人工肝PE联合DPMAS不同序贯顺序对肝衰竭高胆红素血症治疗影响
Effect of Different Sequential Sequence of Artificial Liver PE Combined with DPMAS on the Treatment of Hyperbilirubinemia in Liver Failure

目的：观察人工肝治疗中PE与DPMAS不同序贯顺序对肝衰竭患者血清胆红素、白蛋白及凝血功能的影响。方法：回顾性分析2018.6~2019.12在淄博市第四人民医院ICU住院的50例肝衰竭患者，根据治疗方法将患者分为对照组(n = 20)、试验组(n = 30)，对照组采用PE + DPMAS治疗，试验组采用DPMAS + PE治疗。比较上机前后两组患者的血清总胆红素、白蛋白、PT活动度。结果：对照组上机治疗后胆红素、白蛋白、PT%均较上机前下降，差异有统计学意义(P < 0.05)；试验组胆红素、白蛋白较上机前下降，PT%较前上升，差异有统计学意义(P < 0.05)。下机后两组组间比较，胆红素、白蛋白、PT%差异有统计学意义(P < 0.05)。结论：DPMAS + PE和PE + DPMAS两种治疗均能有效的清除胆红素，PE + DPMAS治疗效果更好。两种治疗均能不同程度的造成白蛋白消耗，DPMAS + PE影响较小。对于凝血功能，DPMAS + PE能明显的改善凝血功能，而PE + DPMAS则造成凝血因子的丢失。
Objective: To observe the effects of different sequence of PE and DPMAS on serum bilirubin, albumin and coagulation function in patients with liver failure. Methods: Fifty patients with liver failure hospitalized in ICU of the Fourth People’s Hospital of Zibo City from June 2018 to December 2019 were retrospectively analyzed. According to treatment methods, the patients were divided into control group (n = 20) and experimental group (n = 30). The control group was treated with PE + DPMAS, and the experimental group was treated with DPMAS + PE. Serum activity of total bilirubin, albumin and PT% were compared between the two groups before and after operation. Results: In control group, bilirubin, albumin and PT% were decreased after treatment, the difference was statistically significant (P < 0.05). Bilirubin and albumin in experimental groups were decreased, and PT% was increased, with statistical significance (P < 0.05). There were significant differences in bilirubin, albumin and PT% between the two groups (P < 0.05). Conclusion: Both DPMAS + PE and PE + DPMAS can effectively clear bilrubin, and PE + DPMAS has a better effect. Both treatments can cause albumin depletion to varying degrees, DPMAS + PE has little effect. For coagulation function, DPMAS + PE can significantly improve coagulation function, while PE + DPMAS can cause loss of coagulation factors.