|
Objective: chronic severe hepatitis and chronic liver disease on the basis of extensive necrosis of the liver cells, caused by the accumulation of metabolic disorders and toxic substances affect liver regeneration and repair. Severe illness, the prognosis is poor comprehensive medical treatment. In recent years, scholars have been carrying out artificial liver support system (artificial liver support system, ALSS) to replace part of the function of the liver, the treatment of acute and chronic liver failure, a significant effect. Plasmapheresis (plasma exchange, PE) the ALSS a method most widely used in domestic applications. In this study, through the application of plasma exchange treatment of chronic severe hepatitis, evaluation plasmapheresis role in the treatment of chronic severe hepatitis, as well as the safety of the therapy, while parsing the factors affecting its efficacy, in order to estimate the prognosis of patients with PE treatment, under the guidance of step therapy, plasmapheresis clinical practice for the treatment of chronic severe hepatitis reference. Methods: 89 patients with chronic severe hepatitis patients choose the People's Liberation Army 202 Hospital, treated with conventional medicine foundation treatment, combined with plasma exchange divided into plasma exchange group (treatment group) and 41 cases and 48 cases plasmapheresis group (control group). Retrospective analysis of patients with the clinical data, to detect liver function before and after plasmapheresis (total bilirubin TBIL, Valley pyruvic transaminase ALT, aspartate aminotransferase AST, serum albumin ALB, prothrombin activity PTA, cholinesterase of CHE) ammonia indicator changes observed overall efficacy. The statistical analysis of the patient's age at the same time, the relationship between the disease staging, complications and PE treatment of chronic severe hepatitis efficacy, clinical judgment. Results: From the perspective of physical and chemical indicators speak PE 24 hours after treatment, the Valley of pyruvic transaminase ALT, aspartate aminotransferase AST, total bilirubin and serum TBIL decreased significantly (P lt; 0.05), serum albumin ALB, of cholinesterase CHE and the clotting The proenzyme time activity PTA was significantly higher (P lt; 0.05), blood ammonia was significantly lower (P lt; 0.01). Speak from the perspective of the overall efficacy in the treatment group, 41 patients, effective in 20 cases (48.8%), 10 patients died, 11 cases (51.2%) left the hospital. The control group 48 cases, effective in 13 cases (27.1%), 17 patients died, left the hospital in 18 cases (72.9%). The treatment group was significantly higher than that in the control group (P lt; 0.05). PE efficacy and patient age, disease stage, complication types of influencing factors related. Lt; 60-year-old patient group effective rate was 62.5%, significantly higher than the ≥ 60-year-old patient group 27.5% (P lt; 0.05). 2.PE treatment early, late rates were 76.9%, 50.0%, 16.7%, and its efficiency early gt; interim gt; late (P lt; 0.05). Compared with the control group, the early treatment group was significantly higher than that in the control group (P lt; 0.05), two groups in the mid-late efficient no significant differences (P gt; 0.05). Treatment group the hepatic encephalopathy improvement rate was 25% (2/8), no improvement in hepatorenal syndrome cases (0/6), the electrolyte imbalance improvement rate was 57.1% (4/7), hepatic encephalopathy improved rate control group 16% (1/6), hepatorenal syndrome does not get better cases, electrolyte imbalance improvement rate was 60% (3/5), the two groups had no significant difference (P gt; 0.05). Treatment group, primary peritonitis rate was 58.7% (7/12), higher than the 14.3% (2/14) (P lt; 0.05). Conclusion: Plasmapheresis is a safe and effective way to a treatment for chronic severe hepatitis, can significantly improve the short-term biochemical indicators of chronic severe hepatitis patients, improve the success rate and prolong the survival of patients with ineffective treatment time. The patient's age, disease stage, complications affecting the important factors of PE treatment of chronic severe hepatitis, older patients, the progression to late complications of hepatic encephalopathy, hepatorenal syndrome, even if the plasma exchange treatment, The prognosis is not ideal.
|