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《Chinese Journal of Critical Care Medicine》 2003-01
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Treatment of plasma exchange plus continuous hemofiltration for acute liver failure

ZHAO Wei-feng,GAN Jian-he,LIANG Feng, et al.Infectious Department of the First Affiliated Hospital,Suzhou University,Suzhou 215006,China  
Objective To evaluate clinically the efficacy and to investigate therapeutic mechanisms of plasma exchange(PE) plus continuous hemofiltration on patients with acute liver failure.Method 11 patients with acute liver failure were treated with plasma exchange and CVVH.Various biochemical parameters and serum endotoxin,TNF-α and IL-6 were determined before and after the treatment.Results All the patients tolerated the treatment of plasma exchange and CVVH. The average duration was 3.1 days.All the patients with hepatic coma improved in the level of encephalopathy.8 patients regained normal consciousness.SIRS components decreased significantly (pre-PE+CVVH 2.33 vs post-PE+CVVH 1.56 , P 0 05).So did the numbers of organ failure (pre-PE+CVVH 2.73 vs post-PE+CVVH 1.36 , P 0 05).The survival rate of patients was 45.45%(5/11).The pathological study of liver indicated that the combined therapeutics could prevent hepatocyte necrosis.It showed that Bil-T,TBA,ET,TNF-α,IL-6 of all patients were decreased but their PTA was increased significantly following PE.TNF-α,IL-6,serum amino, BUN and Cr were lower but Bil-T,TBA,ET had no significant differences after CVVH( P 0 05).Conclusion These results indicated that plasma exchange and CVVH were an effective mothod for removing serum endotoxin and inflammatory cytokines, preventing hepatocyte necrosis and improving hepatic and renal function. It might be of clinical benefit to the prognosis of patients with acute liver failure in early stage.
【CateGory Index】: R575.3
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