Application of plasma exchange based on a "trinity" monitoring system in the treatment of cardiohepatic syndrome
10.13303/j.cjbt.issn.1004-549x.2026.07.010
- VernacularTitle:基于“三位一体”监测体系的血浆置换在心肝综合征治疗中的应用
- Author:
Ling WU
1
;
Qiang TAN
1
;
Lina REN
1
;
Xinyu GAN
1
;
Tao PENG
1
Author Information
1. Department of Blood Transfusion, The General Hospital of Western Theater Command, Chengdu 610083, China
- Publication Type:Journal Article
- Keywords:
cardiohepatic syndrome;
plasma exchange;
bilirubin;
hypocalcemia;
fluid balance;
hemodynamics
- From:
Chinese Journal of Blood Transfusion
2026;39(7):881-886
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the technical considerations and clinical value of plasma exchange (PE) in the treatment of cardiohepatic syndrome (CHS). Methods: A 76-year-old male patient with CHS was treated. The patient’s underlying conditions included valvular heart disease (severe mitral and tricuspid regurgitation), chronic heart failure (cardiac function class IV) complicated with liver failure [total bilirubin (TBIL) up to 590.6 μmol/L; alanine aminotransferase (ALT) up to 325.4 IU/L; aspartate aminotransferase (AST) up to 190.4 IU/L]. Due to poor response to conventional anti-heart failure and hepatoprotective therapy, three sessions of stepwise PE (total volume 6 400 mL) were performed. A "calcium-fluid balance-hemodynamics“ trinity monitoring system was established during treatment, comprising:1) prophylactic calcium supplementation (continuous calcium infusion at 5 mL/h initiated before PE); 2) dynamic blood gas monitoring (ionized calcium measured every 30-60 min with calcium dose adjusted accordingly); 3) individualized fluid balance setting (75%-90%); 4) standby norepinephrine (0.02-0.1 μg/kg/min). Results: Complications such as hypocalcemia (lowest 0.83 mmol/L) and hypotension (lowest 65/38 mmHg) occurred during treatment. Hemodynamics were stabilized by adjusting calcium supplementation, regulating fluid balance, and concomitant use of vasoactive agents. After treatment, B-type natriuretic peptide (BNP) decreased by 42.0% (from 7 122.53 pg/mL to 4 128.77 pg/mL), TBIL decreased by 69.7% (from 590.6 μmol/L to 178.7 μmol/L), ALT decreased by 91.8% (from 325.4 IU/L to 26.7 IU/L), and AST decreased by 83.2% (from 190.4 IU/L to 31.9 IU/L). Conclusion: PE based on the "calcium-fluid balance-hemodynamics" trinity monitoring system can improve cardiac and liver function in patients with CHS.
