Focusing on timing selection and whole-course management of liver transplantation treatment for patients with acute-on-chronic liver failure / 中华肝脏病杂志

Acute-on-chronic liver failure (ACLF) is a clinical syndrome of acute decompensation accompanied by organ failure that occurs on the basis of chronic liver disease and has a high short-term mortality rate. Currently, there are still differences in relation to the definition of ACLF; thus, baseline characteristics and dynamic changes are important bases for clinical decision-making in patients with liver transplantation and others. The basic strategies for treating ACLF currently include internal medicine treatment, artificial liver support systems, and liver transplantation. Multidisciplinary active collaborative management throughout the whole course is of great significance for further improving the survival rate in patients with ACLF.

The predictive value of liver failure-related etiology for clinical outcomes / 中华危重病急救医学

Objective:To assess the predictors of outcomes for different subtypes of liver failure, and the effectiveness of artificial liver support systems in the treatment of liver failure.Methods:The clinical data of 112 patients with hepatitis B virus (HBV)- and non-HBV-related liver failure admitted to the intensive care unit (ICU) of the Fifth People's Hospital of Wuxi were collected from January to December 2020. The relevant etiologies of acute, subacute, acute-on-chronic, subacute-on-chronic, chronic subtype liver failure were analyzed. The efficacies of artificial liver support systems in the treatment of various subtypes of liver failure were also compared. The correlation of various indicators was analyzed by Spearman correlation analysis, the risk factors affecting the prognosis of patients with liver failure were analyzed by multivariate Logistic regression equation, and receiver operator characteristic curve (ROC curve) of subjects was plotted to evaluate the predictive value of each risk factor for the prognosis of patients with liver failure.Results:Among the 112 liver failure patients, 63 were caused by hepatitis B and 49 were caused by non-hepatitis B. The liver failure caused by hepatitis B was 6 times higher than for men than for women, which was higher than that of non-HBV liver failure group (1.33 times). Antithrombin Ⅲ (AT Ⅲ) and total bilirubin (TBil) levels of subacute liver failure were higher than those of pre-liver failure in the HBV liver failure group [AT Ⅲ: (59.33±14.57)% vs. (35.66±20.72)%, TBil (μmol/L): 399.21±112.94 vs. 206.08±126.96, both P < 0.05]. The levels of AT Ⅲ in patients with pre-liver failure and chronic liver failure in the non-HBV liver failure group were significantly higher than those with acute liver failure [(58.33±15.28%), (44.00±19.10)% vs. (31.33±7.57)%, both P < 0.05], patients with acute liver failure had significantly lower level of TBil than pre-liver failure (μmol/L: 107.83±49.73 vs. 286.20±128.92, P < 0.05), the TBil levels in patients with subacute and acute-on-chronic liver failure were also significantly higher than that in pre-liver failure group (μmol/L: 417.27±118.60, 373.00±187.00 vs. 286.20±128.92, both P < 0.05). Patients with subacute liver failure, subacute-on-chronic liver failure and chronic liver failure in the non-HBV failure group were significantly longer than those in acute liver failure (days: 36.00±8.31, 27.52±11.71, 27.72±22.71 vs. 11.00±1.41, all P < 0.05). There was no statistically significant difference in the case fatality rate of using the artificial liver support system between the HBV failure group and the non-HBV failure group (55.6% vs. 50.0%, P < 0.05), the levels of AT Ⅲ in the two groups of surviving patients were significantly higher than that of the dead [HBV liver failure group: (36.20±6.26)% vs. (27.33±8.87)%, non-HBV liver failure group: (41.06±4.16)% vs. (28.71±12.35)%, both P < 0.01]. Correlation analysis showed that there was a clear positive correlation between AT Ⅲ and TBil in the dead patients of HBV liver failure group and the survival and death patients of non-HBV liver failure group ( r values were 0.069, 0.341, 0.064, and P values were 0.723, 1.196 and 0.761, respectively); there was a significant inverse correlation between AT Ⅲ and TBil in the HBV liver failure group ( r = -0.105, P = 0.745). Multivariate Logistic regression analysis showed that AT Ⅲ was an independent risk factor affecting the prognosis of patients with non-HBV liver failure [odd ratio ( OR) = 1.023, 95% confidence interval (95% CI) was -0.001 to 0.001, P = 0.007]. TBil was an independent risk factor affecting prognosis of patients with HBV liver failure ( OR = 1.005, 95% CI was -0.002 to -7.543, P = 0.033). The analysis of ROC curve showed that AT Ⅲ had a predictive value for the prognosis of patients with non-HBV liver failure, the area under the ROC curve (AUC) = 0.747, the 95% CI was 0.592-0.902, P = 0.009. When the optimal truncation value was 39.5%, its sensitivity and specificity were 83.33% and 56.25%, respectively. Conclusions:Artificial liver support system treatment of liver failure was difficult to effectively reduce the mortality of patients with end-stage liver failure. In addition to AT Ⅲ, TBil also could be used as an indicator to assess liver compensatency and predict prognosis in liver failure patients.

