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目的通过分析1例血友病基础上发生的晚期急性重型乙型肝炎的救治过程,探讨重型肝炎的治疗并分享成功经验。方法男性患者,28岁,治疗血友病期间感染急性乙型肝炎,起病5d即进入深昏迷。通过病史、症状、体征及化验检查结果明确诊断,给予积极综合内科治疗,结合文献复习及本病例特点进行分析。结果总胆红素最高达552.3μmol/L,凝血酶原活动度最低仅10.25%,颅脑CT显示沟回变浅,严重脑水肿,先后出现多种严重并发症,经过积极生命支持、内科综合诊治,62d后痊愈出院,随访无复发。结论急性重型肝炎十分凶险,有其他基础疾病时治疗难度很大,在无条件行肝移植和血浆置换术的情况下,需要全面积极综合诊治。
Objective To analyze the treatment of severe hepatitis and to share successful experiences by analyzing the treatment of one severe hepatitis with hemophilia on the latter. Methods Male patients, aged 28, were infected with acute hepatitis B during hemophilia and entered a deep coma 5 days after onset. Through the history, symptoms, signs and laboratory tests confirm the diagnosis, to give a positive comprehensive medical treatment, combined with literature review and the characteristics of this case analysis. Results The total bilirubin was 552.3μmol / L, the lowest prothrombin activity was only 10.25%. The brain CT showed a shallow ditch and serious brain edema. A series of serious complications occurred successively. After active life support, Diagnosis and treatment, 62d discharged after treatment, no recurrence. Conclusions Acute severe hepatitis is very dangerous. In other basic diseases, it is very difficult to treat. In an unconditional liver transplant and plasmapheresis, comprehensive and active diagnosis and treatment is needed.