论文部分内容阅读
目的：探讨人工肝支持系统（ＡＬＳＳ）治疗重症肝炎（重肝）的疗效和血浆置换（ＰＥ）、血浆吸附（ＰＰ）、血液灌流（ＤＨＰ）治疗重肝的适应证。方法：治疗组６４ 例，对照组６０ 例。２ 组病例内科基础治疗相同，治疗组加用ＡＬＳＳ治疗，其中ＰＥ每次置换４０～６０ ｍ ｌ／ｋｇ 异体同型等量血浆；ＰＰ每次交换１００～１５０ ｍ ｌ／ｋｇ 血浆；ＤＨＰ每次交换１７０～２５０ ｍ ｌ／ｋｇ 全血量，２～７ 日治疗１ 次，直到病情稳定好转。结果：治疗组共计治疗１６８ 例次，平均２．６ 次，存活４４ 例，存活率６８．７５％ ；对照组存活２８ 例，存活率４６．６７％ （Ｐ＜ ０．０１）。治疗组早、中、晚期存活率分别为８５．７１％ 、７６．４７％ 和５２．１７％ ，ＰＥ、ＰＰ和ＤＨＰ治疗存活率分别为７３．８１％ 、６６．６７％ 和５０．００％ 。结果显示ＰＥ适合中毒症状严重的各型重肝，ＰＰ宜用于严重胆汁淤积的重肝，ＤＨＰ以降低ＮＨ３ 为主，适宜高氨血症和肝性脑病的治疗。治疗过程中发生不良反应２４ 例次（１５．５８％ ），经对症处理不良反应均能缓解。结论：ＡＬＳＳ治疗重症肝炎能有效清除体内病理成分，包括血清总胆红素、血氨、肿瘤坏死因子和内毒素等，提高存活率，降低?
Objective: To investigate the efficacy of artificial liver support system (ALSS) in the treatment of severe hepatitis (severe liver) and the indication of plasma exchange (PE), plasma adsorption (PP) and hemoperfusion (DHP) Methods: 64 cases in the treatment group and 60 cases in the control group. Two groups of patients with the same basic medical treatment, the treatment group plus ALSS treatment, wherein the PE each replacement of 40 ~ 60 m l / kg allogeneic isotype plasma; PP each exchange of 100 ~ 150 m l / kg plasma; DHP each exchange 170 ~ 250 m l / kg whole blood volume, 2 to 7 days treatment 1, until the condition is stable and improved. Results: In the treatment group, a total of 168 cases were treated with an average of 2.6 times. Survival rate was 68.75% in the 44 cases. Survival rate was 46.67% in the control group (P <0.01). The early, middle and late survival rates were 85.71%, 76.47% and 52.17% in the treatment group and 73.81%, 66.67% and 50.00% in the PE, PP and DHP groups, respectively . The results showed that PE was suitable for all kinds of severe hepatitis with serious symptoms of poisoning. PP should be used for severe liver with severe cholestasis. DHP should be mainly to reduce NH3, suitable for the treatment of hyperammonemia and hepatic encephalopathy. Adverse reactions in the course of treatment 24 cases (15.58%), symptomatic treatment of adverse reactions can be alleviated. Conclusion: ALSS treatment of severe hepatitis can effectively remove the pathological components of the body, including serum total bilirubin, blood ammonia, tumor necrosis factor and endotoxin, improve survival and reduce?