血浆置换不同补充时机对药物性肝损伤疗效的影响
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篇名: 血浆置换不同补充时机对药物性肝损伤疗效的影响
TITLE:
摘要:

目的:探讨血浆置换不同补充时机对药物性肝损伤疗效的影响。方法:96 例药物性肝损伤患者,按照随机数字表法分为

A、B、C组,各32 例。所有患者在常规治疗基础上进行血浆置换治疗。其中,A组患者与血浆置换同步进行的替补液为100%新鲜

血浆;B组患者与血浆置换同步进行的替补液为:先补充40%生理盐水,再补充60%新鲜血浆;C组患者在血浆置换至离体血液达

1 个体循环量的12%时,再开始补充替补液,补充顺序为先补充40%生理盐水,再补充60%新鲜血浆。观察各组患者治疗前后的

临床症状及体征、肝脏功能和凝血酶原活动度。结果:采用血浆置换治疗药物性肝损伤均可获得较好的疗效,但C组患者临床症

状及体征消失的时间显著短于A组和B组,B组又显著短于A组,组间比较差异均具有统计学意义(P<0.05)。3 组患者治疗后的

总胆红素、凝血酶原活动度、白蛋白水平均显著优于治疗前,差异具有统计学意义(P<0.05),且C组优于A、B两组,B组优于A

组,组间比较差异均具有统计学意义(P<0.05)。3 组患者治疗后的丙氨酸转氨酶和天冬氨酸转氨酶水平显著下降,与治疗前比较

差异具有统计学意义(P<0.05),且B、C组显著优于A组,差异具有统计学意义(P<0.05),而B、C两组相似,差异无统计学意义

(P>0.05)。结论:在不同时机进行血浆置换对药物性肝损伤有着不同的疗效,在血浆置换至离体血液达1 个体循环量的12%时,

先补充40%生理盐水,再补充60%新鲜血浆的效果较为显著。

ABSTRACT:

OBJECTIVE:To explore the effect of different plasmapheresis supplement timing on therapeutic efficacy of toxic

liver injury. METHODS:96 patients with toxic liver injury and divided into group A,B ,C and D with 32 cases in each group according

to different plasmapheresis supplement timing. All patients received plasmapheresis supplement based on routine treatment.

In group A,synchronized fluid replacement was 100% fresh plasma;in group B,synchronized fluid replacement was 40% normal

saline firstly,and then 60% fresh plasma;in group C,substitute liquid was given till the in vitro blood reached 12% of circulation

amount,supplement order as 40% normal saline for the first supplement,and then add 60% fresh plasma. The clinical symptoms

and signs,liver function,prothrombin activity and blood biochemical indicators were observed in each group before and after treatment.

RESULTS:Plasmapheresis supplement had good therapeutic efficacy on toxic liver injury;but the time of clinical symptoms

and signs disappearance in group C was significantly shorter than that in group A and B,and the group B was significantly shorter

the group A,with statistical significance(P<0.05). The plasma bilirubin,prothrombin activity,albumin levels of 3 groups after

treatment were significantly better than before,with statistical significance(P<0.05);the group C was better than the group A and

B,and the group B was better than the group A,with statistical significance(P<0.05). Compared with before treatment,the levels

of AST and ALT in 3 groups decreased significantly after treatment,with statistical significance(P<0.05);the group B and C

were better than the group A,with statistical significance(P<0.05);the group B and C was similar to each other,without statistical

significance(P>0.05). CONCLUSIONS:Different plasmapheresis supplement timing have different effect on toxic liver injury.

The supplement method that giving 40% normal saline for the first supplement,and then add 60% fresh plasma when in vitro

blood reach 12% of circulation amount has more significant effect.

期刊: 2015年第26卷第35期
作者: 秦海珍,陈绪军
AUTHORS: QIN Hai-zhen,CHEN Xu-jun
关键字: 药物性肝损伤;血浆置换;时机;替补液
KEYWORDS: Toxic liver injury;Plasmapheresis supplement;Timing;Fluid replacement
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