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目的探讨血浆置换联合去甲肾上腺素对重型肝炎合并Ⅱ型肝肾综合征(hepatorenal syndrome,HRS)的疗效。方法 67例重型肝炎合并Ⅱ型HRS患者分为3组,均给予内科综合治疗;A组(n=19)为对照组,B组(n=23)给予去甲肾上腺素持续静脉泵入,C组(n=25)采用血浆置换联合去甲肾上腺素治疗。观察各组肝肾功能、终末期肝病模型评分(MELD评分)、尿量以及住院病死率。结果 A、B、C3组治疗后总胆红素分别为(254.50±143.41)、(129.65±60.28)、(97.39±39.53)μmol/L;肌酐分别为(153.07±81.00)、(148.00±82.36)、(81.28±12.98)μmol/L;MELD评分分别为27.91±6.55、25.98±8.06、19.26±2.22;尿量分别为(678.42±309.16)、(819.57±66.90)、(1611.20±225.71)ml。C组治疗后肌酐、MELD评分以及尿量与A、B组治疗后比较均有显著性差异(P<0.05),C组治疗后总胆红素与A组治疗后比较有显著性差异(P<0.05)。C组治疗前后比较,各指标均有显著性差异(P<0.05)。3组住院病死率分别为68.4%、43.5%和28.0%,3组比较有显著性差异(掊2=7.157,P<0.05)。结论血浆置换联合去甲肾上腺素是治疗重型肝炎合并Ⅱ型HRS的有效方法。
Objective To investigate the effect of plasma exchange combined with norepinephrine on severe hepatitis complicated with hepatorenal syndrome (HRS). Methods Sixty-seven patients with severe hepatitis and type Ⅱ HRS were divided into three groups and received comprehensive medical treatment. Group A (n = 19) served as control group, group B (n = 23) received continuous noradrenaline infusion, C Group (n = 25) was treated with plasma exchange combined with norepinephrine. The liver and kidney function, end-stage liver disease model score (MELD score), urine output and hospital mortality were observed. Results The total bilirubin in A, B and C3 groups were (254.50 ± 143.41), (129.65 ± 60.28) and (97.39 ± 39.53) μmol / L, respectively; creatinine were (153.07 ± 81.00) and (148.00 ± 82.36) , (81.28 ± 12.98) μmol / L, MELD scores were 27.91 ± 6.55,25.98 ± 8.06 and 19.26 ± 2.22, respectively. The urine output were (678.42 ± 309.16), (819.57 ± 66.90) and (1611.20 ± 225.71) ml, respectively. After treatment, the serum creatinine, MELD score, and urine output in group C were significantly different from those in group A and B after treatment (P <0.05). There was a significant difference between group C and group A after treatment <0.05). Before and after treatment in group C, there was significant difference between each index (P <0.05). The in-hospital mortality rates of the three groups were 68.4%, 43.5% and 28.0% respectively, with significant differences among the three groups (掊 2 = 7.157, P <0.05). Conclusion Plasma exchange combined with norepinephrine is an effective treatment for severe hepatitis with type Ⅱ HRS.