Clinical application of plasma exchange combined with continuous veno-venous hemodialysis filtration in children with acute liver failure

Abstract

Objective To observe the clinical effect of plasma exchange (PE) combined with continuous veno-venous hemodialysis filtration (CVVHDF) in children with acute liver failure. Methods Thirty-nine cases with acute liver failure admitted to pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from August 2008 to January 2014 were treated with PE combined with CVVHDF. CVVHDF was performed after PE immediately, each PE+ CVVHDF lasted 24~72 hours. Prothrombin time, blood ammonia, alanine transaminase, aspartate transaminase, serum total bilirubin, conjugated bilirubin were detected before and after PE+ CVVHDF treatment. Glasgow Coma Scale were assessed before and after PE+ CVVHDF in the thirty-five cases with hepatic encephalopathy. Results After the treatment of PE+ CVVHDF, 20 children were clinical recover, 7 died, 12 abandoned the treatment and the results of follow-up were death. PE+ CVVHDF was effective in the treatment by decreasing serum total bilirubin, conjugated bilirubin, alanine transaminase, aspartate transaminase [(128.8±82.6) μmol/L vs (73.2±92.4) μmol/L; (90.2±71.5) μmol/L vs (55.1±42.6) μmol/L; (3 024.1±2 457.0) U/L vs (1 256.8±757.8) U/L; (3 420.6±2 216.3) U/L vs (579.4±338.6) U/L] (P<0.05), increasing Glasgow Coma Scale (9.5±3.1 vs 12.1±2.9) (P<0.01), shortening prothrombin time [(40.4±23.0) s vs (22.8±9.4) s] (P<0.01), in association with the improvement of hemorrhage tendency. Conclusion PE+ CVVHDF significantly improves clinical symptoms and biochemical abnormalities in children with acute liver failure. Security of PE+ CVVHDF is good and with no obvious adverse reactions. Key words: Acute live failure; Plasma exchange; Continuous veno-venous hemodialysis filtration; Children