急性重型病毒性肝炎治疗体会(1)
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[摘要] 目的 探讨急性重型病毒性肝炎临床抢救成功率的相关因素。 方法 13例应用保肝支持治疗、肾上腺皮质激素、利胆药纠正淤胆等措施治疗的急重肝炎患者为治疗组，14例常规治疗者为对照组，对比两组治疗疗效。 结果 治疗组经综合治疗后临床治愈好转率92.3%，高于对照组治愈好转率71.4%。治疗组生化指标、凝血功能恢复好于对照组。 结论 急性重型肝炎经过精心治疗，病死率低于20%。所以，为提高治愈好转率，按照保肝治疗原则、激素应用原则、抗生素应用原则、治疗淤胆用药等原则治疗急性重型肝炎。
[关键词] 重型肝炎；治疗学；疗效
[中图分类号] R575.1 [文献标识码] B [文章编号] 1673-9701(2012)02-0147-03
Treatment of acute severe viral hepatitis
LV Yimin
Department of Liver Disease, Rushan City Hospital of Traditional Chinese Medicine in Shandong Province, Rushan 264500, China
[Abstract ] Objective To study the acute severe viral hepatitis clinical success rate related factors. Methods All 13 cases of acute liver disease liver (treatment group) were treated with support therapy, application of adrenal cortical hormone, cholagogue corrected cholestatic and other measures. 14 conventional treatment for the control group, and the efficacy were compared. Results The treatment group by comprehensive therapy clinical cure rate 92.3%, which was higher than the control group recovered rate 71.4%. Indexes of biochemistry and coagulation function in treatment group were better than that in control group. Conclusion Acute severe hepatitis after careful treatment, fatality rate should be lower than 20%. In order to improve the healing rate, use the principle of presented with and liver protection therapy principle, hormone application principles, principles of use of antibiotic drugs in treatment of cholestatic in treatment of acute severe hepatitis
[Key words] Severe hepatitis; Treatment; Efficacy
急性重型病毒性肝炎病情进展快，往往出现严重的并发症，死亡率高。县市级基层医院担负着一线救治任务，临床医生审时度势，综合应用多种保肝、抢救措施，纠正酶胆分离，减少并发症，通过恰当的治疗，能够提高临床治愈好转率。我们于2008年3月～2011年3月收治急性重型病毒性肝炎13例(有住院病历举证)，疗效突出，现报道如下。
1 资料与方法
1.1 病例资料
治疗组：2008年3月～2011年3月收入我科住院的急性、亚急性重型病毒性肝炎患者共13例，诊断符合2000年修订的《病毒性肝炎防治方案》标准[1]和2006年《肝衰竭诊疗指南》[2]。男11例，女2例；年龄最大者72岁，最小者31岁，平均年龄(56.23±11.4)岁；急性重型病毒性肝炎11例，慢加急性肝衰竭2例；其中感染HAV1例，HBV4例，HCV2例，HEV3例，EB病毒感染1例，未分型病毒感染者2例；13例中早期肝衰竭7例，中期4例，晚期2例[2]。13例患者入院时凝血酶原活动度均≤40%，平均值(27.63±8.35)%；ALT最高者3375μ/L，最低者1151μ/L,平均值(2132.5±685.7) μ/L；所有患者的ALB最低值在(21.5～37.1)g/L之间，平均值(27.85±4.12)g/L；TBIL最高值在(606.0～218.6)μmoL/L之间，平均值(374.63±107.03)μmol/L；13例患者中出现并发症者9例 ......
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