摘要
目的探讨人工肝技术-双重血浆分子吸附（double plasma molecular adsorption，DPMAS）联合持续肾脏替代（CRRT）的组合式血液净化模式治疗多脏器功能障碍综合征（MODS）且合并肝衰竭患者的临床疗效。方法以2014年4月至2016年10月收住在青海省人民医院急诊ICU的MODS且合并肝功能衰竭患者为研究对象，给予内科综合治疗的基础上，随机（随机数字法）分为CRRT对照组23例和DPMAS＋CRRT治疗组22例。比较分析两组治疗前及治疗后72h的血液生化、凝血指标、炎症因子及危重程度评分。结果①CRRT对照组治疗前后比较谷丙转氨酶（ALT）、谷草转氨酶（AST）、血氨（NH3）、肌酐（CREA）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、心率（HR）、APACHEⅡ评分、SOFA评分变化差异有统计学意义（均P〈0．01），但肝功能指标总胆红素（TBIL）、直接胆红素（DBIL）、胆汁酸（TBA）以及凝血酶原活动度（PTA）、国际标准化比值（INR）差异无统计学意义（均P〉0．05）。②DPMAS＋CRRT治疗组治疗前后比较除ALT、AST、NH3、CREA、IL-6、TNF-α、HR、APACHEⅡ评分、SOFA评分差异有统计学意义（均P〈0．01）外，肝功能和凝血指标差异亦有统计学意义（均P〈0．01）。③两组间比较ALT、AST、TBIL、DBIL、TBA、PTA、INR、IL-6、TNF-α、APACHEⅡ评分、SOFA评分差异有统计学意义（均P〈0．05），CREA、NH3、MAP、HR差异无统计学意义（均P〉0．05）。结论DPMAS＋CRRT治疗组由于联合了双重血浆吸附，除具有CRRT的优势外，同时很好地清除单纯CRRT无法清除的胆红素及胆汁酸，改善了凝血功能，炎症因子的清除效率也更高，危重程度评分降低更明显，具有临床推广价值。
Objective To explore the clinical efficacy of artificial liver technique - double plasma molecular adsorption（DPMAS） combined with continuous renal replacement therapy（CRRT） in the treatment of multiple organ dysfunction syndrome（MODS） patients with liver failure. Methods From April 2014 to October 2016, in the Qinghai Provincial People＇s Hospital emergency ICU hospitalized MODS combined with liver failure patients were enrolled in this study. On the basis of comprehensive medical treatment, these patients were randomly（random number） divided into CRRT control group（23 cases） and DPMAS ＋ CRRT treatment group（22 cases）. Blood biochemical, coagulation index, inflammatory factor and severity score of two groups were comparied before and 72 h after treatment. Results The levels of alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, blood amine（NH3）, creatinine（CREA）, interleukin-6（IL-6）, tumor necrosis factor-α（TNF-α）, heart rate（HR）,APACHE Ⅱ score and SOFA score in CRRT control group were statistically different before and after treatment （P〈0.01）. However, there was no significant difference in the levels of total bilirubin（TBIL）, direct bilirubin（DBIL）, bile acid（TBA）, prothrombin activity（PTA） and international standardized ratio（INR） （P〉 0.05）; In the DPMAS ＋ CRRT treatment group, the levels ofALT, AST, NH3, CREA, IL-6, TNF-α, HR, APACHE Ⅱ and SOFA scores were significantly different before and after treatment （P〈0.01）, as well as the levels of DBIL, TBA, PTA, INR（P〈0.01）. There was significant differences in ALT, AST, TI3IL, DBIL, TBA PTA, INR, IL-6, TNF-α, APACHE Ⅱ and SOFA scores between the two groups （P〈0.05）, while the levels of CREA, NH3, MAP, HR of these two groups had no significant difference （P〉0.05）. Conclusions Because of the combination of double plasma adsorption, besides the advantages of CRRT, DPMAS＋CRRT can remove bilirubin and bile acid which can not be removed by CRRT, also improve coagulation function. The clearance efficiency of inflammatory factors is also higher, and the severity score is reduced more significantly.
作者
张斌
陈明迪
郜琨
任辉邦
张玉红
巩月英
Zhang Bin;Chen Mingdi;Gao Kun;Ren Huibang;Zhang Yuhong;Gong Yueying(Emergency ICU,Qinghai Provincial People＇s Hospital,Xining 810007,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第9期1010-1014,共5页
Chinese Journal of Emergency Medicine
基金
青海省卫生和计划生育委员会指导性科研课题（2014-01）
关键词
双重血浆分子吸附
持续肾脏替代
组合式血液净化
多脏器功能障碍综合征
肝衰竭
Double plasma molecular adsorption
Continuous renal replacement
Combined blood purification
Multiple organ dysfunction syndrome
Liver failure
