| Background: There are still no effective measures to cure patients with chronic severe viral hepatitis B and the mortality rate has reached 50%-90% high. Keep intensive care, internal medical treatment, artificial liver support and liver transplantation are the main treatments .Among them , liver transplantation is the most effective way, but it can not be used broadly for the high cost, shortage of liver donors and high technique needed. Artificial liver support system is a great improvement in the treatment of severe hepatitis. Substantively it is the clinical use of blood purification on liver failure. In recent 3-4 years it has extensively developed to be used on the treatment of severe hepatitis in our country. The main courses of artificial liver system are plasma exchange(PE), hemoperfusion and plasma absorption, among them, PE is the most used one. Evidences in domestic and abroad confirm that those therapeutic measures can eliminate some of the toxic substance in the blood, improve clinical symptom and increase survival rate of the forepart and middle stage but the efficacy is not perfect in the late stage of severe hepatitis.Theoretic base: PE can eliminate the toxic substance just like ammonia, aromatic aminoacid, pseudo-neurotransmitter, endotoxin, bilirubin, circulating immunocomplex etc. At the same time, it can supply bioactive elements such as coagulation elements, albumin, opsonin and so on. Therefore PE has become the most popular therapeutic method of artificial liver. It has positive efficacy on the treatment of severe hepatitis. But on the other hand, PE can cause plasma anaphylaxis, hypernatremia, metabolic alkalosis,and sharp decrease in colloid osmotic pressure, then to aggravate turbulence of internal environment and hydrocephalus. What's more, PE can not eliminate phlogistic factors effectively. Continuous veno-venous hemofiltration(CVVH) is one of the measures of blood purification developed in recent years, it simulates the functions as osmosis and reabsoption of nephron, can eliminate moderate moleculers and regulate turbulance of liquid, electrolyte acid and alkali. New membrane applied to CVVH can also adsorb endotoxin and cellular factors. Hemodynamic keep stable in the CVVH therapy. Now, CVVH is not only used in nephritic disease, but also used in severe diseases like acute pancreatitis and multiple organic disfunction syndrome(MODS).Theoretically speaking, it is applicable on the aid of severe hepatitis. Combining therapy of PE and CVVH can make up the deficiency and reduce side effects associated with PE alone.Objective: To evaluate the clinical efficacy and mechanism of combining PE and CVVH in the treatment of patients with chronic severe viral hepatitis B in middle stage and late stage and increase the clinical efficacy of artificial liver support system on the treatment of severe viral hepatitis B.Methods: 94 patients suffering from chronic severe viral hepatitis B were divided into three groups. All patients had some complications. Group A included 29 patients, 10 in middle stage and 19 in late one, among them, 10 with hepatic encephalopathy and 17 with hyponatremia. The average of total bilirubin (TB)was 470.76± 143.49 mol/L and of prothrombin time activity(PTA) was 20.74%±8.63%; Group B included 31 patients, 12 in middle stage and 19 in late one, among them, 11 with hepatic encephalopathy and 11 with hyponatremia. The average of TB was 473.93±113.87 mol/L and PTA was 21.86%±9.35%; Group C included 34 patients, 16 in middle stage and 18 in late one, among them, 11 with hepatic encephalopathy and 16 with hyponatremia. The average of TB was 425.91±110.66 mol/L and PTA was 19.71%±8.61%; On the base of routine treatment by medicine, Group A was treated with PE plus CVVH. Group B was treated with PE alone and Group C did not receive any artificial liver support. The efficacy of treatment in the above different groups was investigated. Various biochemical parameterswere determined before and after the treatment. Moreover, The levels o... |
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