Model selection and curative effect judgment criteria for artificial liver in the treatment of liver failure / 中华肝脏病杂志

Artificial liver is one of the effective methods to treat liver failure. Patients with liver failure are critically ill and have great individualized differences. Therefore, the specific program for the treatment of liver failure with artificial liver should be individualized. The commonly used non-biological artificial liver models include simple plasmapheresis, double filtration plasmapheresis, plasma filtration with dialysis, double plasma molecular adsorption system, molecular absorbent recirculating system, hemodiafiltration, continuous venovenous hemodiafiltration, hybrid, etc. The curative effect should be properly judged from patient's symptoms, laboratory test indicators, survival rate and other aspects after artificial liver therapy.

Effect of artificial liver with double plasma molecular absorb system model on patients' platelets and corresponding treatment strategy / 北京大学学报(医学版)

OBJECTIVE@#To compare the effects of artificial liver treatment with double plasma molecular adsorption system(DPMAS) mode and traditional plasma exchange (PE) mode on platelets in patients, and to evaluate the clinical efficacy of recombinent human thrombopoietin (rhTPO) in the treatment of thrombocytopenia.@*METHODS@#A total of fifteen patients undergoing artificial liver with DPMAS model admitted to the Fifth Affiliated Hospital of Guangzhou Medical University from January 2018 to November 2020 were selected and included in the DPMAS group, and another 15 patients receiving PE were selected and included in the PE group. The improvement of clinical symptoms, such as fatigue, jaundice, oliguria, edema, etc. before and after artificial liver treatment was compared between the two groups, and the trend of blood routine (especially platelet), coagulation function and other indexes before and after treatment were compared between the two groups. The use of rhTPO and the number of platelets were recorded during treatment.@*RESULTS@#The improvement rate of clinical symptoms in DPMAS group was 86.67%, which was higher than that in PE group, but the difference was not statistically significant (P>0.05). There was no statistical significance in the outcome of the two groups within 90 days (P>0.05). There was no significant difference in white blood cell (WBC) and hemoglobin (HB) between the two groups after treatment (P>0.05). However, the level of platelet(PLT) in DPMAS group was significantly lower than that before treatment (P < 0.05), and was significantly lower than that in PE group (P < 0.05). After treatment, the international normalized ratio (INR) level in PE group was significantly improved (P < 0.05), but there was no significant difference in the INR level in DPMAS group (P>0.05). The patients in the DPMAS group received an average of (8.2±3.1) doses of rhTPO and (1.5±0.3) IU of platelet transfusions during hospitalization. In DMPAS group, platelets increased significantly after infusion of terbium.@*CONCLUSION@#Compared with PE mode, the artificial liver with DPMAS mode can reduce platelet levels in patients, but the application of rhTPO can stimulate platelet regeneration and increase platelet levels in the patients, thereby reducing the risk of bleeding due to platelet hypoplasia.

Research progress on influencing factors of nursing quality control in artificial liver treatment / 中国实用护理杂志

Nursing plays an irreplaceable role in the process of artificial liver treatment. Giving standardized nursing operation, timely finding and correctly handling the problems in the course of treatment are the key to the success of the treatment. Based on the theory of three-dimensional quality structure, this paper summarizes the influencing factors of nursing quality control in the process of artificial liver treatment, in order to improve nursing quality, control the incidence of adverse events of nursing, and ensure the safety of patients′ lives.

