PDF治療重型肝炎的不良反應分析及處理

歐陽兵　熊墨龍　熊云逢　謝能文

[摘要] 目的 分析血漿濾過透析（PDF）治療重型肝炎的不良反應發生情況，探討PDF治療重型肝炎過程中不良反應的防治方法。 方法 選擇2016年1月1日～12月31日期間江西省南昌市第九醫院住院的重型肝炎患者209例，均予PDF治療，治療465例次。觀察并記錄PDF治療過程中不良反應。分析不良反應發生的原因，并制定防治措施。結果 PDF治療過程中，患者發生不良反應86例次（18.49%），其中發生率較高的為血壓下降31例次（6.67%）和皮膚瘙癢皮疹25 例次（5.38%），其次腹痛惡心嘔吐8例次（1.72%）、畏寒寒戰7例次（1.51%）、面部口唇舌尖麻木6例次（1.29%）、穿刺處皮下血腫3例次（0.65%）、三腔管堵塞2例次（0.43%），還有血壓升高、低血糖、心率減慢、血氧飽和度下降各1例次。通過及時處理，上述不良反應均恢復正常，對人工肝治療的繼續進行沒有影響，患者均能順利完成治療。 結論 PDF治療重型肝炎中發生的不良反應是可以積極預防和及時處理的，在PDF治療過程中加強對患者的觀察和不良反應的處理，對保證人工肝PDF治療順利進行、提高治療有效率、降低不良反應的發生率具有重要意義。

[關鍵詞] 血漿濾過透析；重型肝炎；不良反應；處理

[中圖分類號] R575.1 [文獻標識碼] A [文章編號] 1673-9701（2017）13-0001-03

[Abstract] Objective To analyze the incidence of adverse reactions in the treatment of severe hepatitis with plasma filtration dialysis（PDF）， and to explore the prevention and treatment of adverse reactions in the treatment of severe hepatitis with PDF. Methods 209 patients with severe hepatitis who were hospitalized in the Ninth Hospital of Nanchang City in Jiangxi Province from January 1， to December 31， 2016 were studied. The patients were treated with PDF treatment of 465 times. The adverse reactions during the course of PDF treatment were observed and recorded. The causes of adverse reactions were analyzed， and the preventive measures were formulated. Results In the course of PDF treatment， there were 86 cases（18.49%） of patients with adverse reactions. The relatively high incidences were those of blood pressure drop with 31 cases （6.67%） and skin itching rash with 25 cases（5.38%）， respectively， followed by 8 cases （1.72%） of abdominal pain， nausea and vomiting， 7 cases （1.51%） of chills， 6 cases （1.29%） of facial lips numbness， 3 cases（0.65%） of the subcutaneous hematoma， 2 cases （0.43%） of three-lumen blockage. There was 1 case of high blood pressure， low blood sugar， slow heart rate and blood oxygen saturation decrease， respectively. Through timely treatment， the above-mentioned adverse reactions were back to normal， and the treatment had no effect on the continuous treatment of artificial liver. The patient could successfully complete the treatment. Conclusion The adverse reactions of PDF treatment in severe hepatitis can be actively prevented and timely treated. In the course of PDF treatment， strengthening the observation of patients and the treatment of adverse reactions has great significance in ensuring the smooth progress of artificial liver PDF treatment， improving the efficiency of treatment and reducing the adverse reactions.

[Key words] Plasma filtration dialysis； Severe hepatitis； Adverse reactions； Treatment

人工肝支持治療是近年來治療重型肝炎肝衰竭應用較廣的一種治療手段[1]，且越來越受到廣泛的重視[2]。人工肝治療重型肝炎臨床上已取得顯著療效，明顯降低了重型肝炎的死亡率[3]。人工肝支持系統是一種創傷性的治療手段，且有體外血液循環環節，治療過程中可能出現出血、低血壓、過敏反應、腔管堵塞等不良反應，治療對象多為重型肝炎患者，病情危重，容易發生其他嚴重并發癥[4，5]。……