventional treatment measures based on the implementation of plasma perfusion treatment programs, combined with the patient’s situation, each patient 1 to 4 times plasma perfusion therapy. Prothrombin activity (PTA), activated partial thromboplastin time (APTT), international normalized ratio (INR), and serum creatinine were measured before plasma perfusion and 1 h after the first perfusion and 2 h after perfusion. Fibrinogen (FIB), thrombin time (TT), platelets (PLT) and D-dimer (DD) levels. Results The PTA levels were (28.41 ± 3.09)% and (29.73 ± 3.13)% in patients with hepatic failure at 1 h after perfusion and 2 h after perfusion. The APTT levels were (32.79 ± 5.80) s and (31.05 ± 5.62) s and INR were (1.73 ± 0.69) and (1.61 ± 0.65), respectively. The FIB levels were (3.15 ± 0.90) g / L and (3.25 ± 0.91) g / L respectively and the TT levels were (15.29 ± 4.10) s And (14.86 ± 4.12) s, respectively. There was no significant difference between before and after perfusion (P> 0.05). The PLT counts in peripheral blood after 1 h of plasma perfusion and 2 h of plasma perfusion were (101.59 ± 24.92) × 109 / L and (119.84 ± 25.16) × 109 / L and DD levels were (1.63 ± 0.29) mg / L and (1.75 ± 0.30) mg / L respectively, which were significantly different from those before treatment (P <0.05). Conclusions Plasma perfusion can reduce the number of PLT while adsorbing the unfavorable factors in the blood of patients, and have some influence on fibrinolytic function in patients. Precaution and timely treatment should be taken.