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目的观察血浆置换治疗肝功能衰竭的疗效。方法 148例患者在内科综合治疗的基础上给予血浆置换治疗,观察临床疗效和并发症发生情况,监测治疗前后肝功能生化指标的变化情况。结果 148例患者经血浆置换治疗后临床症状有不同程度缓解,有效率为62.2%(92/148);临床症状无好转48例;死亡8例。治疗后TBil、谷丙转氨酶、谷草转氨酶、PT均低于治疗前,白蛋白和PTA均高于治疗前,差异均有统计学意义(P<0.05和P<0.01)。早期患者临床好转率为85.7%均高于中期的59.5%和晚期的38.0%,差异有统计学意义(P<0.05)。连续3次以上(包含3次)血浆置换的患者TBil下降幅度为65.93%高于连续3次以下的43.49%,差异有统计学意义(P<0.01)。148例患者共进行血浆置换治疗436次,出现不良反应58次(13.30%)。结论血浆置换治疗肝功能衰竭疗效明显,连续多次治疗对降低TBil效果更好,治疗早、中期肝功能衰竭最为适宜。
Objective To observe the efficacy of plasma exchange in the treatment of liver failure. Methods A total of 148 patients were treated with plasma exchange on the basis of comprehensive medical treatment. Clinical efficacy and complications were observed. The changes of liver biochemical indexes before and after treatment were monitored. Results In 148 patients, the clinical symptoms were relieved to some extent after the plasma exchange. The effective rate was 62.2% (92/148). No clinical symptoms improved in 48 cases and 8 died. After treatment TBil, alanine aminotransferase, aspartate aminotransferase, PT were lower than before treatment, albumin and PTA were higher than before treatment, the difference was statistically significant (P <0.05 and P <0.01). The rate of clinical improvement in early stage patients was 85.7%, which was higher than 59.5% in middle stage and 38.0% in late stage, the difference was statistically significant (P <0.05). The decrease of TBil in patients who received plasma exchange more than 3 times (including 3 times) was 65.93%, which was higher than 43.49% of patients who were treated 3 times or less. The difference was statistically significant (P <0.01). A total of 148 patients underwent plasma exchange therapy for 436 times, with 58 adverse reactions (13.30%). Conclusions Plasma exchange is effective in treating liver failure. Continuous multiple treatments are more effective in reducing TBil and most suitable for treating early and intermediate liver failure.