Wang Y H, Zhu X, Feng D Y, Wu B Q
Department of Medical Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China.
Zhonghua Gan Zang Bing Za Zhi. 2018 Sep 20;26(9):676-679. doi: 10.3760/cma.j.issn.1007-3418.2018.09.008.
To evaluate the effect of plasma exchange combined with high-dose continuous venovenous hemodiafiltration method (CVVHDF) in the treatment of patients with acute-on-chronic liver failure with stage III-IV hepatic encephalopathy and the feasibility of pre-operative preparation for liver transplantation. Clinical data of 14 cases of medical intensive care unit of our hospital with acute-on- chronic liver failure accompanied with stage III-IV hepatic encephalopathy that underwent plasma exchange combined with high-dose CVVHDF from March 2015 to September 2017 were retrospectively summarized. The indexes of liver and kidney function, blood coagulation function, arterial blood PH, lactic acid and blood ammonia were monitored before and after treatment. Heart rate, blood pressure, APACHE II score, and consciousness recovery time were observed. Student's t- test was used to compare the mean values between the two groups. Serum total bilirubin ( = 9.43, < 0.01), serum creatinine ( = 3.40, < 0.01), serum ammonia ( = 10.64, < 0.01), prothrombin activity ( = 9.19, < 0.01), serum lactate ( = 9.25, < 0.01), heart rate ( = 4.47, < 0.01), and mean arterial pressure ( = 4.41, < 0.05) were significantly improved in 14 patients before and after treatment. In addition, respiratory rate ( = 6.01, < 0.01) and APACHE II score ( = 7.19, < 0.01) were significantly improved ( < 0.05). Eight patients with stage III hepatic encephalopathy were treated with intermittent plasma exchange combined with CVVHDF for 3 to 14 days, and six patients with stage IV were transformed to stage III to II. Liver transplantation was successfully performed on 14 patients with shortest time duration of 3days, and longest time duration of 1 month. Plasma exchange combined with CVVHDF can significantly improve liver and kidney functions, reduce blood ammonia level and improve mental health in patients with hepatic failure accompanied with stage III-IV hepatic coma. In addition, it also effectively increases the average arterial pressure, maintain stability of vital signs, maintain fluids, electrolytes and acid-base balance, create a stable internal environment for liver transplantation before operation, and extend time for liver transplantation.
评估血浆置换联合大剂量持续静静脉血液透析滤过法（CVVHDF）治疗Ⅲ - Ⅳ期肝性脑病的慢性急性肝衰竭患者的疗效及肝移植术前准备的可行性。回顾性总结2015年3月至2017年9月我院重症医学科14例伴有Ⅲ - Ⅳ期肝性脑病的慢性急性肝衰竭患者接受血浆置换联合大剂量CVVHDF治疗的临床资料。监测治疗前后的肝肾功能、凝血功能、动脉血PH值、乳酸及血氨指标。观察心率、血压、APACHE II评分及意识恢复时间。采用学生t检验比较两组均值。14例患者治疗前后血清总胆红素（= 9.43，< 0.01）、血清肌酐（= 3.40，< 0.01）、血氨（= 10.64，< 0.01）、凝血酶原活动度（= 9.19，< 0.01）、血清乳酸（= 9.25，< 0.01）、心率（= 4.47，< 0.01）及平均动脉压（= 4.41，< 0.05）均有显著改善。此外，呼吸频率（= 6.01，< 0.01）及APACHE II评分（= 7.19，< 0.01）也有显著改善（< 0.05）。8例Ⅲ期肝性脑病患者采用间歇性血浆置换联合CVVHDF治疗3至14天，6例Ⅳ期患者转为Ⅲ至Ⅱ期。14例患者成功进行肝移植，最短时间为3天，最长时间为1个月。血浆置换联合CVVHDF可显著改善肝肾功能，降低血氨水平，改善伴有Ⅲ - Ⅳ期肝昏迷的肝衰竭患者的精神状态。此外，它还能有效提高平均动脉压，维持生命体征稳定，维持液体、电解质及酸碱平衡，为肝移植术前创造稳定的内环境，并延长肝移植时间。
