Slow Increase Treatment Efficacy Evaluation Of The Clinical Features Of Acute Liver Failure Analysis And Heat Dampness Cooling Blood Detoxification Method

Objective:Acute on chronic liver failure refers to acute hepatic insult manifesting as jaundice and coagulopathy,complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease.It's a serious threat to human health due to rapid progress and high mortality.There are many researches on liver failure, however, reports on clinical features and treatment in integrated Chinese and western medicine of acute on chronic liver failure are rare. The first part of this study was retrospective analysis the clinical characteristics and different prognostic factors of 139 cases with hepatitis B-related acute on chronic liver failure. The second part was to discuss the clinical efficacy of acute on chronic liver failure with western medicine conventional treatment added qing re hua shi liang xue jie du herbal medicine and traditional enema.Methods:Retrospectively investigated 139 cases of acute on chronic liver failure in Beijing Ditan Hospital during December 2007-September 2010 and analyzed the clinical data.72 cases which according to the diagnostic criteria of acute on chronic liver failure were included observation, divided into treatment group and control group,34 in treatment group and 38 in control group. Using SPSS 17.0 for statistical analysis.Results:(1) The maximum of TBIL and minimum of PTA were 474.09±191.51 umol/L, (23.51±10.92)%, the two peak time appear 35.85±22.31,34.49±25.82days after onset,the duration were 25.18±18.36,120.48±20.91days. (2)The three most common complications were ascites (87.10%),electrolyte imbalance (86.30%), Spontaneous bacterial peritonitis (76.30%),the top three highest mortality were hepatorenal syndrome (91.30%),upper gastrointestinal bleeding (78.95%),hepatic encephalopathy (69.23%). (3)The prognosis of acute on chronic liver failure was shown to correlate with age, proihrombin activity, serum total bilirubin, albumin and presence of complications, hepatic cirrhosis, MELD score of the second week after admission(P<0.05),but not with sex,alanineam inotransferase, aspartateam inotransferase and alphafetoprotein(P>0.05). (4)The symptom recovery, and coagulation recovery of the treatment group were all obviously superior to the control group(P<0.05).There are also certain advantages of dissipation of bilirubin in treatment group.Conclusion:It needs five months or so for reaching peak of TBILand PTA, about three weeks away from peak,patients of HBV-related acute on chronic liver failure may be relatively safe.Data onage, prothrombin activity, serum total bilirubin, albumin and presence of complications, hepatic cirrhosis, MELD score of the second week after admission may be important factors for judgment of prognosis in acute on chronic liver failure. Western medicine conventional treatment combined qing re hua shi liang xue jie du herbal medicine and traditional enema can significantly improve the clinical effect of acute on chronic liver failure.