| 摘要: |
| 目的观察连续性肾替代治疗（CRRT）联合血浆置换（PE）治疗晚期肝衰竭合并肝肾综合征（HRS）的疗效。方法选择2006年10月至2012年12月住院治疗的30例晚期肝衰竭合并HRS患者为观察对象，其中单纯PE治疗和CRRT联合PE治疗各15例，两组患者年龄、性别、终末期肝病模型（MELD）评分相近，比较并分析两组患者治疗前后血生化指标、MELD评分和不良反应等情况。结果治疗后，PE组血清TBil、凝血酶原时间（PT）和内毒素（LPS）水平均明显下降（均P＜0.05），血清尿素氮（BUN）、肌酐（Cr）、Na+和K+水平有所下降，但差异均无统计学意义（均P＞0.05）。治疗后，CRRT+PE组血清TBil、PT、BUN、Cr、Na+、K+和LPS水平均明显改善（均P＜0.05）；此外，治疗后血清K+、BUN、Cr和LPS水平明显低于PE组（均P＜0.05），血清Na+水平明显高于PE组（P＜0.05）。CRRT+PE组治疗后MELD评分明显低于PE组（P＜0.05）。两组患者在治疗过程中不良反应发生率差异无统计学意义（P＞0.05）。结论与单纯PE治疗比较，CRRT联合PE治疗晚期肝衰竭合并HRS能有效改善肾功能和电解质紊乱，疗效更优。 |
| 关键词: 肝衰竭 肝肾综合征 血浆置换 连续性肾替代治疗 |
| DOI： |
| 分类号: |
| 基金项目:浙江省医药卫生科技计划 |
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| Continuous renal replacement therapy combined with plasma exchange versus plasma exchange alone in treatment of terminal liver failure complicated with hepatorenal syndrome |
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ZHAO Haihong,HE Zebao,CAI Miaoguo,LIN Zongmei,LIN Zongmei
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Taizhou enze Medical Center
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| Abstract: |
| Objective To compare the efficacy of continuous renal replacement therapy (CRRT) combined with plasma exchange (PE) with PE alone in treatment of terminal liver failure complicated with hepatorenal syndrome (HRS). Methods Thirty patients with terminal liver failure complicated with HRS admitted from October 2006 to December 2012 were enrolled in this study, included 15 patients treated by PE alone (PE group) and 15 patients treated by CRRT combined with PE (CRRT+PE group). The changes of biochemistry and complications were observed before and after the treatment. Results In PE group, the levels of the total bilirubin, PT, endotoxin were lower after the treatment than those before treatment (P＜0.05), while there were no significant changes in urea nitrogen, creatinine, sodium and potassium levels before and after treatment.In CRRT+PE group, the levels of total bilirubin, PT, urea nitrogen, creatinine, potassium, sodium, endotoxin were significantly decreased after treatment (P＜0.05). There was no significant difference in total bilirubin and PT levels between two groups after treatment.The levels of potassium, urea nitrogen, creatinine and endotoxin in CRRT+PE group were significantly lower than those in PE group after treatment, the sodium level in CRRT+PE group was significantly higher than that in PE group after treatment (P＜0.05). After treatment, the MELD score of CRRT+PE group was significantly lower than that of PE group (P ＜0.05).There was no significant difference in incidence of complications between two groups during the treatment (P ＞0.05). Conclusion CRRT combined with PE and PE alone can effectively improve liver function and endotoxemia, while CRRT combined with PE is superior to PE alone in improving renal function and electrolyte disorder and increasing success rate for patients with terminal liver failure complicated with HRS. |
| Key words: Liver failure Hepatorenal syndrome Plasma exchange Continuous renal replacement therapy |
