连续肾脏替代治疗肝硬化合并肝性脑病的临床效果

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摘要目的探讨连续性肾脏替代（CRRT）治疗肝硬化合并肝性脑病（HE）患者的临床效果。方法选取2018年2月～2019年6月我院收治的60 例肝硬化合并HE 患者作为研究对象，按照随机分组法分为对照组（32 例）和观察组（28 例）。对照组采用常规护肝、抗肝昏迷治疗，观察组采用常规护肝、抗肝昏迷治疗基础上加用CRRT 治疗。比较两组入院诊断时及治疗24 h 后的血氨、白介素-6（IL-6）、白介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）水平及凝血酶原时间（PT）；比较两组神志转清时间、住院时间和死亡率。结果两组治疗前血氨、IL-6、IL-10、TNF-α 水平比较，差异无统计学意义（P＞0．05）；观察组治疗后血氨、IL-6、IL-10、TNF-α 水平低于治疗前，差异有统计学意义（P＜0.05），对照组治疗前后血氨、IL-6、IL-10、TNF-α 水平差异无统计学意义（P＞0．05）；两组治疗后血氨、IL-6、IL-10、TNF-α 水平比较，观察组低于对照组，差异有统计学意义（P＜0.05）；观察组神志转清时间短于对照组，死亡率低于对照组，差异有统计学意义（P＜0.05）；两组治疗前凝血酶原时间比较，差异无统计学意义（P＞0．05）；两组治疗前后凝血酶原时间比较，差异无统计学意义（P＞0．05）；两组治疗后凝血酶原时间比较，差异无统计学意义（P＞0.05）。结论 CRRT 治疗可有效地降低肝硬化合并HE 患者血氨、IL-6、IL-10、TNF-α 水平，缩短神志转清时间及住院时间，降低死亡率；CRRT 治疗对凝血酶原时间无明显影响。

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关键词 ：肝硬化, 肝性脑病, 白介素-6, 白介素-10, 肿瘤坏死因子-&alpha, 连续性肾脏替代治疗

Abstract：Objective To explore the clinical effect of continuous renal replacement therapy (CRRT) in the treatment of cirrhosis patients complicated with hepatic encephalopathy (HE). Methods A total of 60 patients with cirrhosis complicated with HE from February 2018 to June 2019 were enrolled in the study. They were divided into the control group(32 cases) and the observation group (28 cases) according to the randomized grouping method. The control group was treated with routine liver care and anti-hepatic coma therapy. The observation group was treated with routine liver care and anti-hepatic coma therapy, and added the CRRT. The blood ammonia、interleukin-6 (IL-6), interleukin-10 (IL-10),tumor necrosis factor-α(TNF-α) levels and the prothromb in time (PT) of the two groups were compared at the time of admission and after treatment of 24 h. The time of mental conversion and mortality of the two groups were compared.Results The levels of blood ammonia, IL-6, IL-10 and TNF-α of the two groups were compared before treatment, and the difference was not statistically significant (P＞0．05). After treatment, the levels of blood ammonia, IL-6, IL-10 and TNF-α in the observation group were lower than those before treatment (P＜0.05). Before and after treatment, there was no significant difference in the levels of the blood ammonia, IL-6, IL-10 and TNF-α in the control group (P＞0．05).The levels of blood ammonia, IL-6, IL-10 and TNF-α of the two groups were compared after treatment, and the observation group was lower than those in the control group, the differences were statistically significant (P＜0.05). The which in time of mental conversion and hospitalization of the patients in the observation group were shorter than that of the control group, and the mortality rate in the observation group was lower than that of the control group, the differences were statistically significant (P＜0.05). The PT of the two groups was compared before treatment, there was not statistically significant (P＞0．05); the PT of the two groups was compared before and after treatment, and there was not statistically significant (P＞0．05); the PT of the two groups was compared after treatment, there was not statistically significant(P ＞0．05). Conclusion CRRT treatment can effectively reduce the levels of the blood ammonia, IL-6, IL-10 andTNF-α in patients with cirrhosis and HE, shorten the time of mental conversion and hospitalization, and reduce the mortality. CRRT treatment has no obvious effect on the PT.

Key words： Cirrhosis Hepatic encephalopathy Interleukin-6 Interleukin-10 Tumor necrosis factor-α Continuous renal replacement therapy

作者简介: 炉军（1981-），男，江西鹰潭人，硕士，主治医师，研究方向：肝硬化、肝衰竭、肝性脑病

引用本文:

炉军；张珍. 连续肾脏替代治疗肝硬化合并肝性脑病的临床效果[J]. 中国当代医药, 2020, 27(6): 53-56.
LU Jun ZHANG Zhen. Clinical effect of continuous renal replacement therapy in the treatment of cirrhosis complicated with hepatic encephalopathy. 中国当代医药, 2020, 27(6): 53-56.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I6/53

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