Value of serum alpha-fetoprotein for the prognostic evaluation of hepatitis B virus-related acute-on-chronic liver failure treated with artificial liver / 中华肝脏病杂志

Objective@#To investigate the value of alpha-fetoprotein (AFP) level on survived hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients treated with artificial liver.@*Methods@#Clinical indicators of HBV-ACLF patients who were previously treated with plasma exchange-based artificial liver at our department were retrospectively collected. The difference of serum AFP level between the survival and the death group was compared at 30, 90 and 180 days after artificial liver treatment. The ROC curves of the subjects were plotted, and the sensitivity and specificity of AFP for the survival prediction of the patients at 30, 90 and 180 days after artificial liver surgery were calculated. AFP was divided into a high AFP group and a low AFP group using median value. AFP and postoperative survival predictive value at 30, 90, and 180 days were analyzed.@*Results@#A total of 93 cases were included in this study. The AFP of the survival group at 30, 90, and 180 days was (231.0 ± 286.2) ng / ml, (237.69 ± 297) ng / ml, (229.44 ± 286.46) ng/ml, and the death group was (76.4 ± 104.7) ng/ml, (103.13 ± 116.99) ng / ml, (136.34 ± 2.9.29) ng/ml, respectively. AFP of the death group was significantly lower than the corresponding survival group (P < 0.05). Receiver operating characteristic (ROC) curve analyses indicated that the area under the curve (AUC) and its 95% confidence interval at 30, 90, and 180 days after artificial liver surgery were 0.739 (0.611 ~ 0.867), 0.675 (0.550 ~ 0.80), 0.653 (0.524 ~ 0.781), respectively. The median serum AFP value was 110 ng/ml, and the survival analysis showed that the survival time of the high AFP group was significantly higher than the low AFP group at 30 d (P = 0.01), 90 d (P = 0.04) and 180 d (P = 0.03) after artificial liver surgery.@*Conclusion@#Serum AFP can be used as a predictor of survival for HBV-ACLF patients after artificial liver therapy and its clinical value needs to be further verified by the larger sample size.

Guideline for diagnosis and treatment of liver failure / 中华肝脏病杂志

Liver failure is a familiar clinical severe liver disease syndrome with a very high mortality rate. Over the years, scholars from around the world have been exploring the definition, etiology, classification, types, diagnosis and treatment, and prognostic judgment of liver failure. Reflecting changes, that have transpired in recent years at home and abroad relevant to clinical evidence, this guideline updates the information previously published by the Chinese Society of Infectious Diseases, Chinese Medical Association, Liver Failure and Artificial Liver Group, Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Guidelines for Diagnosis and Treatment of Liver Failure (2012 Edition).

Guideline for diagnosis and treatment of liver failure / 中华肝脏病杂志

Liver failure is a familiar clinical severe liver disease syndrome with a very high mortality rate. Over the years, scholars from around the world have been exploring the definition, etiology, classification, types, diagnosis and treatment, and prognostic judgment of liver failure. Reflecting changes, that have transpired in recent years at home and abroad relevant to clinical evidence, this guideline updates the information previously published by the Chinese Society of Infectious Diseases, Chinese Medical Association, Liver Failure and Artificial Liver Group, Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Guidelines for Diagnosis and Treatment of Liver Failure (2012 Edition).

Observation on efficacy of artificial liver plasma bilirubin adsorption for treatment of patients with severe hepatitis B / 中国中西医结合急救杂志

