PE CVVH PE+HP HP+CVVH HP+CVVH+PE CVVH. ENLAV of HCO - 3 ENLAV-HCO ± μmol /L HP+PE HP+CVVH HP+CVVH+PE

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1 plasma exchange PE hemoperfusion HP continuous venovenous hemofiltration CVVH 54 PE CVVH PE+HP HP+CVVH HP+CVVH+PE 183 exceed normal limit absolute value ENLAV prothrombin time PT PE total bilirubin TBi 204.9±82.8 μmol /L 357.0±133.7 μmol /L P< 0.01 direct bilirubin DBi 124.6± 60.4 μmol /L 227.4±106.7 μmol /L P<0.01 PT 17.6± ±11.3 P<0.01 creatine Cr 95.4±74.1 μmol /L 85.8±76.6 μmol /L P<0.01 ENLAV of Cl - ENLAV-Cl ±5.46 μmol /L 2.27±3.45 μmol /L CVVH TBi 252.2±152.0 μmol /L 232.1±149.6 μmol /L P<0.01 DBi 162.0±101.7 μmol /L 151.4±104.9 μmol /L P<0.01 blood urea nitrogen BuN 11.8±6.9 mmol /L 15.7±12.2 mmol /L P<0.01 Cr 119.0±74.1 μmol /L 163.9±139.6 μmol /L P<0.01 ENLAV of K + ENLAV-K ±0.10 μmol /L 0.14± 0.36 μmol /L P< 0.05 ENLAV of Na + ENLAV-Na ±1.93 μmol /L 3.66±5.78 μmol /L P<0.01 ENLAV-Cl ±1.87 μmol /L 2.50±4.62 μmol /L P< ENLAV of HCO - 3 ENLAV-HCO ± μmol /L 1.60±2.90 μmol /L P<0.05 HP+CVVH TBi DBi BuN 8.1±5.9 mmol /L 10.5±8.9 mmol /L P<0.01 Cr 82.4±62.0 μmol /L 112.3±108.4 μmol /L P<0.05 PT 36.6± ±15.3 P<0.01 HP +CVVH+PE TBi 283.0±131.4 μmol /L 369.0±145.6 μmol /L P< 0.01 DBi 138.6±96.0 μmol /L 369.0±145.6 μmol /L P<0.01 PE CVVH HP+PE HP+CVVH HP+CVVH+PE HP+CVVH+PE Clinical investigation for treatment of fifty-four patients suffering from liver failure with plasma exchange hemoperfusion and continuous venovenous hemofiltration Ren Jincai Infectious Department the Third People's Hospital Nantong China Abstract Objective To investigate the clinic efficacy of plasma exchange PE hemoperfusion HP and continuous venovenous hemofiltration CVVH and their combinations in treatment of liver failure. To find the best blood purification combinations in treatment of liver failure. Methods The clinical data of 54 patients with liver failure were retrospectively reviewed the patients had been treated with PE CVVH HP+PE HP+CVVH or HP+CVVH+PE besides integrated medicine treatment. The liver and renal function the exceed normal limit absolute value ENLAV blood ammonia prothrombin time PT and the degree of hepatic encephalopathy were compared before and after 183 times of treatment. Results The data after and before treatment were respectively like these. PE serum total bilirubin TBi 204.9±82.8 μmol /L and 357±133.7 μmol /L P< 0.01 direct bilirubin DBi 124.6± 60.4 μmol /L and 227.4± μmol /L P< 0.01 PT 17.6 decline±3.6 seconds and 31.9±11.3 P<0.01 seconds shortened serum creatinine Cr 95.4± 74.1 μmol / L and 85.8±76.6 μmol /L P<0.01 increased blood electrolyte abnormalities of chloride ion ENLAV of Cl absolute value ENLAV-Cl 5.26 ±5.46 μmol /L and 2.27±3.45 μmol /L CVVH TBi 252.2± μmol /L and 232.1±149.6 μmol /L P<0.01 DBi 162.0±101.7 μmol /Land 151.4±104.9 μmol /L P<0.01 increased blood urea nitrogen BuN 11.8±6.9 mmol /L and 15.7±12.2 mmol /L P<

