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目的观察血浆置换联合去甲肾上腺素治疗重型肝炎Ⅰ型肝肾综合征患者的疗效。方法回顾性分析我院2008年1月～2010年12月收治重型肝炎Ⅰ型肝肾综合征27例住院患者的临床资料,根据治疗方法不同,分为对照组12例和观察组15例。分析重型肝炎Ⅰ型肝肾综合征患者的病因、肝肾功能、MELD评分、尿量以及住院病死率。结果该病主要发生于肝功能衰竭患者,易出现腹水、自发性腹膜炎、肝性脑病以及消化道出血等并发症。对照组治疗前后各指标无显著差异;观察组在治疗后总胆红素、肌酐以及MELD评分降低,尿量增加,与治疗前比较差异有统计学意义(P<0.05);两组治疗后总胆红素、肌酐、MELD评分以及尿量比较有显著差异(P<0.05);两组住院病死率差异无统计学意义(P>0.05),但在MELD评分<30分患者中,观察组住院病死率比对照组低(25.0%vs.85.7%,P<0.05)。结论血浆置换联合去甲肾上腺素治疗重型肝炎合并Ⅰ型肝肾综合征患者,有利于患者肝肾功能恢复,有一定的治疗作用。
Objective To observe the effect of plasma exchange combined with norepinephrine in the treatment of severe hepatitis type Ⅰ hepatorenal syndrome. Methods The clinical data of 27 hospitalized patients with severe hepatitis type Ⅰ hepatorenal syndrome admitted to our hospital from January 2008 to December 2010 were retrospectively analyzed. According to the different treatment methods, they were divided into control group (n = 12) and observation group (n = 15). Analysis of etiology, liver and kidney function, MELD score, urine output and hospital mortality in patients with severe hepatitis type Ⅰ hepatorenal syndrome. Results The disease occurred mainly in patients with liver failure, prone to ascites, spontaneous peritonitis, hepatic encephalopathy and gastrointestinal bleeding and other complications. There were no significant differences in each index before and after treatment in the control group. The total bilirubin, creatinine, MELD score and urine output in the observation group after treatment were significantly lower than those before treatment (P <0.05) There were significant differences in bilirubin, creatinine, MELD score and urine volume (P <0.05). There was no significant difference in in-hospital mortality between the two groups (P> 0.05). However, in MELD score <30, The mortality was lower than that of the control group (25.0% vs.85.7%, P <0.05). Conclusion Plasma exchange combined with norepinephrine treatment of patients with severe hepatitis type Ⅰ hepatorenal syndrome, liver and kidney function is conducive to the recovery of patients with a certain therapeutic effect.