Clinical efficacy of modulation of intestinal microecology and plasmapheresis for preventing and treating multiple organ failure in patients with severe hepatitis
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摘要:
目的探讨防治重型肝炎内毒素血症和多器官功能衰竭的办法。方法收集2006年-2014年在中南大学湘雅二医院住院的重型肝炎合并中毒性肠麻痹患者61例,随机分为三组,分别施以(1)血浆置换;(2)血浆置换+结肠透析;(3)血浆置换+结肠透析+口服微生态制剂3种治疗方案。观察各组临床症状与体征、肝功能、内毒素水平与治疗结局的异同。计量资料组间比较采用单因素方差分析,进一步两两比较采用SNK-q检验;计数资料两组间比较采用χ2检验。结果三组治疗后肝功能均较治疗前好转,第3组内毒素下降水平优于第1、2组(P值均<0.05)。三组症状好转率分别为35.3%、64.7%、81.5%;症状复发率分别为83.3%、72.7%、36.4%;临床好转率依次为5.9%、17.6%、48.1%,第3组与第1组相比差异有统计学意义(χ2=8.59,P<0.05)。结论血浆置换、结肠透析联合肠道微生态调节可有效改善重型肝炎合并中毒性肠麻痹患者预后,有助于防治多器官功能衰竭。
Abstract:Objective To explore the methods for prevention and treatment of endotoxemia and multiple organ failure in patients with severe hepatitis. Methods A total of 61 patients with severe hepatitis and toxic enteroparalysis were randomly assigned to three groups. The first group was treated with plasmapheresis,the second group with plasmapheresis and colon dialysis,and the third group with plasmapheresis,colon dialysis,and oral probiotics. Analyses were performed on the clinical symptoms and physical signs,hepatic function,endotoxin level,and clinical outcome in each group. Comparison of continuous data between groups was performed by analysis of variance,and further pairwise comparison by SNK test; comparison of categorical data between two groups was performed by chi-square test. Results The liver function improved in all groups after treatment. The endotoxin level was significantly lower in the third group than in the other two groups( P <0. 05). The symptom improvement rates in the three groups were 35. 3%,64. 7%,and 81. 5%,respectively; the recurrence rates were83. 3%,72. 7%,and 36. 4%,respectively; the clinical remission rates were 5. 9%,17. 6%,and 48. 1%,respectively,and the third group had a significantly higher rate than the first group( χ2= 8. 59,P < 0. 05). Conclusion A combination of plasmapheresis,colon dialysis,and oral probiotics can effectively improve the prognosis of patients with severe hepatitis and toxic enteroparalysis,and can help prevent and treat multiple organ failure in such patients.
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Key words:
- severe hepatitis /
- endotoxemia /
- multiple organ failure /
- probiotics /
- plasma exchange /
- dialysis
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