本文選題：人工肝 + 病毒性肝炎��； 參考：《華中科技大學(xué)》2013年碩士論文

【摘要】：目的通過回顧性研究，探討不同人工肝支持系統(tǒng)對(duì)乙型肝炎慢加急性肝功能衰竭臨床療效差異。 方法選擇2011年1月至2012年6月在武漢同濟(jì)醫(yī)院感染科住院的乙型肝炎慢加急性肝功能衰竭患者119例，共進(jìn)行人工肝治療179人次，按照人工肝類型分為3組，血漿膽紅素吸附（Plasma bilirubin absorption,簡稱PP）組39例，血漿置換（Plasma exchange,簡稱PE）組44例，血漿膽紅素吸附聯(lián)合血漿置換（簡稱PP+PE）組36例，記錄人工肝治療當(dāng)日前后及治療后1周患者血生化指標(biāo)及患者出院時(shí)臨床療效，比較不同組的療效差異。 結(jié)果①PP+PE清除總膽紅素效果更為明顯，治療后總膽紅素清除率為60%，高于PE組、PP組的43%、34%，差異有統(tǒng)計(jì)學(xué)意義。治療后1周PP+PE組、PE組膽紅素改善幅度下降，PP+PE組治療后1周膽紅素下降幅度高于PE，差異無統(tǒng)計(jì)學(xué)意義。對(duì)于直接膽紅素（DBIL）、間接膽紅素（IBIL）清除率PP+PE、PE基本一致，而PP清除IBIL高于DBIL。②PP+PE組膽汁酸清除率為33%，高于PE組、PP組的17%、25%，差異有統(tǒng)計(jì)學(xué)意義。③肝性腦�、蚨纫韵拢琍P+PE與PE治療后肝性腦病的癥狀好轉(zhuǎn)，血氨明顯下降，但下降比例兩組之間差異無統(tǒng)計(jì)學(xué)意義，而肝性腦病Ⅲ度以上，兩組人工肝治療后肝性腦病的癥狀無改善，血氨反而上升。④PP+PE、PE治療后凝血功能明顯改善，PP治療后PTA低于治療前水平，1周后凝血功能明顯恢復(fù)。PP+PE組、PE組治療1周后PTA改善幅度下降，PP+PE組治療后1周PTA上升幅度高于PE，差異無統(tǒng)計(jì)學(xué)意義。⑤PP+PE、PE治療后K+改變不明顯，可以糾正低Na+血癥；PP對(duì)低Na+無治療作用。PP+PE、PE治療后1周Na+降低，恢復(fù)到治療前水平。⑥PE治療后患者好轉(zhuǎn)率為52.5%（21/40），低于PP+PE的63.9%（23/36），差異無統(tǒng)計(jì)學(xué)意義。 結(jié)論相對(duì)PE來說，PP+PE增加了膽紅素、膽汁酸的清除，相對(duì)PP來說，克服了PP治療后凝血功能下降的不足，拓寬了PP的適用范圍，適用于凝血功能障礙的肝衰竭患者。PP+PE、PE能糾正低鈉血癥，，PP無治療作用。
[Abstract]:Objective to investigate the clinical efficacy of different artificial liver support systems in patients with chronic hepatitis B and acute hepatic failure. Methods from January 2011 to June 2012, 119 patients with chronic hepatitis B and acute hepatic failure were selected and divided into 3 groups according to the type of artificial liver. There were 39 patients in plasma bilirubin absorption group, 44 patients in plasma exchange group, 36 patients in plasma bilirubin adsorption and plasma exchange group. The blood biochemical indexes of patients before and after treatment and the clinical efficacy at discharge were recorded before and after the treatment of artificial liver, and the difference of therapeutic effects between different groups was compared. Results the clearance rate of total bilirubin in 1PP PE group was more obvious than that in PP group (P < 0.05). The clearance rate of total bilirubin in PE group was higher than that in PP group (P < 0.05). The improvement of bilirubin in PP PE group was higher than that in PE1 week after treatment, and there was no significant difference between PP PE group and PE group. For direct bilirubin, indirect bilirubin and bilirubin IBIL, the clearance rate of PP PEPE was basically the same. The clearance rate of bile acid in PP group was higher than that in DBIL.2PP PE group (33%), and the clearance rate of bile acid in PP group was higher than that in PP group. The difference was statistically significant. 3 the symptoms of hepatic encephalopathy were improved and the blood ammonia was significantly decreased after treatment with PP PE and PE. However, there was no significant difference between the two groups in the proportion of decrease. However, there was no improvement in the symptoms of hepatic encephalopathy after artificial liver treatment in the two groups, but the degree 鈪

本文編號(hào)：1903474