尤瑞克林联合单唾液酸四己糖神经节苷脂治疗急性脑梗死的临床研究

邓珊　阳洪　蒋祝昌　翁保慧　陈仕检

【摘要】目的 研究小剂量血浆置换（PE）联合血浆灌流（PP）对妊娠期急性脂肪肝（AFLP）的临床疗效。方法将13例进行常规剂量PE的AFLP患者设为对照组，12例进行小剂量PE联合PP的AFLP患者设为治疗组，对比两组人工肝治疗前后的肝功能指标变化及预后。结果治疗后，两组的总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）水平以及对照组治疗后凝血酶原时间（PT）值均较治疗前明显改善，差异有统计学意义（P<0.01），治疗组治疗后PT值较治疗前无明显改变（P>0.05）；治疗后两组上述指标的检测值比较差异无统计学意义（P>0.05）。对照组10人经治疗后治愈出院，治愈率为76.9%，治疗组11人治愈出院，治愈率为91.7%，两组治愈率比较差异无统计学意义（P=0.5930）。结论小剂量PE联合PP不但减少了血浆使用量，而且在改善AFLP患者肝功能、清除代谢产物方面与常规剂量PE效果相似。

【关键词】妊娠期急性脂肪肝；血浆灌流；小剂量；血浆置换

中图分类号：R714.2 文献标识码：ADOI：10.3969/j.issn.10031383.2015.06.011

【Abstract】ObjectiveTo investigate clinical efficacy of low dose plasma exchange（PE） combined with plasma perfusion（PP） in patients with acute fatty liver of pregnancy（AFLP）.Methods13 cases of AFLP treating with normal dose of PE were selected as control group，and 12 cases treating with low dose of PE combined with PP as treatment group.Then，changes of liver function indexes before and after artificial liver treatment as well as the prognosis were compared between groups.Results After treatment，serum levels of total bilirubin（TBIL），direct bilirubin（DBIL），alanine aminotransferase（ALT），aspartate transaminase（AST） of the two groups as well as value of prothrombin time（PT） of the control group significantly improved，difference was statistically significant（P<0.01）.However，PT value of the treatment group did not significantly improved after treatment（P>0.05）.There was no significant changes in the abovementioned indexes of the two groups after treatment（P>0.05）.10 cases in the control group left hospital after being cured，cure rate was 76.9%.11 cases in the treatment group left hospital after being cured，and cure rate was 91.7%.Difference of the cure rates of the two groups was not statistically significant（P=0.5930）.ConclusionLow dose PE combined with PP not only reduce usage amount of plasma，but also has similar effect with regular dose of PE in improving liver function of AFLP patients and eliminating metabolic product.

【Key words】AFLP；hemoperfusion；low dose；plasma exchange

妊娠期急性脂肪肝（acute fatty liver of pregnancy，AFLP）是发生于妊娠晚期的严重并发症，临床上以迅速出现的黄疸、凝血功能障碍和肝功能衰竭为主要特征，近年国外报道孕产妇死亡率仍高达7%～18%[1～3]。目前国内多家医院在乙型肝炎导致慢加急性肝功能衰竭病例中进行血浆灌流联合小剂量血浆置换（800～1400 ml）治疗[4～8]，证实此法与常规剂量血浆置换（2800～3500 ml）疗法疗效相似而不良反应发生率降低，且血浆需求量明显减少。由于AFLP以急性肝功能损害为主要临床表现，因此我科尝试将小剂量血浆置换（plasma exchange，PE）联合血浆灌流（plasma perfusion，PP）应用于重症妊娠期急性脂肪肝患者的治疗中，现就其疗效报告如下。