2 2625 Cr 119.0±74.1 μmol /Land 163.9±139.6 μmol /L P<0.01 decreased ENLAV of K + ENLAV-K ± 0.10 μmol /L ± μmol /L P < ENLAV of Na + ENLAV-Na ± μmol /L and 3.66±5.78 μmol /L P < ENLAV-Cl ± μmol /L and ± μmol /L P < ENLAV of HCO - 3 ENLAV-HCO ±1.87 μmol /L 1.60±2.90 μmol /L and P<0.05 decreased HP + CVVH TBi DBi increased BuN 8.1±5.9 mmol /L and 10.5±8.9 mmol /L P<0.01 Cr 82.4±62 μmol /L and 112.3±108.4 μmol /L P<0.05 decreased PT 36.6±19.5 seconds 29.6±15.3 seconds P< HP+CVVH + PE TBi extended 283 ± μmol /L and 369 ± μmol /L P < DBi 138.6±96 μmol /L and 369±145.6 μmol /L P<0.01 decreased all of these are statistically significant. The treatment of simple PE or CVVH patients with hepatic encephalopathy after treatment was more serious than before treatment.there was no aggravation of hepatic encephalopathy after the treatment of HP+PE HP+CVVH HP+CVVH+PE and before treatment. Conclusions HP+CVVH+PE combination treatment is more favourable to remove various toxic substance including macromolecular or protein-bound stustances small middle molecular substances regulate electrolyte acide-base balance and prevents the progress of severe complication of hepatic encephalopathy and hepatorenal syndrome Key words Plasma exchange Hemoperfusion Continuous venovenous hemofiltration Combination treatments Liver failure 2. HP CVVH PE HP CVVH AUUQRIS CRRT HP HA230 HA ~ 200 ml /min 2 CVVH AV ~ 200 ml /min ml /h ~ ml /h 4 000~ ml 0.9% ml+ plasma exchange PE hemoperfusion HP hemofiltration HF MARS 6~ 25 PT MARS 40 s PE PE HP HF plasauto IQ21 EC-40W HP 120 ml /min 25% 2 ~ 3 continuous venovenous hemofiltration CVVH PE ml PT 183 5% 500 ml+ 500 ml+5% 250 ml 10% 30~ 40 ml AU ± exceed normal limit absolute value ENLAV ENLAV = ENLAV = Sysmex CA prothrombin time PT West Haven x±s 珋 t SSPS P< PE TBi 204.9±82.8 μmol /L 357.0± μmol /L P< 0.01 DBi 124.6± 60.4 μmol /L 227.4± μmol /L

3 2626 P<0.01 ALT 188.4± IU /L 479.4± IU /L P<0.01 NH3 47.8± 27.4 μmol /L 63.7± 45.7 μmol /L P<0.05 PT 17.6± ±11.3 P<0.01 CR 95.4±74.1 μmol /L 85.8±76.6 μmol /L P< 0.01 CVVH TBi 252.2±152.0 μmol /L 232.1±149.6 μmol /L P<0.01 DBi 162.0±101.7 μmol /L 151.4±104.9 μmol /L P<0.01 BuN 11.8±6.9 mmol /L 15.7± 12.2 mmol /L P< 0.01 Cr 119.0± 74.1 μmol /L 163.9±139.6 μmol /L P<0.01 ALB 33.4± 1.60± 2.90 mmol /L P< 0.05 HP g /L 32.0±4.4 g /L P<0.01 PE+ CVVH ENLAV-Ca ± mmol /L ± HP TBi 171.1±71.0 μmol /L 336.8±114.6 μmol /L P< 0.01 DBi 112.2±56.0 μmol /L 227.6±99.0 μmol /L P< 0.01 ALT 122.4± IU /L 375.3± IU /L P< 0.01 PT 17.3± ± 11.1 P< 0.01 HP + CVVH BuN 8. 1 ± 5. 9 mmol /L 10.5±8. 9 mmol /L P < Cr ± μmol /L 112.3± μmol /L P < ALB ± 4. 4 g /L 34.4±4.4 g /L P<0.05 GLO 20.0±5.7 g /L 22.8±6.1 g /L P<0.05 PT 36.6± ±15.3 P< 0.01 HP + CVVH + PE TBi ± μmol /L ± μmol /L P < DBi 138.6±96.0 μmol /L 197.1±112.7 μmol /L P< /L P<0.01 PE 100.0±18.1 g /L BuN Cr ALT NH3 PT 124.5±22.6 g /L P< 0.01 PE+HP 93.5± 20.7 g /L 1 2. ENLAV PE ENLAV-Cl ± mmol /L ± 3.45 mmol /L P < PE + HP ENLAV-Cl ± mmol /L 1.27±3.12 mmol /L P<0.01 CVVH ENLAV-K ±0.10 mmol /L 0.14±0.36 mmol / L P<0.05 ENLAV-Na ±1.93 mmol /L 3.66±5.78 mmol /L P<0.01 ENLAV-Cl ±1.87 mmol /L 2.50± 4.62 mmol /L P< 0.01 ENLAV-HCO ± 1.87 mmol /L mmol /L P< West Haven PE CVVH PE+HP HP+CVVH HP+CVVH+PE 3 4. PE 3.16± /L 3.94± /L P< 0.01 PE+HP 3.02± /L 3.85± /L P< 0.01 HP+CVVH 2.97± /L 3.25± /L P<0. 01 HP + CVVH + PE ± /L ± 118.9±22.0 g /L P<0.01 HP+CVVH 91.9±22.3 g /L 1 TBi μmol /L DBi μmol /L BuN mmol /L Cr μmol /L ALT IU /L PE ± ± ± ± ±691.2 PE ± ± ± ± ± CVVH ± ± ± ± ±206.1 CVVH ± ± ± ± ±200.6 PE+HP ± ± ± ± ±405.9 PE+HP ± ± ± ± ± HP+CVVH ± ± ± ± ±457.9 HP+CVVH ± ± ± ± ±375.3 HP+CVVH+PE ± ± ± ± ±353.8 HP+CVVH+PE ± ± ± ± ±177.8 ALB g /L GLO g /L PT s NH3 μmol /L PE ± ± ± ±45.7 PE ± ± ± ± CVVH ± ± ± ±53.6 CVVH ± ± ± ±70.6 PE+HP ± ± ± ±32.7 PE+HP ± ± ± ±22.7 HP+CVVH ± ± ± ±60.6 HP+CVVH ± ± ± ±48.2 HP+CVVH+PE ± ± ± ±48.9 HP+CVVH+PE ± ± ± ± P< P<0.01 PE1 CVVH1 PE+HP1 HP+CVVH1 HP+CVVH+PE1 PE2 CVVH2 PE+HP2 HP + CVVH2 HP+CVVH+PE2