Objective To observe the clinical efficacy of artificial liver plasma bilirubin adsorption for treatment of patients with severe viral hepatitis B (HBV). Methods A retrospective study was conducted, the 120 patients with severe HBV B and their historical data of having undergone treatment of artificial liver plasma bilirubin adsorption admitted to Department of Respiration of Mianyang Central Hospital from August 2015 to August 2017 were collected, and there were 68 cases in the cirrhotic group and 52 cases in the non-cirrhotic group. The indexes of liver function and coagulation function before and after the treatment of artificial liver plasma bilirubin adsorption were collected; the differences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamine transferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein (TP), albumin (Alb), globulin (Glo), prothrombin time (PT), prothrombin activity (PTA), total bilirubin (TBil) and indirect bilirubin (IBil), total bile acid (TBA), etc were compared between cirrhotic group and the severe hepatitis B non-cirrhotic group. Results The levels of ALT, AST, ALP, LDH after artificial liver plasma bilirubin adsorption therapy were lower than those before the treatment [ALT (U/L): 138.8±26.2 vs. 993.4±185.2, AST (U/L): 121.7±119.9 vs. 798.7±226.8, ALP (U/L): 129.7±8.1 vs. 178.9±14.1, LDH (μmol·L-1·s-1·L-1): 4.50±0.32 vs. 8.15 ±1.75, all P < 0.05], PTA was higher than that before the treatment [(43.2±25.6)% vs. (30.0±16.1)%, P < 0.05]. After the treatment, the decline rate of ALP, TBil, and TBA of non-cirrhotic group was higher than those in cirrhotic group (ALP: 34.20% vs. 17.80%, TBil: 39.10% vs. 18.10%, TBA:30.70% vs. 5.00%, P < 0.05), the elevation rate of PTA in non-cirrhotic group was also higher than that in cirrhotic group (52.50% vs. 25.10%, P < 0.05). Conclusion Artificial liver plasma bilirubin adsorption therapy is effective for treatment of patients with severe HBV B, particularly the effect being good on the early severe viral HBV B non-cirrhotic group.

Diagnosis and treatment of tumor-associated acute liver failure in children / 中国小儿急救医学

Liver is the most common location for hematogenous spread of solid tumors. Clinically acute hepatic failure ( ALF) secondary to either a solid organ tumor or a hematologic malignancy is rare,but with a poor prognosis and high mortality. The time between the onset of symptoms and ALF was relatively rapid. Malignancy is one of the causes of pediatric acute liver failure (PALF). Common clinical symptoms were jaundice,haemorrhage,and hepatic encephalopathy. It is lack of specific clinical features and difficult to diagnose in early phase. Delayed diagnosis and treatment contribute to poor prognosis. How to combine the treatment of primary tumors and liver protection is critical issue to clinician. The effective therapy for patients with PALF is liver transplantation. In recent years,the development of artificial liver support is to provide a facilitating recovery chance and to prolong the window of opportunity for liver transplantation.

Effect and safety of plasma exchange combined with plasma bilirubin absorption in the treatment of liver failure associated with hepatitis B virus / 新乡医学院学报

