背景:双重血浆分子吸附不仅能特异性吸附胆红素和胆汁酸, 还可以清除体内毒素、炎症递质、细胞因子, 在缺乏血浆或血浆不足的情况下, 可有效清除有害物质, 防止多脏器功能衰竭, 为肝脏再生、肝功能的恢复争取时间, 适用于各种原因引起的肝衰竭.目的:对比新型双重血浆分子吸附联合血浆置换与单纯血浆置换治疗肝衰竭的有效性和安全性.方法:收集2014年10月至2017年10月在贵州省人民医院收治的肝衰竭患者60例, 随机分为2组, 每组30例.血浆置换组单纯采用血浆置换治疗, 血浆置换量为2 500-3 000 mL;联合组采用双重血浆分子吸附联合血浆置换治疗, 血浆置换量为1 000-1 500 mL.均于治疗3次后评估临床效果及肝功能, 并观察人工肝治疗过程中出现的不良反应.结果与结论:①治疗后2组血清总胆红素、谷丙转氨酶水平较治疗前显著降低, 凝血酶原活动度水平较治疗前显著升高 (P <0.05) , 但治疗前后联合组血清白蛋白水平差异无显著性意义, 治疗后联合组血清总胆红素、谷丙转氨酶、血清白蛋白水平显著低于血浆置换组, 凝血酶原活动度水平显著高于血浆置换组 (P <0.05) ;②联合组治疗总有效率 (83％) 显著高于血浆置换组 (63％) (P <0.05) ;③联合组人工肝治疗过程中出现皮疹、寒战、低血压各1例;血浆置换组未出现不良反应;④结果提示, 双重血浆分子吸附联合血浆置换与单纯血浆置换均可以显著改善肝衰竭患者肝功能, 且不良反应少.但双重血浆分子吸附与血浆置换联合应用的治疗效果更具优势, 同时可以减少血浆用量.%BACKGROUND: Double plasma molecular adsorption system cannot only specifically absorb bilirubin and bile acids, but also eliminate toxins, inflammatory transmitters and cytokines in the body. In the absence of plasma or in the case of plasma deficiency, it can effectively remove harmful substances, prevent multiple organ failure and fight for time for the liver regeneration and recovery of liver function, which is suitable for liver failure caused by various reasons. OBJECTIVE: To compare the validity and safety of double plasma molecular adsorption system combined with plasma exchange and simple plasma exchange in the treatment of liver failure. METHODS: Sixty patients with liver failure admitted to the Guizhou Provincial People's Hospital from October 2014 to October 2017 were included and randomized into two groups (n=30/group) . Plasmapheresis was used in plasma exchange group, and the volume of plasma exchanged was 2 500-3 000 mL. The combination treatment group was treated by double plasma molecular adsorption system combined with plasma exchange, and the volume of plasma exchanged was 1 000-1 500 mL. In the two groups, the clinical effects and liver function were evaluated after three treatment sessions, and adverse reactions were observed during the artificial liver treatment. RESULTS AND CONCLUSION: After treatment, the levels of serum total bilirubin and alanine aminotransferase were significantly lower than those before treatment, and the prothrombin activity was significantly higher than that before treatment (P < 0.05) . However, the serum albumin level showed no significant difference in the combination treatment group before and after treatment. Compared with the plasma exchange group, the post-treatment levels of serum total bilirubin, alanine aminotransferase and serum albumin were significantly lower in the combination treatment group, and the prothrombin activity was significantly higher (P < 0.05) . (2) The total effective rate of the combination treatment group (83％) was significantly higher than that of the plasma exchange group (63％) (P < 0.05) . (3) During the artificial liver treatment, there was one case of rash, one case of chills and one case of hypotension in the combination group, while no adverse reaction occurred in the plasma exchange group. (4) To conclude, either double plasma molecular adsorption combined with plasma exchange or simple plasma exchange can markedly improve the liver function of patients with liver failure, and produce few adverse reactions. However, the combination of double plasma molecular adsorption and plasma exchange has an advantageous therapeutic effect and can reduce plasma consumption.
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