Observation Of The Clinical Effect Of Artificial Liver In Patients With Severe Acute Liver Failure In The Dual Plasma Molecular Adsorption Mode Artificial Liver

Objective:To observe and compare the effect of dual plasma molecular adsorption（DPMAS）artificial liver in patients with acute liver failure admitted to the intensive care unit（ICU）,and to explore reasonable alternative treatment methods for non-biological artificial liver.Methods: From August 2019 to June 2021,66 patients with acute liver failure who had received artificial liver therapy in icu of our hospital（Icu Iv,East Hospital and ICU I,South Hospital）were selected and divided into observation group（n=34）and control group（n=32）according to treatment methods.On the basis of general medical conservative treatment,DPMAS in observation group and PE in control group were received.Baseline data(gender,Age,etiology,APACHE-II Evaluation（Acute Physiology,Age and Chronic Health Evaluation）,liver function（ALT,AST,ALB,TBIL）,coagulation function PTA（Prothrombin activity）and complications（upper gastrointestinal bleeding,ascites,hepatic encephalopathy,etc.）at admission were compared whether the difference was statistically significant.Results: There was no statistically significant difference in baseline data（gender,age,etiology,APACHE-II evaluation,liver function（TBIL,ALT,AST,ALB）,coagulation function（PTA）and complications（upper gastrointestinal bleeding,ascites,hepatic encephalopathy,etc.）at admission）between 2 groups.In DPMAS group,TBIL,ALT,AST,WBC,inflammatory indexes（CRP,PCT）and inflammatory mediators（IL-6,IL-8,TNF-α）were decreased after on-machine treatment,with statistical significance（P < 0.05）.In PE group,liver function indexes（TBIL,ALT,AST,ALB）,inflammatory indexes（CRP,PCT）and inflammatory mediators（IL-6,IL-8,TNF-α）were decreased after machine therapy,while PTA was increased,the difference was statistically significant（P < 0.05）.The difference of ALB and PTA between the two groups before and after machine operation was statistically significant（P < 0.05）.Comparison of liver function（TBIL,ALT,AST）,electrolyte（Na,K）,blood routine（WBC,RBC,PLT）,inflammatory indicators（CRP,PCT）,inflammatory mediators（IL-6,IL-8,TNF-α）,total effective rate,average length of stay and 28-day survival rate between the two groups.There was no significant difference（P > 0.05）."Low fever" adverse reactions occurred in DPMAS group,and "fever,abdominal distension,vomiting,rash and diarrhea" mainly occurred in PE group.The total incidence of adverse reactions in DPMAS was lower than that in PE group（8.82% vs 37.50%）,and the difference was statistically significant（P < 0.05）.Conclusion:Both DMPAS and PE have good efficacy in patients with acute liver failure.DPMAS can overcome the limitations of PE therapy,effectively improve the symptoms of patients with acute liver failure,with good safety,shorten the hospitalization period,improve the cure rate,and possibly save medical costs.DPMAS can be used as an alternative to PE artificial liver therapy in the case of plasma shortage.