Objective To investigate the clinical effect of plasma exchange(PE)combined with plasma bilirubin ad-sorption(PBA)in the treatment of liver failure associated with hepatitis B virus(HBV). Methods A total of 75 patients with HBV related liver failure were selected from May 2014 to May 2016 in the People's Hospital of Guangxi Zhuang Autonomous Region. The patients were divided into PE group,PBA group and PE combined PBA(PE + PBA)group according to their will, 25 cases in each group. The levels of serum alanine aminotransferase(ALT),total bilirubin(TBIL),albumin(ALB),prothrom-bin time(PT),prothrombin activity(PTA),serum creatinine(SCr)and blood ammonia were compared among the three groups before and after treatment,and the adverse reactions were observed. Results There was no significant difference in serum ALT,TBIL,ALB and SCr levels among the three groups before treatment(P > 0. 05). The levels of serum ALT,TBIL and SCr after treatment were significantly lower than those before treatment in the three groups(P < 0. 05). The level of serum ALB af-ter treatment was significantly higher than that before treatment in the PE group and the PE + PBA group(P < 0. 05),but the level of serum ALB after treatment was significantly lower than that before treatment in the PBA group (P < 0. 05). There was no significant difference in serum ALT,TBIL and SCr levels among the three groups after treatment(P > 0. 05). The serum ALB levels in the PE group and the PE + PBA group was significantly higher than that in the PBA group after treatment(P <0. 05). There was no significant difference in serum ALB level between the PE group and the PE + PBA group after treatment (P > 0. 05). There was no significant difference in the PT,PTA and blood ammonia level among the three groups before treat-ment(P > 0. 05). Compared with before treatment,the PT shortened significantly after treatment,the PTA increased significant-ly,and the blood ammonia level decreased significantly in the three groups(P < 0. 05). Compared with the PBA group,the PT shortened significantly,the PTA increased significantly,and the blood ammonia level decreased significantly in the PE group and the PE + PBA group after treatment(P < 0. 05). There was no significant difference in PT,PTA and blood ammonia level between the PE group and the PE + PBA group after treatment(P > 0. 05). The plasma consumption of patients in the PE group and the PE + PBA group was(2908. 11 ± 287. 91)and(1107. 24 ± 213. 67)mL respectively,the plasma consumption in the PE + PBA group was significantly less than that in the PE group(t = 23. 782,P < 0. 05). The treatment time of patients in the PE group,the PBA group and the PE + PBA group was(2. 90 ± 0. 87),(3. 02 ± 0. 77),(3. 22 ± 0. 69)h respectively;there was no significant difference in the treatment time among the three groups(F = 1. 881,P > 0. 05). The total effective rate in the PE group,the PBA group and the PE + PBA group was 64. 0％(16 / 25),56. 0％(14 / 25),64. 0％(16 / 25),respectively;there was no significant difference in the total effective rate among the three groups(χ2 = 7. 281,P > 0. 05). The incidence of eryth-ra,chill and rigor,numbness and convulsion,infection and errhysis in the PE group was 32. 0％(8 / 25),28. 0％(7 / 25), 16. 0％(4 / 25),8. 0％(2 / 25),8. 0％(2 / 25),respectively. The incidence of erythra,chill and rigor,numbness and convul-sion,infection and errhysis in the PBA group was 16. 0％(4 / 25),16. 0％(4 / 25),12. 0％(3 / 25),4. 0％(1 / 25),4. 0％(1 /25),respectively. The incidence of erythra,chill and rigor,numbness and convulsion,infection and errhysis in the PE + PBA group was 20. 0％(5 / 25),20. 0％(5 / 25),12. 0％(3 / 25),4. 0％(1 / 25)and 4. 0％(1 / 25),respectively. The incidence of erythra,chill and rigor,numbness and convulsion,infection and errhysis in the PBA group and the PE + PBA group was signifi-cantly lower than that in the PE group(P < 0. 05). There was no significant difference in the incidence of erythra,chill and rig-or,numbness and convulsion,infection and errhysis between the PBA group and the PE + PBA group(P > 0. 05). Conclusion PE combined with PBA is effective,safe and feasible in the treatment of HBV related liver failure,and it can reduce plasma consumption.

The whole series of artificial liver support system for the treatment of acute fatty liver in pregnancy: a case report / 中国实用护理杂志

Objective To conclude nursing experience of full series artificial liver support system in the treatment of acute fatty liver in pregnancy. Methods Development of artificial liver support system according to patient's condition, total continuous renal replacement therapy 7days, double plasma molecular absorb system 3 times, plasma replacement 3 times, molecular adsorbent circulation system 2 times. Results After treatment, the patient was discharged after 20 days in hospital. Conclusions The full range of artificial liver support system can effectively treat the patients with acute fatty liver in pregnancy, it will greatly reduce the mortality of patients with acute fatty liver in pregnancy.

The clinical therapeutic effect and nursing experience of using artificial liver bilirubin specific adsorption for treatment of patients with hyperbilirubinemia / 中国中西医结合急救杂志

