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目的探讨人工肝血浆置换治疗重型肝炎的疗效对不良反应的预防和处置。方法住院的重型肝炎病例42人分成人工肝组和药物组,两组均应用常规保肝支持治疗,人工肝组22例加用血浆置换,平均每例次输血浆2000ml,平均每例治疗2·6次。两组治疗前后分别检测血总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、白蛋白、球蛋白、凝血酶元时间、凝血酶元活动度,记录不良反应及处理结果,进行统计学处理。结果人工肝组和药物组的显效率分别是61·9%和15%,有效率分别是14·3%和30%,无效率分别为23·8%和55%。人工肝治疗组的血清总胆红素降低明显,与对照组相比差异显著,P<0.05。人工肝组有4例过渡到肝移植。为肝移植术后胆汁淤积患者血液净化,渡过危险期。不良反应有一过性皮疹、瘙痒,静脉置管处渗血、皮下血肿,置管侧下肢静脉血栓形成,对症处理,解除症状。结论人工肝血浆置换是治疗重型肝炎及肝移植围手术期肝功能障碍的安全有效的方法。
Objective To investigate the efficacy and safety of artificial liver plasmapheresis in the treatment of severe hepatitis in prevention and treatment of adverse reactions. Methods Forty-two cases of hospitalized severe hepatitis were divided into artificial liver group and drug group. Both groups were treated with conventional hepatic supportive therapy. In the artificial liver group, 22 cases were treated with plasma exchange, with an average of 2000 ml for each case, with an average of 2 cases per treatment 6 times. Blood total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, albumin, globulin, thrombin time, activity of thrombin in the two groups were measured before and after treatment, and the adverse reactions and treatment results were recorded and statistically analyzed Learn to deal with. Results The effective rates of the artificial liver group and the drug group were 61.9% and 15% respectively, the effective rates were 14.3% and 30% respectively, and the inefficiencies were 23.8% and 55% respectively. The serum total bilirubin decreased significantly in the artificial liver treatment group compared with the control group, P <0.05. Artificial liver group, 4 cases of transition to liver transplantation. Blood purification for patients with cholestasis after liver transplantation, through the dangerous period. Adverse reactions have a transient rash, itching, venous catheter bleeding, subcutaneous hematoma, catheter side venous thrombosis, symptomatic treatment, relieve the symptoms. Conclusion Artificial liver plasma exchange is a safe and effective method for the treatment of severe hepatitis and perioperative liver dysfunction during liver transplantation.