The Therapeutic Effect And Nursing Strategy Of Molecular Adsorbents Recycling System For Liver Falure

Background and objectivesLiver failure, a severe liver damage caused by a variety of factors, presents with a set of clinical syndrome including dysfunction in blood coagulation mechanism, jaundice, hepatic encephalopathy and ascites, leading to the disorder of synthesis, detoxification, excretion and biogenesis. In China, hepatitis virus is one of the major causes of liver failure (mainly the hepatitis B virus), followed by liver toxic substances and drugs. Liver failure is not an independent clinical diagnosis, but a functional judgment. Non-invasive therapy is not very effective with high mortality. Liver transplantation is currently one of the most effective way to treat liver failure, however, because of shortage of donors, long waiting time and being expensive, the clinical usage is severally limited. Molecular adsorption recycling system (MARS) artificial liver is quickly developed under the background, which applies the existing dialysis technology and the simulation of the liver cell biological detoxification function, by eliminating the protein toxins and water-soluble toxins in patients’bodies, to maintain a stable internal environment for regeneration of liver cells and functional recovery. This study was to explore the therapeutic effect and nursing strategy of molecular adsorption recycling system for liver failure.MethodsFrom2008.3to2012.6,134patients with liver failure were divided into MARS group of69cases treated with MARS artificial liver on the basis of synthetic internal comprehensive medical treatment, and plasma exchange (PE) group of65cases treated with PE on the basis of synthetic internal comprehensive medical treatment. The clinical symptoms, liver function, kidney function, blood coagulation function and MELD scores were evaluated before and after the treatments. Moreover, we monitored the3months mortality rate of these cases, used the MELD scoring system for prognosis analysis of the efficiency after treatments and implemented relevant nursing strategy to deal with complications.Results①Two groups of clinical symptoms after treatment both had different degrees of improvement, and the MELD scores significantly decreased (P<0.05) while the MARS group scores decreased more significantly (P<0.05).②Liver function, renal function, blood coagulation function improved significantly in patients of MARS group after treatments, but the removal of bilirubin and the improvement of blood coagulation were inferior to PE group (P<0.05), while the ability to lower creatinine and the MELD score were significantly superior to the latter (P<0.05).③For those patients who had a score on MELD<20,20≥MELD<30,30≥MELD<40, the3months actual fatality rates were respectively0%,44.7%,52.9%after MARS treatment, significantly lower than the predictable death rate27%,76%and83%(P<0.05), and significantly less than3months actual mortality11.1%,55.9%and71.4%after PE treatment (P<0.05).But for patients with the MELD score of40or more, there was no significant difference in the3months actual mortality after the treatments of MARS group and PE group, and they were the same as the3months predictable mortality respectively (P>0.05).④The major complications of MARS artificial liver treatment include puncture site bleeding (17.4%), drop of blood pressure (8.7%) and infection (4.3%).Conclusion1. MARS and PE treatment could effectively improve liver failure in patients with clinical symptoms and reduce the MELD score.2. MARS treatment improved patients’hepatic function, renal function, blood coagulation function significantly. It was not as effective as PE group in the removal of bilirubin and improving blood coagulation, but it was Superior to the latter in reducing the creatinine and the ability to MELD score. 3. For MELD<40patients with liver failure, compared with PE treatment, MARS could effectively improve the recent prognosis of patients and prolong the survival period.4. In patients with MELD≥40, MARS and PE treatment were not effective, suggesting early initiation of liver transplantation.5. The major complications of MARS artificial liver treatment include puncture site bleeding, drop of blood pressure and infection.6. Nursing strategy:observing the blood pressure fluctuation closely, strict aseptic techniques, strengthening nursing care of catheters.