Clinical analysis and prognostic judgment of artificial extracorporeal liver support therapy for pediatric acute liver failure
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摘要:
目的观察人工肝治疗儿童暴发性肝衰竭(PALF)的疗效并对预后因素进行分析。方法回顾性分析2012年1月-2015年2月于吉林大学第一医院儿科重症监护病房住院的23例PALF并行人工肝治疗患儿的临床资料,依据随访3个月内临床转归情况分为存活组(n=15)和死亡组(n=8)。分别观察两组患儿治疗前后肝功能、凝血功能的变化并比较两组患儿治疗前的相关指标和MELD评分,分析人工肝治疗PALF的疗效以及影响预后判断的因素。计量资料组间比较采用t检验。结果予人工肝治疗后,存活组ALT、TBil、血氨以及乳酸(Lac)水平均较治疗前明显降低,差异具有统计学意义(t值分别为8.812、6.243、8.431、6.721,P值均<0.01);死亡组中仅ALT水平较治疗前降低,差异有统计学意义(t=2.532,P<0.05)。与治疗前相比,存活组治疗后的凝血酶原时间(PT)、凝血酶原活动度(PTA)、国际标准化比值(INR)均明显改善,差异均具有统计学意义(t值分别为6.256、-2.738、6.711,P值均<0.05)。与存活组治疗前比较,死亡组治疗前ALT水平明显降低(t=6.28...
Abstract:Objective To observe the clinical efficacy of artificial extracorporeal liver support therapy in the treatment of pediatric acute liver failure( PALF) and to analyze the associated prognostic factors. Methods The clinical records of 23 patients with PALF treated from January 2012 to February 2015 in the Pediatric Intensive Care Unit of the First Hospital of Jilin University were analyzed retrospectively. After three- month follow- up,15 patients survived( survival group,n = 15),while 8 patients died( death group,n = 8). The changes in biomarkers of liver function and coagulation function after treatment were evaluated within groups. At the same time,the above parameters and Model for End- Stage Liver Disease( MELD) score before treatment were compared between the two groups. The efficacy of artificial extracorporeal liver support therapy was analyzed,and the prognostic factors were reviewed. The t test was applied in the comparison of continuous data. Results In the survival group,the levels of serum alanine aminotransferase( ALT),total bilirubin( TBil),ammonia,and lactic acid were significantly reduced after treatment( t = 8. 812,6. 243,8. 431,and 6. 721,respectively; all P < 0. 01). However,in the death group,only ALT level was significantly reduced after treatment( t = 2. 532,P < 0. 05). Compared with the levels before treatment,the levels of prothrombin time( PT),prothrombin time activity( PTA),and international normalized ratio( INR) were significantly improved after treatment( t = 6. 256,- 2. 738,and 6. 711,respectively; all P < 0. 05). Before treatment,compared with the survival group,patients in the death group presented significantly lower level of ALT( t = 6. 283,P < 0. 01),significantly higher level of TBil( t =- 3. 938,P = 0. 001),significantly longer PT( t =- 2. 394,P = 0. 026),and significantly higher MELD score( t =- 6. 239,P < 0. 01). Conclusion Artificial extracorporeal liver support therapy is an effective way of treating PALF. Once patients with high ALT level,short PT,and high MELD score have been diagnosed with PALF,artificial extracorporeal liver support therapy should be applied as soon as possible to improve the survival rate. Bile enzyme separation,prothrombin time,and MELD score could assist in determining the prognosis of PALF.
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Key words:
- liver failure,acute /
- liver,artificial /
- treatment outcome /
- prognosis /
- child
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