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Objective:To investigate the efficacy and safety of plasma exchange (PE) combined with plasma perfusion (PP) in treatment of liver failure and the influence on inflammatory factors and liver function.Methods:98 patients with liver failure in our hospital from February 2014 to February 2016 were selected as the subjectswere,and they were randomly divided into experimental group and control group,and each group was 49 cases.The experimental group was treated with PE combined with PP,and the control group was received PE alone.The liver function before and after treatment was detected by automatic biochemical analyzer.The serum levels of C-reactive protein (CRP),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA).The total effective rate,the incidence of side effects,the levels of liver function and inflammatory factors before and after treatment were compared between the two groups.Results:The clinical effective rate in the experimental group (91.84％) was significantly higher than that in the control group (73.47％),the difference was statistically significant (P＜0.05).The incidence of adverse reactions in the experimental group (10.20％) was significantly lower than that in the control group (38.78％),the difference was statistically significant (P＜0.05).The levels of serum alanine aminotransferase (ALT),total bilirubin (TBIL) and blood ammonia (NH3) were significantly decreased in both groups after treatment (all P＜0.05).Albumin (ALB) and thrombin activity (PTA) were significantly increased in both groups after treatment (both P＜0.05).After treatment,the serum levels of ALT,TBIL and NH3 in the experimental group were lower than those in the control group (all P＜0.05),the levels of ALB and PTA were higher than those of the control group,the difference was statistically significant (both P＜0.05).After treatment,the serum levels ofCRP,TNF-α and IL-6 were lower than those before treatment,and the serum levels of CRP,TNF-α and IL-6 in the experimental group were lower than those in the control group (all P＜0.05).Conclusion:The combination of plasma exchange and plasma perfusion has a good effect in the treatment of liver failure,and the incidence of adverse reactions is low.It can effectively remove inflammatory factors,improve liver function and improve the quality of life of patients.
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Objective To observe the curative effect of plasma perfusion (PP) combined with continuous veno-venous hemofiltration (CVVH) on different degrees of paraquat poisoning induced acute lung injury (ALI), and assess its clinical value for treatment of paraquat poisoning. Methods Data of 197 patients with paraquat poisoning hospitalized in our hospital from June 2013 to April 2017 were retrospectively analysed, including 128 cases with mild-to-moderate poisoning (5 mg·h/L≤SIPP≤25 mg·h/L) and 69 cases with severe poisoning (25 mg·h/L<SIPP≤50 mg·h/L). Patients were divided into treatment group and control group according to the treatment of PP and CVVH. The incidence rate and time of irreversible lung injury were compared between the two groups of patients. Results (1) In patients with mild-to-moderate poisoning, the incidence rate of lung injury was significantly lower in treatment group than that of control group (P<0.05). In patients with severe poisoning there was no significant difference in the incidence rate of lung injury between two groups ( P>0.05). (2) There was no significant difference in the occurrence time of irreversible lung injury between two groups of patients with different degrees of poisoning (P>0.05). (3) The blood toxicant concentration of 4.35 mg·h/L and SIPP value 19.35 mg·h/L were used as a critical indicator of prognosis in treatment group. Conclusion Plasma perfusion combined with continuous veno-venous hemofiltration can obviously reduce the incidence of paraquat poisoning of lung injury in mild-to-moderate patients, but which has no obvious influence on the occurrence time.
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The high mortality of paraquat (PQ) poisonings is mainly due to the lack of effective treatments. Most toxicologists recommend rapid initiation of charcoal haemoperfusion (CHP) to lower plasma PQ levels and to limit pulmonary and other organs uptake of PQ. Although there are considerable evidences of CHP efficacy in the reversion of the fatal outcome resulting from PQ poisonings, the usefulness of this therapy has been the subject of significant controversy with several evidences published in the literature showing a lack of clinical benefit in numerous cases. Considering that the blood concentration at a given time is directly related to clinical outcome, the rebound in plasma paraquat concentration after haemoperfusion may be partly relate to the poor clinical benefit, but may indicate the necessity for prolonged haemoperfusion. Continuous rather than intermittent haemoperfusion has been advocated for treatment of paraquat poisoning. However, 24h daily conventional pump driven haemoperfusion is usually impossible to carry out due to bleeding complications. Plasmapheresis is also a blood purification process. Unselective therapeutic plasma exchange is the first technology used for therapeutic apheresis (TA). However, limited efficacy by restricted plasma volume that can be exchanged in a single session is one of the severe limitations. To further increase the clearance of target molecules, plasma perfusion (PP) techniques was developed. modification of the conventional plasma perfusion in patients with paraquat poisoning has been reported and plasma levels of paraquat were reduced effectively.
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The high mortality of paraquat (PQ) poisonings is mainly due to the lack of effective treatments. The optimal method of extracorporeal removal of paraquat is often a matter of debate. Due to the lack of well-designed studies, we are often left with circumstantial evidence, and we must exercise our best clinical judgment as to whether extracorporeal paraquat removal is beneficial and if so, by what method. It is clear, however, that rapidity in paraquat removal is beneficial. Due to the urgent nature of treatment for paraquat poisoning, there may never be well-designed evidence-based studies to help guide us. In the meantime, we must continue to use less than ideal evidence and our own experience to guide our decision-making process. Most toxicologists recommend rapid initiation of charcoal haemoperfusion (CHP) to lower plasma PQ levels and to limit pulmonary and other organs uptake of PQ.
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Objective To study the therapeutic effect of plasma exchange and plasma perfusion(PE+PP)on acute fatty liver of pregnancy.Methods Twenty-one patients with acute fatty liver of pregnancy were divided into two groups.In the treated group,the patients were treated with (PE+PP) on the basis of the conventional therapy,and the control group received the conventional therapy only?Liver function,kidney function and prothrombin activity(PTA) before treatment and 4 weeks,6 weeks after treatment were observed.Results After treatment with (PE+PA),the liver function,kidney function and PTA were ameliorated at 4 weeks and 6 weeks(P
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Objective To evaluate the abilities of plasma perfusion and plasma exchange to remove blood endotoxin and cytokines from hepatic failure patients. Methods Plasma perfusion and plasma exchange were performed on 7 cases and 10 cases for the treatment of chronic severe hepatitis, respectively. Changes of blood endotoxin and cytokines before and after treatment were analyzed. Results The levels of cytokines and endotoxin in patient blood decreased greatly, but bilirubin decreased slightly after treatment with plasma perfusion. The changes of interleukin 6 were very limited. Compared with plasma perfusion, the removal of bilirubin was higher but that of cytokines was lower after plasma exchange. Conclusion Plasma perfusion can remove cytokines with high efficiency and retard the development of hepatic failure.