The application effect of plasma exchange and double plasma molecular adsorption system in patients with liver failure and severe hyperbilirubinemia
10.3969/j.issn.1008-9691.2024.06.014
- VernacularTitle:血浆置换结合双重血浆分子吸附系统在肝衰竭伴严重高胆红素血症患者中的应用效果
- Author:
Lingxin CHEN
1
;
Ruixi YANG
1
;
Mingxin LIU
1
;
Dongmei CAO
1
;
Guoxian KOU
1
Author Information
1. 四川省绵阳市中心医院感染疾病科,四川 绵阳 621000
- Publication Type:Journal Article
- Keywords:
Liver failure;
Hyperbilirubinemia;
Plasma exchange;
Dual plasma molecular adsorption system;
Clinical efficacy analysis
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(6):720-724
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the effectiveness of plasma exchange(PE)combined with the double plasma molecular adsorption system(DPMAS)in managing liver failure complicated by severe hyperbilirubinemia.Methods A total of 120 patients with liver failure who received artificial liver therapy were selected in Mianyang Central Hospital from June 2023 to June 2024 were as study objects.These patients were divided into an observation group and a control group,with 60 cases in each group.The control group received standard medical treatment,while the observation group underwent PE+DPMAS therapy in addition to the standard regimen,concrete method:firstly,low molecular weight heparin sodium at 25000 U was added to the 0.9%physiological saline(NS)1 750 mL pre flushing tube;Secondly,low molecular weight heparin sodium at 12 500 U and 0.9%NS at 500 mL were administered,and finally 0.9%NS 500 mL was used for flushing pipes,based on the patient's coagulation function,low molecular weight heparin sodium at 12500 U and 0.9%NS at 500 mL can be sequentially moved forward,after the pre flushing was completed,it can be connected to the catheter and wait for it to be loaded onto the machine.The circulating flow rate for the first 30 minutes after starting the machine was 1 800-2000 mL/h,with a flow rate of 125-140 mL per minute,blood is drawn out from the arterial terminals and separated by a plasma separator,the separated plasma was adsorbed by a series of AR-350 bilirubin columns and YTS-200 hemoperfusion apparatus before flowing into the venous circuit tube and returning to the body.The differences of clinical symptoms and laboratory indicators,including liver function indicators[aspartate transaminase(AST),alanine transaminase(ALT),alkaline phosphatase(ALP),γ-glutamyl transferase(GGT),total bile acid(TBA),total bilirubin(TBil),direct bilirubin(DBil),albumin(ALB)],kidney function indicators[creatinine(Cr)],coagulation function indicators[prothrombin time(PT)and prothrombin activity(PTA)]before and after treatment between the two groups were compared,and clinical efficacy and adverse reactions of the two groups were observed.Results Following treatment,both groups exhibited significant reductions in AST,ALT,ALP,TBA,TBil,and DBil levels compared to before treatment,the levels of total AST,ALT,TBA and TBil after treatment in the observation group were significantly lower than those in the control group[AST(U/L):84.2±69.3 vs.158.3±130.2,ALT(U/L):119.3±112.1 vs.145.9±124.7,TBA(μmol/L):59.1±48.3 vs.158.3±130.2,TBil(μmol/L):101.3±56.4 vs 145.9±124.7,all P<0.05];ALB increased significantly in the both groups after treatment compared to before treatment(g/L:the observation group was 35.1±3.7 vs.32.1±4.6,the control group was 33.1±3.1 vs.31.8±3.5,both P<0.05),however,there was no significantly difference between the two groups(P>0.05).In the observation group,PT shortened significantly after treatment(s:13.6±1.4 vs.14.5±2.1,P<0.05),while PTA increased significantly after treatment[(95.1±19.5)%vs.(83.2±21.1)%,P<0.05];moreover,the time required to achieve 30%,50%,and 70%reductions in TBil was markedly shorter in the observation group than in the control group[time required to achieve 30%reductions in TBil(days):6.1±4.3 vs.9.7±4.8,time required to achieve 50%reductions in TBil(days):9.3±5.1 vs.11.9±6.2,time required to achieve 70%reductions in TBil(days):13.2±5.9 vs.18.1±6.9,all P<0.05].The total effective rate of observation group was significantly higher than that of control group[93.3%(56/60)vs.68.3%(41/60),P<0.05].Both groups completed the treatment without deaths.During the treatment,5 cases experienced allergic reactions and 3 cases experienced a decrease in blood pressure,after symptomatic treatment,all patients continued to complete the treatment.Conclusion PE combined with DPMAS shows considerable clinical benefits for patients with liver failure and severe hyperbilirubinemia by effectively lowering bilirubin levels and accelerating recovery,thus shortening the disease course.
