| Research background and purposeLiver failure is a set of clinical syndrome including blood coagulation dysfunction, jaundice, hepatic encephalopathy and ascites, which has a severe liver damage caused by a variety of factors, leading to dysfunction of the synthesis, detoxification, excretion and biogenesis. The main treatment includes medical comprehensive treatment, artificial liver support therapy and transplantation. Artificial liver support system can provide replacement of liver detoxification function, remove toxic substances of the body, improve the internal environment, so winning longer time for liver transplantation or liver cell regeneration. Both Plasma exchange and MARS are currently the used artificial liver technology in clinical, but their efficacy and safety is a lack of advanced control study, especially the lack of systematic research how to adopt targeted nursing for different artificial liver technology. Running of artificial liver support system is mainly performed by nurses who plays an important role in the process of artificial liver treatment. It is successful guarantee of artificial liver treatment that nursing staff has skilled operation procedure, serious assessment for the patients before treatment, and careful observation in operation and the post operation. So, it is very necessary for reducing side effects and complications, improving the level of artificial treatment that experience is seriously sum up, reasonable care scheme is explored, especially targeted nursing countermeasures is build in according to the different characteristics of artificial liver support system.MethodsThe study was a retrospective case-control study. The research object was admitted150patients with liver failure due chronic hepatitis B for receiving artificial liver therapy from January2009to June2009in our hospital. The efficacy, cost, complications, side effects, mortality and the cause of death were multi-level analysed. Diagnostic criteria of liver failure was accord with the guide of diagnosis and treatment of hepatic failure (2012edition, China). All patients were divided into group A and group B according to the different artificial liver treatment. Group A was atotal of62cases(45cases of male, female17cases, mean age43.5±11.2years old), which were received single therapy of plasma exchange; Group B was a total of88cases(60male cases,28cases female, mean age42.6±12.4years old), which were received combination therapy of plasma exchange and MARS. In addition, group B was divided into group B1(received plasma exchange)and group B2(received MARS). Artificial liver therapy standards:serum total bilirubin level was more than350u mol/L, and the total bilirubin rise daily more than17.1u mol/L, PTA was less than40%. Terminated artificial liver therapy standards:patient serum total bilirubin was less than200u mol/L, daily increase of<10u mol/L, PTA was more than60%; Basic discharge standards:patient had improved gastrointestinal symptoms, had no important complications including hepatic encephalopathy, hepatorenal syndrome, infection, gastrointestinal bleeding, total bilirubin was less than100u mol/L, and PTA was greater than70%. Nursing measures include:(1)before operative preparing of psychological nursing, environment and goods, patient body preparation(such as the skin) and machine and pipe;(2) intraoperative strict aseptic operation, observation of patient’s vital signs, instrument operation and anticoagulant nursing;(3) postoperative observation of adverse reaction, nursing of the femoral vein catheter and dietary guidance for patient, etc. The overall efficacy, complications, the death cause of group A and group B was compared and analyzed; hospitalization days, artificial liver treatment costs and total medical cost of survival patients was compared and analyzed;Also, Routine blood, biochemical index and complications after every plasma exchange(group A, group B1) and every MARS(group B2) was compared and analyzed.Statistical software SPSS13.0was used for statistical analysis. Measurement data noted as x±s. T-test was used to do group differences;Rate compare was used chi-square test.When P was<0.05, it act as statistically significant.ResultsBefore the artificial liver treatment, the hepatic function index of group A and group B patients were significantly abnormal and achieve diagnostic criteria of fulminant hepatitis, but were no significant differences (P>0.05) between group A and group B. Serum sodium levels of the two groups had a different degree of decline, the remaining biochemistry index have no obvious abnormal, significant difference (P>0.05) of biochemistry index between group A and group B was no funding.After artificial liver treatment, death cases of group A and group B had no significant difference(P>0.05), the fatality rate in group A and in group B were35.5%and36.4%, respectively, that shown same efficacy in group A and in group B(P>0.05). But, direct cause of death was slightly different in the two groups, which death cases from renal failure in group A was significantly higher than in group B (12.9.0%vs2.3%, P<0.05), the other cause of death in the two groups was no significant difference. Among main complications, new incidence of hepatic encephalopathy in group A was significantly higher than in group B (35.5%vs19.3%, P<0.05), and other complications in the two groups had no significant difference. Hospitalized days and medical expense of survival patients after artificial live treatment was compared and analyzed, it shown that hospitalization days of group B patients was slightly longer than of group A, but no statistical difference. Artificial liver expenses and total medical expenses of group B were significantly higher than of group A (P<0.01), which the main cause was expense in MARS treatment. The change of blood routine, hepatic function and biochemical index were compared and analyzed before and after plasma exchange in group A,before and after plasma exchange or MARS in group B.The decline of total bilirubin.in group A and group B2received plasma exchange were significantly greater than MARS treatment (P<0.01).The rise of PTA in group A and group B2received plasma exchange was also significantly higher than MARS treatment (P<0.01).Levels of ALT, blood ammonia and total cholesterol were no significant difference (P>0.05) between group A and group B. Number of peripheral blood leukocyte was no statistical difference in every groups, but decreased level of red blood cells and platelets in after MARS treatment were significantly greater than in group A and group B(P<0.01). Restoring normal rates of abnormal sodium, potassium, chloride and urea nitrogen and creatinine in MARS treatment group were significantly higher than that in group A plasma exchange and B2group (plasma exchange)(P<0.01). Major adverse reactions including nasal bleeding, gums bleeding, digestive tract hemorrhage, intubation local bleeding, rashes, and cold chills, limb numbness were were compared and analyzed. It shown that cases of nasal bleeding and bleeding gums in MARS treatment group(group B1) were significantly greater than in group A and group B2(P<0.05),and cases of other adverse reactions included skin rashes, chills chills and limb numbness were significantly less than group A and group B2(P<0.05).ConclusionsArtificial liver technology can obviously improve the survival rate of patients with liver failure, which the efficacy of alone plasma exchange and plasma exchange combined with MARS therapy was resemble. Among the death factors, renal failure in plasma exchange group(group A) was more common, but heart failure, hepatic encephalopathy, infection, MOF in the two groups had no significant difference.Expenses of plasma exchange combine with MARS was significantly higher than plasma exchange therapy alone, which the main reason was the high cost of raw materials used MARS. New hepatic encephalopathy was more common in plasma exchange group, other complications including hepatorenal syndrome, gastrointestinal bleeding and infection was no significant difference in every groups. Among adverse reactions or side effects, allergic phenomenon (fever, rash, chills,limbs pins) were more common in plasma exchange group; MARS local bleeding including the nose, gums bleeding, intubation bleeding, skin and gastrointestinal bleeding were more common in MARS group.According to different characteristics of plasma exchange and MARS therapy, targeted to build nursing countermeasures is of great significance to improve the clinical curative effect. The nursing countermeasures should include artificial liver support therapy center management, strictly control the infection, close observation of complications and adverse reactions and processed in a timely manner, to the patients with good health education. |
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