Objective To discuss the clinical effects and safety of plasma exchange (PE) and continuous veno-venous hemodiafiltration (CVVHDF) treatment for children with acute liver failure.Methods PE+CVVHDF technology was applied for 15 cases of acute liver failure in PICU.Total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT) , blood ammonia, coma evaluation and clinical manifestations before and after treatment were compared. Meanwhile, adverse reactions of the treatment were observed and safety was evaluated.Results After treatment, significant decrements were observed in TBIL, DBIL, ALT, AST, PT, international normalized ratio and blood ammonia (t value was 5.724, 5.390, 5.321, 4.532, 4.038, 3.06 and 3.112,respectively, all P <0.01).The conscious condition of patients became better after the treatment (Glasgow Coma Scale increasing), and the difference was statistically significant (t =2.183,P<0.05).Jaundice, fatigue, nausea, vomiting and abdominal distention improved significantly.After the PE+CVVHDF treatment, 11 children recovered and discharged, 2 died during the treatment, and the other 2 gave up treatment for personal reasons and then died.No hypersensitivity or thrombus occurred in these 15 cases.Conclusion PE combining CVVHDF treatment for infantile acute liver failure is good, and no remarkable adverse reaction occurs.It is of clinical application value.%目的 探讨血浆置换(PE)联合连续性血液透析滤过(CVVHDF)治疗小儿急性肝功能衰竭的临床效果和安全性.方法 应用PE+CVVHDF技术对重症监护病房15例急性肝功能衰竭患儿进行治疗,比较治疗前后总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、凝血酶原时间、血氨、昏迷评分及临床症状的改善程度,同时观察治疗的不良反应,并进行治疗安全性评价.结果 ①经PE+CVVHDF治疗后总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶、凝血酶原时间、国际标准化比率、血氨均较治疗前明显下降(t值分别为5.724、5.390、5.321、4.532、4.038、3.06、3.112,均P<0.01);②患儿治疗后意识状态好转(昏迷评分升高),与治疗前比较差异具用统计学意义(t=2.183,P<0.05);黄疸、乏力、恶心、呕吐、腹胀等症状明显缓解;③转归:11例患儿肝功能恢复正常出院,2例治疗过程中死亡,2例因个人原因放弃治疗,后电话随访死亡;④15例患儿治疗过程无1例过敏、血栓等不良反应出现.结论 血浆置换联合连续性血液透析滤过治疗小儿急性肝功能衰竭具有良好的效果,且无明显的不良反应,具有临床应用价值.
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