Therapeutic Effects Of Plasma Exchange In Acute Fatty Liver Of Pregnancy And The Factors Influencing Prognosis Of Maternity

Objective: Summarized the clinical characteristics of acute fatty liver of pregnancy to explore the clinical application value of plasma exchange and to know about the factors influencing prognosis of maternity. Methods: Retrospective analysis was performed on 18 cases, which were diagnosed and treated by the Affiliated Hospital of Zunyi Medical College recent 14 years, with clinical data such as the general situation, clinical manifestations, relevant examination, complications and pregnancy outcomes and so on. Then, to compare the therapeutic effects between the two groups which were divided according to whether have been received the treatment of plasma exchange. Results: 1)11 cases were accepted the treatment of plasma exchange and 3 cases combined continuous renal replacement therapy among these 18 cases. 8 cases recovered and 3 cases died of serious complications, the mortality was 27.3%(3/11). The control group in 7 cases, 3 cases died, the case fatality rate was 42.9%(3/7). 11 cases had no adverse reactions except for scattered wheals occurred in 1 case. 2) After plasma exchange treatment, the liver function of AST, ALT, TBIL, DBIL decreased obviously(P<0.05), the creatinine decreased obviously compared before(P<0.05), the PT in blood coagulation function was shorten than before, a significant rise in the PTA, and the FIB increased obviously(P<0.05), and the liver and kidney function and blood coagulation function recovery time was significantly shortened in the treatment group; 3) The digestive tract symptoms such as nausea, vomiting, diarrhea, lack of power as the first symptoms occured in the patients of AFLP, some cases combined with jaundice or itchy skin. These symptoms were relieved after treatment, and 12 patients recovered completely; 4)Different extent coagulation dysfunction occurred in 18 cases, and acute renal damage and kidney failure in 11 cases, acute hepatic failure and hepatic encephalopathy in 8 cases, 7 cases combined with multiple organ dysfunction syndrome, 6 cases of death patients died of hepatic failure and multiple organ dysfunction syndrome.Conclusion:1) Plasma exchange therapy applied in pregnancy with acute fatty liver was safe and effective, the function of liver and kidney and blood coagulation function was improved obviously, so as the survival rate; 2) In order to reduce the occurrence of serious complications and improve the prognosis, will the plasma exchange be as a routine method for the treatment of AFLP, it remains to be further observation and exploration.