Study On The Therapeutic Effect Of Dual Plasma Molecular Adsorption System On Patients With Hepatic Failure And Hyperbilirubin

BackgroundLiver failure(LF)refers to a large number of liver cell necrosis caused by drugs,viruses,alcohol and other factors,decompensated liver function or severe disorders,clinical symptoms such as hepatic encephalopathy,jaundice,ascites,and coagulopathy.Liver failure seriously affects the patient’s quality of life,and the mortality rate is extremely high.At present,due to the lack of specific medicines,internal medicine treatment is not satisfactory.Liver transplantation is considered to be the most effective treatment,but factors such as limited donors,high prices,and long-term use of immunosuppressive agents after liver transplantation have limited its use in clinical treatment.In this context,Artificial Liver Support System(ALSS)has received widespread attention.Plasma exchange(PE)and dual plasma molecular adsorption system(DPMAS)are currently widely used artificial liver treatment technologies in clinical practice,and have played an important role in clinical treatment of liver failure,but also There are certain advantages and disadvantages.This research is improved on the basis of the existing technology.On the ordinary Fresenius hemofiltration machine(MUlti Filtrate),the pipeline is modified,and the DPMAS treatment is completed by a single machine;It has the advantages of simple operation,low extracorporeal blood volume,and good economy,but its efficacy is still under investigation.Therefore,this study intends to compare PE and improved DPMAS in the treatment of patients with hepatic failure and hyperbilirubinemia.Observe the effectiveness and safety of treatment for patients with hepatic failure and hyperbilirubinemia,and provide some guidance for clinical treatment.MethodsTo compare the safety and effectiveness of plasma exchange and the improved dual plasma molecular adsorption system(DPMAS)in the treatment of patients with liver failure and hyperbilirubin,and to provide a certain reference for the clinical search for the best artificial liver treatment plan.Result1.Baseline data: The basic data of the two groups of patients was investigated.The results showed that the average age of the PE group was 49.4 ± 7.5 years,28 males and19 females;the average age of the DPMAS group was 49.1 ± 7.3 years and 30 males.18 women.The classification of liver failure mainly includes acute liver failure,subacute liver failure,chronic plus subacute liver failure,and chronic liver failure.The causes of liver failure are mainly viral,drugs,alcohol,and unknown.The complications are mainly upper gastrointestinal bleeding,ascites,Hepatorenal syndrome and hepatic encephalopathy.There was no statistical difference in the baseline survey results between the two groups,P> 0.05,which was comparable.2.Changes in liver function indexes: There was no significant difference in TBIL,AST,and ALT values between the two groups before operation,and they decreased significantly after operation.The decrease rate of TBIL,AST,and ALT in the DPMAS group was significantly higher than that in the PE group.,P <0.05.The ALB value of PE group was significantly higher than that before operation,while the ALB value of DPMAS group was significantly lower than that before operation,the difference was statistically significant(P <0.05).Observation of liver function indexes in the two groups of patients within 1 month showed that the TBIL,AST,and ALT levels in the PE group and the DPMAS group showed partial rebound after 3d and 5d,and the TBIL showed from the 7th,14 d,21d,and 28 d Compared with the DPMAS group,the downward trend was relatively slow in the PE group.The DPMAS group and the PE group had statistical differences at 3d,5d,14 d,21d,and 28 d after surgery compared with pre-operation,P <0.05.The ALB values on the 3rd,5th,7d,14 d,and 28 d postoperative patients in the PE group and the DPMAS group were statistically different from those before the operation.P <0.05.The ALB values in the PE group showed an increasing trend compared with those before the operation,while the DPMAS group ALB showed a slow downward trend compared with before surgery.3.Changes in blood coagulation function:There were no significant differences in the coagulation function indexes of patients in the DPMAS group before and after surgery(P>0.05).In the PE group,the PT and INR indexes were significantly reduced before and after surgery,and the FIB value was significantly increased.The difference was statistically significant(P< 0.05)See Table 9;the comparison of the blood coagulation index change rate of the two groups of patients showed that the postoperative PT value reduction rate of the PE group was significantly higher than that of the DPMAS group,and the difference was statistically significant(P<0.05).The PTA and INR of the two groups of patients There was no significant difference in the rate of change of,FIB,APTT(P>0.05)4.Inflammatory factor levels: The TNF-α,IL-6 and CRP values of PE group and DPMAS group after operation were significantly lower than that before operation,the difference was statistically significant(P <0.05);the postoperative inflammatory factors decreased between the two groups of patients The rate showed that the decrease rate of TNF-α,IL-6 and CRP in the DPMAS group was significantly higher than that in the PE group,the difference was statistically significant(P <0.05).5.Blood routine and ion level: NEU% in PE group was significantly higher immediately after surgery than before surgery,while RBC and HGB were significantly lower,the difference was statistically significant(P <0.05),blood routine before and after surgery in DPMAS group There was no significant difference(P> 0.05).After treatment,patients in the PE group had significantly higher Na + and Cl-than before operation,while Ca + had significantly lower than before operation,the difference was statistically significant(P <0.05),while patients in the DPMAS group had postoperative Na +,Cl-,Ca+ plasma The level was not significantly different from that before operation(P> 0.05).Comparison of postoperative blood routine and ion levels between the two groups showed that there was a significant difference in the rate of decrease in RBC,NEU%,HGB,Na +,Cl-,and Ca + between the PE group and the DPMAS group after operation(P <0.05).6.Renal function changes: The postoperative renal function indexes BUN and Cr of patients in PE group and DPMAS group were significantly lower than that before operation.Comparison of the decline rates of renal function BUN and Cr between the two groups showed that the decrease rate of BUN and Cr indexes in DPMAS group was significantly higher than that of PE group,the difference was statistical Significance(P<0.05).7.Adverse reactions and effectiveness: After PE and DPMAS treatment,patients mainly suffered from lip numbness,pruritus,and rash.The incidence of postoperative adverse reactions in the PE group(23.40%)was significantly higher than that in the DPMAS group(4.17%).The effective rates of postoperative treatment in the PE group and DPMAS group were 51.06% and 54.16%,respectively,with no statistically significant difference(P> 0.05).Conclusion1.Both PE and DPMAS can effectively reduce liver function indexes(AST,ALT)and bilirubin levels in patients with liver failure and hyperbilirubin,and improve the symptoms of patients.It is a safe and effective treatment for patients with liver failure and hyperbilirubin Means,but DPMAS treatment effect is more obvious,better than PE surgery.2.The coagulation function index of patients in the DPMAS group before and after operation has no obvious effect,and PE treatment can significantly improve the coagulation function of patients.Therefore,artificial liver treatment should be selected according to the patient’s condition.PE surgery can be used for patients with severe coagulopathy Treatment can relieve coagulation dysfunction in patients.DPMAS can be used in patients with plasma shortage and relatively mild coagulation function.3.The DPMAS group reduced the level of inflammatory cytokines in patients with hepatic failure and high bilirubin,which was significantly better than the PE group,and the adverse reactions were lower,which was worthy of clinical promotion.4.DPMAS is not limited by the shortage of plasma resources.It has a higher efficiency and lower adverse reactions.It is a safe and effective treatment for liver failure.