4 ENLAV ENLAV-K+ ENLAV-Na + ENLAV-Cl - ENLAV-HCO - 3 ENLAV-Ca 2+ mmol /L mmol /L mmol /L mmol /L mmol /L PE ± ± ± ± ±0.07 PE ± ± ± ± ±0.16 CVVH ± ± ± ± ±0.2 CVVH ± ± ± ± ±0.19 PE+HP ± ± ± ± ±0.06 PE+HP ± ± ± ± ±0.11 HP+CVVH ± ± ± ± ±0.13 HP+CVVH ± ± ± ± ± HP+CVVH+PE ± ± ± ± ±0.23 HP+CVVH+PE ± ± ± ± ± P< P< PE CVVH PE+HP HP+CVVH HP+CVVH+PE 1 PE Z P ±22.9 g /L P<0.01 HP+CVVH+PE 83.0±19.3 g /L 104.4±25.4 g /L P<0.01 PE 8.3± /L ± /L P < HP + CVVH 13.5± /L 11.8± /L P<0.01 PE ± /L ± /L P < 0.01 CVVH 64.7 ± /L ± /L P < 0.01 PE+HP 81.2± /L 105.8± /L P< 0.01 HP+CVVH 47.2± /L 66.1± /L P<0.01 HP+CVVH+PE 58.3± /L 96.2± /L P< HP PT PE PE 2 PE Cr PE PE 3 PE CVVH BuN Cr 4 CVVH BuN Cr K + Na + Cl - HCO - 3 CVVH ALB CVVH 5 CVVH PT HA HP 500~ Da RBC /L HB g /L WBC 10 9 /L PLT 10 9 /L PE ± ± ± ±54.5 PE ± ± ± ± CVVH ± ± ± ±59.2 CVVH ± ± ± ± PE+HP ± ± ± ±73.1 PE+HP ± ± ± ± HP+CVVH ± ± ± ±39.5 HP+CVVH ± ± ± ± HP+CVVH+PE ± ± ± ±58.9 HP+CVVH+PE ± ± ± ± P< P<0.01

5 HP CVVH PE HP PE HP CVVH HP CVVH PE HP 1. - J HP CVVH J HP CVVH BuN Cr 3 Abe T Kobata H Hanba Y et al. Study of plasma exchange for liver failure Beneficial and harmful effects J. Therapeutic CVVH Apheresis and Dialysis J J J HP+CVVH PT 7. J J BuN Cr NH3 Na + Cl - HCO J PT ALB HP CVVH PE 10. J J HP CVVH PE TBi DBi PE PE+HP HP +CVVH HP + CVVH + PE CVVH NCPAP PS NRDS NCPAP PS NRDS NCPAP PS A PS B NCPAP C PS NCPAP 24 h PS NCPAP NRDS NRDS NCPAP 1 NCPAP PS PS SFZD ~ ~ g Apgar 3.0 ~ 4.5