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目的:探讨HA中性大孔树脂(HA330-Ⅱ)治疗重型肝炎的疗效,把握血液灌流治疗的重要护理环节和过程,提高治疗成功率.方法:应用HA中性大孔树脂进行血液灌流治疗重型肝炎肝衰竭患者40例,共96次,在灌流前后观察患者临床症状及体征,最终治疗效果,检测肝功能、肾功能、凝血酶原活动度(PTA)、血常规、肿瘤坏死因子(TNF-α)、白介素(IL-6)的水平.首选直接动静脉穿刺建立循环回路,如穿刺困难则采用股静脉穿刺置管术.结果:灌流后患者临床症状体征均有不同程度改善;ALT、TBIL、DBIL等明显下降(92.3±53.1IU/Lvs176.8±120.2IU/L;283.2±90.2μmol/Lvs363.0±140.3μmol/L;122.8±71.7μmol/Lvs247.5±106.4μmol/L;均P<0.01);PTA明显升高(39.6%±12.5%vs29.2%±14.8%,P<0.01);灌流后患者IL-6、TNF-2明显下降(27.6±22.5ng/Lvs88.5±32.8ng/L,0.47±0.4μg/Lvs0.83±0.6μg/L;均P<0.01);电解质及血常规无明显变化.患者病情好转出院29例(72.5%),病情危重自动出院3例(7.5%),死亡8例(20%).在治疗过程直接动静脉穿刺成功者36例(90%),股静脉穿刺置管术4例(10%).结论:HA树脂血液灌流治疗能清除重型肝炎患者体内的毒素,能不同程度改善患者的临床症状、体征及治疗效果.充分准备、熟练技术、密切观察和及时处理不良反应是保证血液灌流治疗效果的关键.
Objective: To investigate the curative effect of HA neutral macroporous resin (HA330-Ⅱ) in the treatment of severe hepatitis and to grasp the important nursing procedure and process of hemoperfusion therapy and to improve the success rate of treatment.Methods: Hemoperfusion with HA neutral macroporous resin 40 patients with hepatitis and liver failure, a total of 96 times before and after perfusion to observe the clinical symptoms and signs, the final treatment effect, detection of liver function, renal function, prothrombin activity (PTA), blood, tumor necrosis factor (TNF- α) and interleukin (IL-6) levels.Previous direct arteriovenous puncture was used to establish a circulation circuit, and femoral vein puncture catheterization was used when the puncture was difficult.Results: The clinical signs and symptoms of the patients after perfusion were improved to varying degrees; ALT, TBIL (92.3 ± 53.1IU / Lvs176.8 ± 120.2IU / L; 283.2 ± 90.2μmol / Lvs363.0 ± 140.3μmol / L; 122.8 ± 71.7μmol / Lvs247.5 ± 106.4μmol / L; (P <0.01). PTA was significantly higher in patients with post-perfusion (39.6% ± 12.5% vs29.2% ± 14.8%, P <0.01) (P <0.01). There was no significant change in electrolytes and blood routine in 29 patients (72.5%) with disease recovered, disease In the course of treatment, 36 cases (90%) were successful in direct arteriovenous puncture and 4 cases (10%) were treated by femoral vein puncture and catheterization.Conclusion: HA Resin hemoperfusion can remove toxins from patients with severe hepatitis, and can improve clinical symptoms, signs and treatment effects of patients to varying degrees.Preliminary preparation, skilled technique, close observation and timely treatment of adverse reactions are the keys to ensure the therapeutic effect of hemoperfusion.