Clinical Effect Analysis Of Plasma Exchange And Dual Plasma Molecular Adsorption System In The Treatment Of Liver Failure

ObjectiveTo provide more theoretical basis for the clinical diagnosis and treatment of patients with liver failure by analyzing and comparing the clinical efficacy of internal medicine combined therapy,plasma exchange（PE）and combined plasma exchange and dual plasma molecular adsorption system（DPMAS）in the treatment of patients with liver failure.MethodsClinical data of 75 patients diagnosed with liver failure who were admitted to the Department of Infection of Jingzhou Central Hospital from June 2018 to October 2020were collected.Patients with liver failure will be charged according to the treatment method for group A,B,C three.A group of 30 patients were given internal medicine comprehensive treatment.A total of 27 patients in group B received 63 times of artificial liver PE,with an average of 2.33 times per patient,and were treated with internal medicine combined therapy plus pure plasma exchange（PE）.18 patients in group C were treated with internal medicine combined therapy+PE+dual plasma molecular adsorption system（DPMAs）,and 43 times of artificial liver PE+DPMAs were treated,with an average of 2.39 times per patient.The indexes of liver and kidney function,electrolyte,blood routine and coagulation function were collected before and after treatment.Clinical data of the three groups at admission were analyzed and compared,including gender,age,etiology,classification and stage of liver failure,as well as liver function and coagulation function.By analyzing the changes of liver function,coagulation function,blood routine,creatinine and electrolyte indexes of the three groups before and after treatment,as well as the decline rate of each index of the three groups,the clinical efficacy of the three treatment methods was compared.The therapeutic effect of the three groups was analyzed.To analyze the therapeutic effect of different stages of liver failure.Results1.There was no significant difference in age,gender and clinical stage of liver failure patients in the medical treatment group,PE group and PE+DPMAS group（P>0.05）,which was comparable.The indexes of ALT,AST and TBIL in liver function of liver failure patients in the three groups at admission were statistically different（P<0.05）.There was no statistical difference in the indexes of coagulation function such as INR,PT and PTA among the three groups（P>0.05）,which showed comparability.2.After treatment,ALT,AST and TBIL of liver function indexes in group B and C decreased,while ALB increased（P<0.01）.In group A,AST decreased and ALB increased after treatment（P<0.01）.The decrease rates of ALT,AST and TBIL in liver failure patients of the three groups after treatment were significantly different,with statistical significance（P<0.05）.Moreover,the decrease rate of ALT,AST and TBIL in liver function of groups B and C was greater than that of group A（P<0.05）,and the decrease rate of TBIL in liver function of group C was greater than that of group B（P<0.05）.3.The indexes of coagulation function in liver failure patients in the three groups were significantly decreased compared with before treatment,while PTA was increased（P<0.01）.There were significant differences in the decrease rates of INR,PT and PTA in liver failure patients among the three groups after treatment,with statistical significance（P<0.05）.Moreover,the decrease rates of INR and PT in coagulation function indexes of liver failure patients in groups B and C were greater than those in group A,while the increase of PTA was more obvious than that in group A（P<0.05）.4.There were no significant differences in WBC and PLT among the three groups（P>0.05）,and the Hb of liver failure patients in group B and group C was significantly decreased compared with before treatment（P<0.01）.There was no significant difference in the rate of Hb and PLT decrease among the three groups（P>0.05）.5.Ca²⁺and K⁺in liver failure patients in three groups were significantly increased compared with before treatment（P<0.01）.There was no significant difference in the decrease rates of Na⁺,K⁺and Cr among the three groups after treatment（P>0.05）.The increasing rate of Ca²⁺in liver failure among the three groups was significantly different（P<0.05）.6.The effective rate of group A was 26.7%,the effective rate of group B was44.4%,the effective rate of group C was 55.6%.There was no statistical difference in the effective rate between group B and group C（P>0.05）.7.The effective rate of early liver failure was 73.7%,the response rate was 34.1%in patients with intermediate stage,the response rate in advanced patients was13.3%.The effective rate of patients with different stages had statistical difference（P<0.05）.Conclusions1.Plasmapheresis with artificial liver technology combined with dual plasma molecular adsorption system is significantly better than plasma exchange alone in reducing TBIL,and the improvement of liver function and coagulation function indexes in patients with liver failure by the two groups of treatment methods is significantly better than the comprehensive medical treatment.Both artificial liver techniques reduced calcium ions,but had no significant effect on blood routine,creatinine,sodium ions and potassium ions.2.Two kinds of artificial liver techniques have a certain effect on the treatment of liver failure.Different clinical stages of liver failure patients have different therapeutic effects.The earlier the treatment such as artificial liver is adopted,the better the clinical effect of patients will be.