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.

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.

Objective To observe the clinical efficacy of artificial liver plasma bilirubin adsorption for treatment of patients with severe viral hepatitis B (HBV). Methods A retrospective study was conducted, the 120 patients with severe HBV B and their historical data of having undergone treatment of artificial liver plasma bilirubin adsorption admitted to Department of Respiration of Mianyang Central Hospital from August 2015 to August 2017 were collected, and there were 68 cases in the cirrhotic group and 52 cases in the non-cirrhotic group. The indexes of liver function and coagulation function before and after the treatment of artificial liver plasma bilirubin adsorption were collected; the differences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamine transferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein (TP), albumin (Alb), globulin (Glo), prothrombin time (PT), prothrombin activity (PTA), total bilirubin (TBil) and indirect bilirubin (IBil), total bile acid (TBA), etc were compared between cirrhotic group and the severe hepatitis B non-cirrhotic group. Results The levels of ALT, AST, ALP, LDH after artificial liver plasma bilirubin adsorption therapy were lower than those before the treatment [ALT (U/L): 138.8±26.2 vs. 993.4±185.2, AST (U/L): 121.7±119.9 vs. 798.7±226.8, ALP (U/L): 129.7±8.1 vs. 178.9±14.1, LDH (μmol·L-1·s-1·L-1): 4.50±0.32 vs. 8.15 ±1.75, all P < 0.05], PTA was higher than that before the treatment [(43.2±25.6)% vs. (30.0±16.1)%, P < 0.05]. After the treatment, the decline rate of ALP, TBil, and TBA of non-cirrhotic group was higher than those in cirrhotic group (ALP: 34.20% vs. 17.80%, TBil: 39.10% vs. 18.10%, TBA:30.70% vs. 5.00%, P < 0.05), the elevation rate of PTA in non-cirrhotic group was also higher than that in cirrhotic group (52.50% vs. 25.10%, P < 0.05). Conclusion Artificial liver plasma bilirubin adsorption therapy is effective for treatment of patients with severe HBV B, particularly the effect being good on the early severe viral HBV B non-cirrhotic group.

Objective To observe the curative effect of using artificial liver bilirubin specific adsorption for treatment of patients with hyperbilirubinemia and its effect on nursing.Methods A prospective study was conducted, 146 patients with hyperbilirubinemia admitted to Mianyang Central Hospital from January 2015 to December 2016 were enrolled, and they were divided into an observation group (77 cases) and a control group (69 cases) according to random number table method. The observation group was treated by medical treatment and the artificial specific liver bilirubin adsorption, while the control group only treated by medical therapy. The changes of levels of liver function indexes alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil) before and after treatment and clinical curative effect were observed in the two groups.Results Before treatment, there were no statistical significant differences in levels of the ALT, AST, TBil, DBil between the two groups (allP > 0.05), after treatment, the above indexes were significantly decreased compared to those before treatment, and the degrees of decrease in observation group were more obvious than those in control group [ALT (U/L): 341±42 vs. 455±37, AST (U/L): 120±35 vs. 197±37, TBil (μmol/L): 185.4±20.6 vs. 302.6±30.6, DBil (μmol/L): 42.6±10.8 vs. 87.5±11.6, allP < 0.05]. The total effective rate in observation group was obviously higher than that of control group [62.3% (48/77) vs. 40.6% (28/69),P < 0.05].Conclusions Based on liver protection, symptomatic and supportive medical treatment, using artificial liver bilirubin specific adsorption for treatment of patients with hyperbilirubinemia is safe and effective, and in addition, close observation and careful nursing is beneficial to the reduction of incidence of complications and elevation of therapeutic efficiency.