Assessment of curative effect of sequential type artificial liver with regional citrate anticoagulation in patients with hepatic failure at high risk of bleeding / 中国基层医药

ABSTRACT

Objective To assess the efficacy and safety of sequential type artificial liver with regional citrate anticoagulation in patients with hepatic failure at high risk of bleeding.Methods Fifteen patients with hepatic failure at high risk of bleeding treated with plasma exchange(PE)plus continuous veno -venous hemofiltration (CVVH)for 4h anticoagulation selected anticoagulant citrate dextrose solution A (ACD -A),blood flow velocity was setted to 100 -120mL/min.In the former,ACD -A solution was delivered pre -filter,with the rate adjusted to maintain a postfilter ionized calcium (iCa2 +)level between 0.35 -0.45mmol/L.Before the extracorporeal blood returned to the patients, 10% calcium gluconate was infused to maintain a systemic iCa2 + level between 0.90 -1.20mmol/L.Hypoxemia and hypocalcemia were correctted before treatment.Acid -base changes,serum sodium,total calcium -ionized calcium ratio were recorded at 2h,4h and 6h during the treatment.Effective therapeutic time (the therapy was completed successfully)also was recorded.Results The total 38 sessions were performed,effective performance was 35 sessions. 3 sessions were stopped because of high transmembrane pressure.Acid -base change,serum sodium had no significant changes.Serum iCa2 + concentration was detected 110 times,16 times were below 0.9mmol/L,the lowest concentration was 0.62mmol/L.Convulsion of the limbs appeared two times because of hypocalcemia.The total calcium -ionized calcium ratio above 2.5 appeared totally 6 times.The events improved after augmented substitution fluid.All events presented in advanced hepatic failure.Conclusion Under closely monitoring and application of preventive measures, regional citrate anticoagulation sequential type artificial liver is safe and efective for patients with hepatic failure at high risk of bleeding.The application in patients with advanced hepatic failure still is cautious.