Objective To observe the curative effect of using artificial liver bilirubin specific adsorption for treatment of patients with hyperbilirubinemia and its effect on nursing.Methods A prospective study was conducted, 146 patients with hyperbilirubinemia admitted to Mianyang Central Hospital from January 2015 to December 2016 were enrolled, and they were divided into an observation group (77 cases) and a control group (69 cases) according to random number table method. The observation group was treated by medical treatment and the artificial specific liver bilirubin adsorption, while the control group only treated by medical therapy. The changes of levels of liver function indexes alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil) before and after treatment and clinical curative effect were observed in the two groups.Results Before treatment, there were no statistical significant differences in levels of the ALT, AST, TBil, DBil between the two groups (allP > 0.05), after treatment, the above indexes were significantly decreased compared to those before treatment, and the degrees of decrease in observation group were more obvious than those in control group [ALT (U/L): 341±42 vs. 455±37, AST (U/L): 120±35 vs. 197±37, TBil (μmol/L): 185.4±20.6 vs. 302.6±30.6, DBil (μmol/L): 42.6±10.8 vs. 87.5±11.6, allP < 0.05]. The total effective rate in observation group was obviously higher than that of control group [62.3% (48/77) vs. 40.6% (28/69),P < 0.05].Conclusions Based on liver protection, symptomatic and supportive medical treatment, using artificial liver bilirubin specific adsorption for treatment of patients with hyperbilirubinemia is safe and effective, and in addition, close observation and careful nursing is beneficial to the reduction of incidence of complications and elevation of therapeutic efficiency.

Clinical selection of individualizd artificial liver support / 中华临床感染病杂志

Liver failure is characterized by hepatic encephalopathy, jaundice, hypo-coagulation and high mortality.Artificial liver support aims to temporarily replace hepatic function until liver function recover or bridge to liver transplantation.Individualized artificial liver support should be balanced and cover the following aspects: removing albumin bound toxins and/or water soluble toxins, eliminating inflammatory mediators and correcting blood coagulation disorders, in order to support metabolism and modulate immune function and to promote the regeneration of hepatocyte and reverse multiple organ failure that may lead to death of patients.Traditional non-biological artificial liver support can't meet individualized treatment.Recently developed hybrid blood purification model, such as albumin dialysis, fractionated plasma separation and adsorption (Prometheus system) and plasma diafiltration (PDF) have provided more and better choices for individualized artificial liver support.Based on the characteristics of pathophysiology and organ dysfunction of liver failure, the author has designed an alignment diagram of individualized artificial liver support for clinical selection.

Research progress on artificial liver support systems / 中华临床感染病杂志

Artificial liver support system (ALSS),as a means of bridging patients with liver failure to transplantation,has been widely used at home and abroad.However,clinical trails show that different ALSS may have different therapeutic effects.This review briefly introduces the widely-used non-biological liver support technologies and extensively-studied biological liver support technologies,and tries to give an overview on their impact on biochemical markers and survival.

Extracorporeal Liver Support with Less Fresh Frozen Plasma for Treatment of Acute-on-chronic Liver Failure / 华中科技大学学报(医学版)

Objective To observe the efficacy of extracorporeal liver support by using less fresh frozen plasma in the treat‐ment of acute‐on‐chronic liver failure.Methods A total of 45 patients with acute‐on‐chronic liver failure were divided into ob‐servation group[plasma perfusion(PP) with a small amount of plasma+ plasma exchange(PE)] ,control group 1(PE) ,control group 2(PP+PE)in terms of the amount of plasma used on the day of treatment. All the patients received artificial liver treatnts 62 times totally.Results The clinical symptoms were improved in the three groups after treatments.There were significant differences in the decrease of alanine transaminase (ALT) ,aspartate transaminase(AST) and direct bilirubin(DBil)rather than the decrease of total bilirubin(TBil)and blood ammonia among the groups.No significant difference was noted in the liver and kidney function among the three groups. The improvement of the coagulation function was poor in the observation group when compared with the control group 1 and control group 2 and there were significant differences.Conclusion During the short sup‐ply of the plasma ,plasma perfusion combined with small amount of plasma can be considered to be used in artificial liver treat‐ments ,which can effectively decrease the level of TBil ,relieve symptoms and decrease the occurrence of complications.

