摘要
BACKGROUND:Acute liver failure(ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders,the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artif icial liver treatments for patients with acute liver failure(ALF) complicated by multiple organ dysfunction syndrome(MODS).METHODS:Thirty-one patients with mid- or late-stage liver failure complicated by MODS(score 4) were randomly divided into three treatment groups:plasmapheresis(PE) combined with hemoperfusion(HP) and continuous venovenous hemodiafiltration(CVVHDF),PE+CVVHDF,and HP+CVVHDF,respectively. Heart rate(HR) before and after treatment,mean arterial pressure(MAP),respiratory index(PaO2/FiO2),hepatic function,platelet count,and blood coagulation were determined.RESULTS:Signifi cant improvement was observed in HR,MAP,PaO2/FiO2,total bilirubin(TBIL) and alanine aminotransferase(ALT) levels after treatment(P<0.05). TBIL and ALT decreased more signifi cantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups(P<0.01). Prothrombin time(PT) and albumin were signifi cantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups(P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups(P<0.05). The survival rate of the patients was 58.1%(18/31),viral survival rate 36.4%(4/11),and non-viral survival rate 70%(14/20).CONCLUSION:Liver function was relatively improved after treatment,but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites,especially bilirubin. The survival rate was signifi cantly higher in the patients with non-viral liver failure than in those with viral liver failure.
BACKGROUND： Acute liver failure （ALF） caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders, the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artificial liver treatments for patients with acute liver failure （ALF） complicated by multiple organ dysfunction syndrome （MODS）. METHODS： Thirty-one patients with mid- or late-stage liver failure complicated by MODS （score 4） were randomly divided into three treatment groups： plasmapheresis （PE） combined with hemoperfusion （HP） and continuous venovenous hemodiafiltration （CWHDF）, PE＋CWHDF, and HP＋CWHDF, respectively. Heart rate （HR） before and after treatment, mean arterial pressure （MAP）, respiratory index （PaO2/FiO2）, hepatic function, platelet count, and blood coagulation were determined. RESULTS： Significant improvement was observed in HR, MAP, PaO2/FiO2, total bilirubin （TBIL） and alanine aminotransferase （ALT） levels after treatment （P〈0.05）. TBIL and ALT decreased more significantly after treatment in the PE＋CWHDF and PE＋HP＋CWHDF groups （P〈0.01）. Prothrombin time （PT） and albumin were significantly improved only in the PE＋CWHDF and PE＋HP＋CWHDF groups （P〈0.05）. TBIL decreased more significantly in the PE＋HP＋CWHDF group than in the HP＋CVVHDF and PE＋CWHDF groups （P〈0.05）. The survival rate of the patients was 58.1% （18/31）, viral survival rate 36.4% （4/11）, and non-viral survival rate 70% （14/20）. CONCLUSION： Liver function was relatively improved after treatment, but PE＋HP＋CWHDF was more efficient for the removal of toxic metabolites, especially bilirubin. The survival rate was significantly higher in the patients with non-viral liver failure than in those with viral liver failure.
基金
supported by a grant from Xuzhou Municipal,China
作者简介
Corresponding Author： Mao-qin Li, Email：limaoqinxi@126.com
