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目的观察血浆吸附灌流(plasma perfusion,PP)联合血浆置换(plasma exchange,PE)的组合型人工肝方法治疗肝衰竭和高胆红素血症的临床疗效。方法将PP和使用少量血浆的PE联合在1次治疗模式(联合组)中完成,治疗51例66例次肝衰竭和高胆红素血症患者,检测治疗前、结束时及治疗结束48h时患者血总胆红素、总胆汁酸、PTA、ALB及WBC水平,并观察不良反应发生情况,与同期进行的36例79例次单纯PE治疗患者(PE组)做对照。结果①联合组治疗的总有效率为60.87%,高于PE组的52.78%,但差异无统计学意义(P>0.05);②2组患者治疗结束及治疗结束48h时血清总胆红素均明显低于治疗前水平(P<0.05),联合组治疗结束时血清总胆红素下降幅度高于PE组(P<0.05);③2组患者治疗结束时血清总胆汁酸均低于治疗前水平(P<0.05),但2组间比较差异无统计学意义(P>0.05);④2组治疗结束时PTA值均高于治疗前水平(P<0.05);⑤同治疗前比较,联合组治疗结束时及治疗结束48h时血清ALB、GLO均无明显变化(P>0.05),而PE组则明显减少(P均<0.05);⑥同治疗前比,2组治疗结束时及治疗结束48h时血WBC总数均无明显变化(P>0.05),2组治疗结束时血PLT总数均明显减少(P均<0.05);⑦联合组平均使用血浆量明显少于PE组;⑧未发生严重不良反应。结论本研究建立的PP联合PE的人工肝方法血浆用量少,治疗肝衰竭和高胆红素血症安全有效。
Objective To observe the clinical effects of combination therapy of plasma perfusion (PP) and plasma exchange (PE) on liver failure and hyperbilirubinemia. Methods A total of 66 patients with liver failure and hyperbilirubinemia were treated with PP in combination with a small amount of plasma PE in one treatment group (combination group), and 51 cases of liver failure and hyperbilirubinemia were detected before and at the end of treatment and 48 hours after the end of treatment The levels of total bilirubin, total bile acid, PTA, ALB and WBC in patients were observed. The incidence of adverse reactions was observed and compared with 36 PE patients treated with PE in the same period. Results ① The total effective rate of combination group was 60.87%, which was higher than that of PE group (52.78%), but the difference was not statistically significant (P> 0.05); ②Serum total bilirubin was significantly higher at the end of treatment and 48h (P <0.05). The decrease of serum total bilirubin in the combination group was higher than that in the PE group (P <0.05). The serum total bile acids in the two groups were lower than the pre-treatment level (P <0.05), but there was no significant difference between the two groups (P> 0.05); ④ PTA values of the two groups were higher than those before treatment (P <0.05); ⑤Compared with those before treatment, (P <0.05), while the PE group was significantly decreased (P <0.05); ⑥ before treatment than before treatment, the end of treatment group 2 and 48h after the end of treatment of blood (P> 0.05). The total number of PLT in the two groups was significantly decreased at the end of treatment (all P <0.05). (7) The average amount of plasma used in combination group was less than that in PE group. (8) No serious adverse reactions occurred. Conclusions The artificial liver method of PP combined with PE established in this study is safe and effective in the treatment of liver failure and hyperbilirubinemia.