临床荟萃

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血浆滤过透析治疗肝衰竭合并脓毒症的疗效

  

  1. 甘肃省人民医院 重症医学科, 甘肃 兰州 730000
  • 出版日期:2019-04-20 发布日期:2019-05-16
  • 通讯作者: 王贤东,Email:wxd_724@163.com

Efficacy of plasma  diafiltration in treatment of hepatic failure complicated with sepsis

  1. Department of Intensive Medicine, Gansu Provincial Hospital, Lanzhou 730000, China
  • Online:2019-04-20 Published:2019-05-16
  • Contact: Corresponding author: Wang Xiandong,Email:wxd_724@163.com

摘要: 目的 探讨血浆滤过透析(Plasmadiafiltration,PDF)治疗肝衰竭合并脓毒症的临床疗效。方法 回顾性分析2017年1月至2019年1月我院ICU收治的31例肝衰竭合并脓毒症患者临床资料,上述患者行PDF及抗感染等内科综合性治疗,观察治疗前后临床症状及体征的改善;观察治疗前后凝血酶原活动度(PTA)及纤维蛋白原、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、血氨及终末期肝病模型(MELD)评分变化;观察治疗前后降钙素原(PCT)、白细胞介素6(IL6)、C反应蛋白(CRP)、血常规、乳酸及序贯性器官功能衰竭(SOFA)评分变化;观察治疗过程中的不良反应。结果 PDF治疗后临床有效率达61.29%,不良反应为8.21%;PDF 治疗前后PTA、纤维蛋白原、TBIL 、AST、Na+、K+、PCT、IL6、CRP、白细胞(WBC)、乳酸、SOFA及MELD评分差异有统计学意义(P<0.05)。结论  PDF结合内科治疗显著改善肝衰竭合并脓毒症患者的凝血功能和肝功能,同时能清除炎症因子从而有效缓解病情。

关键词: 肝功能衰竭;脓毒症, 血浆滤过透析, 临床疗效

Abstract: Objective  To explore the clinical efficacy of plasma  diafiltration(PDF) in treatment of hepatic failure with sepsis. Methods  Clinical data of 31 patients with hepatic failure and sepsis were retrospectively analyzed. The recruited patients accepted comprehensive medical treatments such as PDF, antiinfection and others.Changes in clinical symptoms and physical signs  were observed  before and after treatment. The levels of coagulation function (prothrombin activity and fibrinogen), biochemical indicators (transaminase, total bilirubin, blood creatinine and ions) and endstage liver disease model score  were investigated  before and after treatment, and the changes of primogen, interleukin6, Creactive protein, blood routine, lactic acid, and sequential organ failure scores were compared were evaluated  before and after PDF.Results  The clinical effective rate was 61.29%, and the adverse reaction was 8.21%. There were significant differences in PTA, fibrinogen, TBIL, AST, Na+, K+, PCT, IL6, CRP, WBC, lactic acid, SOFA and MELD scores before and after PDF treatment (P<0.05). Conclusion  PDF can significantly improve the coagulation function and liver function of patients with hepatic failure and sepsis, and can eliminate inflammatory factors and effectively relieve the disease with combined treatment.

Key words: liver failure, sepsis, plasma , diafiltration; , clinical efficacy