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目的探讨人工肝支持系统(ALSS)治疗重型肝炎合并肝性脑病的临床价值。方法应用血液灌流(DHP)联合血浆置换(PE)治疗10例(39例次)重型肝炎合并肝性脑病患者,每次治疗前、后检验肝功生化、电介质、血氨(NH3)、凝血酶原时间(PT)等指标。结果治疗后患者症状、体征均明显减轻,肝功能明显改善,血胆红素明显下降,凝血酶原活动度明显回升。6例神志转清,1例神志改善,存活7例,存活率70%,ALSS并发症主要为血浆过敏反应和一过性低血压。结论DHP联合PE是辅助治疗重型肝炎合并肝性脑病的有效方法。提高ALSS疗效途径:治疗应早期、每次置换的量应大、DHP与PE交替治疗、对重型肝炎出现Ⅲ级以上肝性脑病首选肝移植。
Objective To investigate the clinical value of artificial liver support system (ALSS) in the treatment of severe hepatitis with hepatic encephalopathy. Methods Ten patients (39 cases) with severe hepatitis complicated with hepatic encephalopathy were treated with hemoperfusion (DHP) and plasma exchange (PE). Hepatic biochemistry, electrolyte, blood ammonia (NH3), thrombin The original time (PT) and other indicators. Results After treatment, symptoms and signs of patients were significantly reduced, liver function improved significantly, serum bilirubin decreased significantly, prothrombin activity increased significantly. 6 cases of consciousness to clear, 1 case of consciousness to improve, survival in 7 cases, the survival rate of 70%, ALSS complications mainly for plasma anaphylaxis and transient hypotension. Conclusions DHP combined with PE is an effective method for adjuvant treatment of severe hepatitis with hepatic encephalopathy. Improve the efficacy of ALSS pathway: treatment should be early, the amount of each replacement should be large, DHP and PE alternating treatment of severe hepatitis appears grade Ⅲ hepatic encephalopathy or more preferred liver transplantation.