李清奇 郭婷 张丽丽

[摘要]目的 探讨人工肝血浆置换术治疗肝衰竭的临床效果。方法 选取2013年3月～2019年3月我院收治的88例肝衰竭患者作为研究对象，按照随机数字表法分为A组（44例）与B组（44例）。A组采用内科综合治疗方法，B组在A组的基础上行人工肝血浆置换术治疗，比较两组的临床疗效、肝功能指标、炎性因子水平。结果 治疗2周后，B组的好转率为75.00%，高于A组的40.90%，差异有统计学意义（P<0.05）;治疗后，B组的血清天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TBil）与血清白介素（IL）-17、IL-12、IL-35水平低于A组，差异有统计学意义（P<0.05）。结论 人工肝血浆置换术治疗肝衰竭效果显著，可有效改善患者肝功能，并缓解机体炎性反应。

[关键词]人工肝血浆置换术;内科综合治疗;肝衰竭;疗效;炎性因子

[中图分类号] R575.3          [文献标识码] A          [文章编号] 1674-4721（2020）6（b）-0040-03

[Abstract] Objective To explore the clinical effect of artificial liver plasma exchange in the treatment of liver failure. Methods A total of 88 patients with liver failure who were admitted to the hospital fron March 2013 and March 2019 were selected as the subjects. They were divided into group A （44 cases） and group B （44 cases） by the random number table method. Groups A was given comprehensive medical treatment， and group B were additionally treated with artificial liver plasma exchange on the basis of group A. The clinical effect， levels of liver function indicators and inflammatory factors were compared between the two groups. Results After 2 weeks of treatment， the improvement rate in group B was 75.00%， which was higher than that in group A （40.90%）， the difference was statistically significant （P<0.05）. After treatment， the levels of serum aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， total bilirubin （TBil）， and serum interleukin （IL） -17， IL-12， and IL-35 in group B were lower than those in group A， the differences were statistically significant （P<0.05）. Conclusion The effect of artificial liver plasma exchange is significant in the treatment of liver failure. It can effectively improve the liver function of patients and relieve inflammatory response.

[Key words] Artificial liver plasma exchange; Comprehensive medical treatment; Liver failure; Curative effect; Inflammatory factor

多种因素导致的肝衰竭常引发排泄、排毒、生物转化功能失代偿或功能障碍，并产生黄疸、肝性腦病、腹水、凝血功能障碍等合并症，严重影响患者生命安全[1-2]。目前，其主要治疗方法为肝移植和内科综合干预，其中肝移植是治疗肝衰竭最有效的方式，但因治疗费用高昂、肝脏资源有限、基层医院无法开展等因素，临床应用受到限制[3]。内科综合干预虽能防治肝衰竭并发症和提高患者免疫能力，但最终病死率仍在70%以上[4]。随着人工肝血浆置换术的应用，内科综合治疗的临床效果得到较大提升。作为人工肝治疗系统中最常见疗法之一，其以新鲜血浆置换肝衰竭患者体内大量毒性血浆，不仅能帮助患者肝功能恢复，还能促进体内新陈代谢，维持内环境稳定[5-6]。……