Evaluation Of The Effect Of Modified Plasma Exchange In The Treatment Of Hepatic Failure

Objective1.The effect of modified plasma exchange therapy on patients with liver failure was evaluated by changing the timing and supplementation of fresh frozen plasma and comparing the efficacy of traditional plasma exchange in order to provide a basis for improving the clinical application of plasma exchange.2.This study was aimed at evaluating the safety of modified plasma exchange therapy and provide a reference for individualized treatment of patients with liver failure.Methods34 patients with liver failure admitted to a third-grade hospital in Qingdao were selected from February 2018 to January 2019.The experimental group and the control group were determined by using convenience sampling method.The patients in both groups were given conventional comprehensive medical treatment.16 patients in the experimental group were treated with modified plasma exchange for a total of 55 times while 18 patients in the control group were treated with conventional plasma exchange for a total of 57 times.The biochemical indicators,coagulation parameters,and adverse reactions of the two groups were recorded before and after treatment.The changes of serum biochemical indexes and coagulation indexes before and after plasma exchange were compared between the two groups in order to evaluate the clinical efficacy and short-term?3 months?survival rate.The incidence of adverse reactions after plasma exchange therapy in the two groups was compared in order to evaluate the safety of modified plasma exchange.Results1.Comparison of liver function and coagulation function before and after plasma exchange in the experimental group After the plasma exchange in the experimental group,alanine aminotransferase?ALT?,aspartate aminotransferase?AST?,serum total bilirubin?TBiL?,blood ammonia?NH₃?decreased,prothrombin activity?PTA?increased,and the difference was statistically significant?P<0.05?,indicating that improved plasma exchange can improve the liver function and coagulation function in patients with liver failure.Albumin?ALB?increased and the difference was not statistically significant?P>0.05?,which means the modified plasma exchange has no effect on ALB level.2.Comparison of liver function and coagulation function between experimental group and control group before and after treatment There was no statistically significant difference?P>0.05?in alanine aminotransferase?ALT?,aspartate aminotransferase?AST?,serum total bilirubin?TBiL?,blood ammonia?NH₃?,albumin?ALB?and prothrombin activity?PTA?before treatment.And there was no significant difference in plasma dosage during treatment?P>0.05?.After treatment,alanine aminotransferase?ALT?,aspartate aminotransferase?AST?,and serum total bilirubin?TBiL?decreased,and prothrombin activity?PTA?increased,which was considered statistically significant?P<0.05?.The difference in blood ammonia?NH₃?and albumin?ALB?was not statistically significant?P>0.05?,which indicated that the modified plasma exchange could improve the clearance efficiency of ALT,AST and TBiL and significantly improve the PTA of patients when compared with the traditional plasma exchange under the same plasma exchange volume,but had no significant effect on the ALB and NH₃ levels.3.Comparison of MELD score between experimental group and control group before and after treatment There was no significant difference in the MELD score between the experimental group and the control group before the treatment?P>0.05?while after the treatment the difference of MELD score was statistically significant?P=0.001?.It suggested that modified plasma exchange may improve short-term?3 months?survival in patients with hepatic failure,especially in patients with a MELD score in the middle and low level.4.Comparison of incidence of adverse reactions between experimental group and control group There was no statistical significance in the incidence of adverse events between the two groups?P>0.05?,indicating that modified plasma exchange did not increase the incidence of adverse reactions and was worth applying and popularizing.Conclusion1.Modified plasma exchange can improve liver function and coagulation function in patients with liver failure.2.With the same plasma exchange volume,modified plasma exchange can increase the plasma clearance of patients with liver failure and improve the therapeutic effect.3.Modified plasma exchange may increase the short-term?3 months?survival rate of patients with MELD score in the middle or low score.4.Modified plasma exchange therapy does not increase the incidence of adverse reactions.It is worth applying clinically.