| Objctive:To observe the clinical efficacy and safety of combined CVVH-bilirubin adsorption treatment of hyperbilirubinemia and compare to the traditional plasma separation perfusion.Methodology:16 patients with hyperbilirubinemia received total 55sessions artificial liver support therapy(ALS). Patients were treated with conventional plasma perfusion (conventional method) for the first treatment. The rate of blood flow was set at100-120ml/min and the rate of plasma separated was set at 30-40ml/min; Followed with combined CVVH-bilirubin adsorption(combination method).The rate of blood flow was set at 200-250ml/min and the rate of plasma separated was set at 90ml/min.Separated blood plasma components were filtrated by the CVVH filter AV600 when ultrafiltration rate was set at 66ml/min. Then concentrated plasma components were adsorpted by BRS-350 adsorption column and they were reinfusioned in vivo. At the same time bicarbonate replacement fluid at the speed of 4000ml/hr with pre-dilution mode was input before plasma component separator EC40W. ALS was performed with 8 hours. Blood biochemistry and coagulation were measured before and after single treatment.Similaly blood biochemistry, plasma biochemistry before plasma separator and plasma biochemistry before and after BRS-350 were measured at the 30min,2hr,4hr,6hr and 8hr of therapy. Clinical vital signs need to be recorded. Asessment the acute physiology and chronic health evaluation (APACHEII), Glasgow coma score, MELD score of liver function before and after single treatment.Results:The average reduction rate of TBL, DBL, IDBL, TBA were (46.1±8.3)%, (47.3±8.0)%, (40.7±24.8)%, (36.5±5.2)%, respectively, with the conventional method after single treatment and the reduction rate of TBL,DBL,IDBL, TBA were(54.4±5.2)%, (54.2±5.3)%, (63.8±7.2)%, (47.6±14.7)%, respectively, with combined CVVH-bilirubin adsorption after single treatment. The clearance of TBL were (22.3±2.2)ml/min, (12.2±4.4)ml/min, (9.0±2.8)ml/min, respectively,with the conventional treatment at the 0.5h,2h,4h therapy.The clearance of TBL were (28.7±13.1)ml/min, (21.9±9.1)ml/min, (16.1±4.3)ml/min respectively, with combination treatment, at the time corresponding to conventional treatment. At the end of treatment, the clearance of TBLwere (8.3±3.0)ml/min and (9.3±4.1)ml/min,respectively. The clearance of TBL, DBL, IDBL decreased with time on the course of treatment weather combined CVVH-bilirubin adsorption or conventional treatment. The concentration of on total protein (TP), albumin (ALB)were lower than before treatment and APTT, PT, INR were longer with conventional treatment. But blood BUN, Scr, ALT, AST were decreased and there were no effect on TP, ALB and coagulation with combination method after single treatment. As for 5 patients with the number of continuous treatment for more than 3 times, The concentration of TBL, DBL, IDBL were lower significantly at the end of all treatment than those before treatment.However, there were no effect on TP, Alb,and coagulation function. Systolic blood pressure, heart rate and APACHEII, MELD score were improved with the combined treatment. The survival rate In ICU at 30 day was 69%,56% in hospital. During the treatment, all patients vital signs were stable and there were no adverse events.Conclusion:The combined CVVH-bilirubin adsorption therapy is a novel and effective artificial liver support therapy. It can significantly reduce bilirubin levels, improve the biochemical indexes and relieve some clinical symptoms. Moreover it was well tolerated for patients and there were no effect on albumin and coagulation.It can improve MELD score of liver function and APACHEII.It is the artificial liver support worthy of promotion and application clinically. |
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