Effect Of Plasma Exchange Combined With Continuous Blood Purification On Pediatric Acute Liver Failure

Background and Objective:Acute liver failure(ALF)is caused by many factors when liver cell damage,leading to its secretion,excretion,metabolism,immune defense and biotransformation dysfunction or clinical decompensation,involve multiple organs and systems syndrome.Pediatric acute liver failure(PALF)complicated with infection,hepatic encephalopathy,etc..At present,liver transplantation is the basic method for the treatment of acute liver failure.However,due to the shortage of donor,the high cost and the abnormal reaction,the liver transplantation is restricted.As a result,the artificial liver support system(ALSS),as a liver replacement system,came into being and played the role of "bridge" in liver transplantation.At present,continuous blood purification and plasma exchange is non bioartificial liver therapy in the treatment of liver failure with wide application,has been generally carried out in adults,but non bioartificial liver single treatment of liver failure have their own shortcomings and deficiencies,continuous blood purification combined with blood plasma replacement in the treatment of rare.Objective toanalyze the clinical efficacy of plasma exchange combined with continuous veno venous hemofiltration in the treatment of acute liver failure.Method:From January 2010 to October 2016,the clinical data in 85 cases of acute liver failure in Hunan Children's Hospital,divided into routine medical therapy group(control group)and artificial liver group based on the comprehensive treatment of the artificial liver group,including plasma exchange combined with continuous veno venous hemofiltration group(combined group)and continuous blood purification group and plasmapheresis group.There were 30 cases in the internal medicine group,and the other in the combined group with a total of 19 cases,the continuous blood purification group(n = 27)and the plasma exchange group(n = 9).There were 45 males and females with a total of40 cases.The clinical efficacy of four groups of children with acute liver failure was analyzed.The data were analyzed with SPSS18.0 statistical software,quantitative data is described by the mean and standard deviation;the qualitative data described by the number of cases and percentage;quantitative data between the two groups were compared using the Wilcoxon rank sum test,multiple groups were compared using the Kruskal-Wallis test,within groups using paired T test;qualitative data were compared by Fisher exact test or chi square test.Result:(1)comparison of different biochemical indexes: plasmaexchange combined with continuous veno venous hemofiltration treatment can reduce ALT,AST,TBIL,DBIL,TBA,NH3,Scr,BUN,INR,PT,APTT,ALB increased,the difference before and after treatment were statistically significant(P<0.05).After treatment,the ALT,AST,DBIL,TBA,TBIL,Scr,BUN of the treatment group were lower than those of the medical group,the continuous blood purification group and the plasma exchange group,the difference was statistically significant(P <0.05).The level of INR,PT and APTT before and after treatment in the combined group was not statistically significant compared with those in the other three groups(P>0.05).(2)PE group had the highest incidence of allergic(P<0.05),CBP group had the highest incidence of membrane fouling(P>0.05),PE group and CBP group had a high incidence of bleeding(P<0.05).The incidence rate of blood pressure and blood pressure decreased in the combined group(P<0.05).(3)Comparison of clinical efficacy: 9 cases in the plasma exchange group,the effective rate was 44.4%;continuous blood purification group of 27 cases,the effective rate was 51.9%,the combined group of the effective rate of 68.4% cases in the medical group,the effective rate was36.7% in the treatment group(n = 19).The highest effective rate was combined group(P> 0.05).Conclusion:Plasma exchange or continuous blood purification iseffective in the treatment of children with acute liver failure,and the combination therapy is superior to medical treatment,plasma exchange therapy and continuous blood purification treatment.