Combined use of non-biological artificial liver treatments for patients with acute liver failure complicated by multiple organ dysfunction syndrome / 世界急诊医学杂志（英文）

BACKGROUND: Acute liver failure (ALF) caused by viral and non-viral hepatitis is often accompanied with severe metabolic disorders, the accumulation of toxic substances and continuous release and accumulation of a large number of endogenous toxins and inflammatory mediators. The present study aimed to investigate the effects of various combined non-biological artificial liver treatments for patients with acute liver failure (ALF) complicated by multiple organ dysfunction syndrome (MODS). METHODS: Thirty-one patients with mid- or late-stage liver failure complicated by MODS (score 4) were randomly divided into three treatment groups: plasmapheresis (PE) combined with hemoperfusion (HP) and continuous venovenous hemodiafiltration (CVVHDF), PE+CVVHDF, and HP+CVVHDF, respectively. Heart rate (HR) before and after treatment, mean arterial pressure (MAP), respiratory index (PaO2/FiO2), hepatic function, platelet count, and blood coagulation were determined. RESULTS: Signifi cant improvement was observed in HR, MAP, PaO2/FiO2, total bilirubin (TBIL) and alanine aminotransferase (ALT) levels after treatment (P<0.05). TBIL and ALT decreased more signifi cantly after treatment in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.01). Prothrombin time (PT) and albumin were signifi cantly improved only in the PE+CVVHDF and PE+HP+CVVHDF groups (P<0.05). TBIL decreased more significantly in the PE+HP+CVVHDF group than in the HP+CVVHDF and PE+CVVHDF groups (P<0.05). The survival rate of the patients was 58.1％ (18/31), viral survival rate 36.4％ (4/11), and non-viral survival rate 70％ (14/20). CONCLUSION: Liver function was relatively improved after treatment, but PE+HP+CVVHDF was more efficient for the removal of toxic metabolites, especially bilirubin. The survival rate was significantly higher in the patients with non-viral liver failure than in those with viral liver failure.

Clinical application of plasma exchange combined with continuous veno-venous hemodialysis/filtration in treatment of children with acute liver failure / 国际儿科学杂志

Acute liver failure is a pediatric clinical critical disease with complex etiology,rapid progress and medical treatment,contributing to a high fatality rate. Artificial liver support system can remove a variety of toxic substances through mechanical,physicochemical or biological device to replace part of liver function like metabolism,detoxification,or synthesis temporarily to win precious time for liver cell regeneration and further clinical therapy,which has become an important treatment of acute liver failure at present. Considered the limita-tions of different blood purification mode,combined mode of blood purification is mostly applied in clinical ther-apy. This article aims to review the effect of plasma exchange combined with continuous veno-venous hemodial-ysis/filtration for the treatment of children with acute liver failure.

Nursing care of critically ill patients infected by H7N9 avian influenza / 中国实用护理杂志

Objective This research summarized the nursing experience of critically ill patients infected by H7N9 avian influenza who were treated with extracorporeal membrane oxygenation (ECMO) and artificial liver device.Methods 10 critically ill patients infected by H7N9 avian influenza were selected,during treatment of ECMO combined with artificial liver device,nursing care such as careful observation of the changes of symptoms,strict disinfection and protection,contact isolation,symptomatic treatment to fever,correct management of airway and ventilator circle,pipeline nursing of ECMO and artificial liver device,mental nursing,symptomatic and support therapy which included antivirus,anti-hypoxia and anti multiple organ failure,anti-shock,anti-infection,microecological balance maintenance and water-electrolyte balance maintenance.Results 4 critically ill patients infected by H7N9 avian influenza improved and removed ECMO and artificial liver device,among whom one patient rehabilitated and was discharged.Another 6 patients were in a steady state.Conclusions For critically ill patients infected by H7N9 avian influenza,comprehensive and elaborate care can facilitate early recovery of patients.

Current status and prospect of artificial liver support system / 中华消化外科杂志

Liver transplantation is the best treatment for end-stage liver disease.Because of the severe shortage of donor sources,most of the patients died while waiting for liver grafts.Artificial liver support system can improve the liver function in a short time,and help patients to pass the waiting periods.Artificial liver support system takes place of composition,detoxification and metabolism function of liver,stabilizes the physiological and biochemical index of liver,relieves the burden of liver and helps patients to prepare for the liver transplantation.With the wide application of artificial liver support system,new types of the artificial liver support systems gradually conquered the defects of the old types,but they still have their own defects.This review concludes the merits and demerits of artificial liver systems,its clinical application and the problems so as to help the treatment of end-stage liver disease.