| Objective:To observe the clinical efficacy of middle typal artificial liver support system in treating patients with HBV related hepatic failure. To investigate the methods of prevention and treatment of complications caused by Artificial Liver Support System in treating liver failure patients.Method:576 cases with liver failure caused by HBV infection were collected from August 2003 to February 2011 and were divided into retrospective group and prospective group according to the date of June 2010. In retrospective group,203 patients received artificial liver treatment and 292 as controls; In prospective group.29 patients received artificial liver treatment and 52 as controls. The clinical symptoms, liver function, MELD scores and prothrombin time activity were examined and compared before and after the treatment. Observe the artificial liver subgroup in prospective group related adverse reactions.Results:Total bilirubin was significantly decreased in MELD<20 subgroup and 20≤MELD <25 subgroup. However, in 25≤MELD<30 and MELD≥30 subgroup, there was no significant difference. Prothrombin time ratio of international standardization in MELD<20 and 25≤MELD<30 subgroup of prospective treatment group were significantly decreased (p<0.05;p<0.01), preview the treatment group and review the treatment group contrast inconsistent results before and after. After implement CHDF therapy alone or combined in 40 cases of retrospective group and prospective group of patients, patients's creatinine fell obviously than before treatment (p<0.01). Meld score in MELD<20 subgroup and 20≤MELD<25 subgroup of preview and review the treatment groups compared with before treatment, are obviously decline, differences have statistical significance (p<0.01; p<0.05), but in 25≤MELD<30 and MELD≥30 group, after treatment dropped slightly than before treatment, but before-and-after difference was not statistically significant(p> 0.05). ALSS treatment can obviously reduce MELD<20 subgroup and 20≤MELD < 25 subgroup's MELD score, and the effect is better than the control group. Whether the 25≤MELD<30 and MELD≥30 subgroups in treatment groups or in contrast groups are unable to effectively decrease patient's MELD score. During the treatment of PE Combined HP or combined PE,HP,CHDF of ALSS's therapies can a rash and itchy skin, facial brothers tingling, a postural hypotension adverse reactions such as ever,after received alimta all can get better, did not happen serious complications.Conclusions:1. Artificial liver joint medical comprehensive treatment is a valid way of liver failure caused by HBV infection. It can temporarily improve the clinical symptoms, and could improve biochemical indicators, such as TB,MELD score, and could more effectively reduce patient case fatality.2. Pure or joint CHDF treatment could obviously decrease the patients's creatinine.3. Medical comprehensive treatment and ALSS is effective for patients whose MELD score are less than 25. We should close observe the change of the MELD score of those whose MELD score kept rising. According to the illness development of them reasonable implement various ALSS treatment.4. ALSS treatment effect is better than that of Medical comprehensive treatment for those patient MELD scores were 20～25. We should as early as possible implement ALSS treatment if patient's MELD scores kept raising.5. Both Medical comprehensive treatment and ALSS cannot obviously decrease those patients whose MELD score higher than 25.We should contact implement liver source in targeted therapy of various complications premise as soon as possible. 6. The treatment of PE Combined HP or combined PE,HP,CHDF of ALSS's therapies existed certain adverse reactions,but don't affect the treatment.It is safe. |
PDF Full Text Request