Li Mao-qin, Li Jia-qiong, Shi Zai-xiang, Xu Ji-yuan, Zhang Zhou, Lu Fei, Li Lin, Xu Yan-jun, Mo Xun, Lu Bo, Wang Xiao-meng, Ma Li-li, Zhang Xian-jiang, Cheng Shu-li
Xu Zhou Hospital Affiliated Medical School of South-Eastern University, Xuzhou, China,
Cell Biochem Biophys. 2014 Apr;68(3):571-5. doi: 10.1007/s12013-013-9740-3.
We sought to study the clinical efficacy of various combined blood purification techniques in patients with non-viral acute liver failure complicated by multiple organ dysfunction syndrome (MODS). For this purpose, 19 patients diagnosed of mid- or late-stage liver failure with MODS score-4 were randomly divided into 3 treatment groups of PE+HP+CVVHDF, PE+CVVHDF, and HP+CVVHDF, respectively. Pre- and post-treatment heart rate (HR), mean arterial pressure (MAP), arterial blood gases (pH, PaO2, and PaCO2), hepatic function, platelet count, and blood coagulation were determined. The data show significant improvement in HR, MAP, PaO2/FiO2, total bilirubin (TBIL), and alanine aminotransferase (ALT) levels after treatment (P < 0.05). TBIL decreased more significantly after treatment in PE+CVVHDF and PE+HP+CVVHDF groups (P < 0.01). Significant improvement in prothrombin time and albumin was observed only in PE+CVVHDF and PE+HP+CVVHDF groups (P < 0.05). The decrease of TBIL and improvement of PaO2/FiO2 ratio were more pronounced in PE+HP+CVVHDF than in HP+CVVHDF group (P < 0.05). To conclude, liver function was relatively improved by all the three combined blood purification techniques used; however, PE+HP+CVVHDF approach was found more efficient in the removal of toxic metabolites, especially bilirubin. The data suggest that the combined blood purification techniques used were effective and involved minor side effects.
我们试图研究各种联合血液净化技术对非病毒性急性肝衰竭合并多器官功能障碍综合征（MODS）患者的临床疗效。为此，将19例诊断为中晚期肝衰竭且MODS评分为4分的患者随机分为3个治疗组，分别为PE+HP+CVVHDF组、PE+CVVHDF组和HP+CVVHDF组。测定治疗前后的心率（HR）、平均动脉压（MAP）、动脉血气（pH、PaO2和PaCO2）、肝功能、血小板计数和凝血情况。数据显示治疗后HR、MAP、PaO2/FiO2、总胆红素（TBIL）和丙氨酸转氨酶（ALT）水平有显著改善（P<0.05）。PE+CVVHDF组和PE+HP+CVVHDF组治疗后TBIL下降更显著（P<0.01）。仅在PE+CVVHDF组和PE+HP+CVVHDF组观察到凝血酶原时间和白蛋白有显著改善（P<0.05）。PE+HP+CVVHDF组TBIL的下降和PaO2/FiO2比值的改善比HP+CVVHDF组更明显（P<0.05）。总之，所使用的三种联合血液净化技术均使肝功能得到相对改善；然而，发现PE+HP+CVVHDF方法在清除有毒代谢产物尤其是胆红素方面更有效。数据表明所使用的联合血液净化技术有效且副作用较小。
