Abstract:

Objective: To observe the clinical efficacy and safety of combined CVVH-bilirubin adsorption treatment on patients with hyperbilirubinemia and compare to the traditional plasma separation perfusion. Methodology: Sixteen cases with hyperbilirubinemia received total 55 sessions artificial liver support therapy (ALS). All of them were treated with conventional plasma perfusion (conventional method) for the first treatment. The rate of blood flow was set at100-120ml/min and the rate of plasma separated was set at 30-40ml/min. Then they were treated with combined CVVH-bilirubin adsorption (combination method).The rate of blood flow was set at 200-250ml/min and the rate of plasma separated was set at 90ml/min. Separated blood plasma components were filtrated by the CVVH filter AV600 when ultrafiltration rate was set at 66ml/min. Then concentrated plasma components were adsorpted by BRS-350 adsorption column and they were reinfusioned in vivo. At the same time bicarbonate replacement fluid at the speed of 4000ml/hr with pre-dilution mode was input before plasma component separator EC40W. ALS was performed with 8 hours. Blood biochemistry and coagulation were measured before and after single treatment. Similarly blood biochemistry, plasma biochemistry before plasma separator and plasma biochemistry before and after BRS- 350 were measured at the 30min, 2hr, 4hr, 6hr and 8hr of therapy. The clinical vital signs were recorded, and the acute physiology and chronic health evaluation (APACHEII), Glasgow coma score, MELD score of liver function before and after single treatment were assessed. Results: The average reduction rate of TBL, DBL, IDBL, and TBA were (46.1 ± 8.3)%, (47.3 ± 8.0)%, (40.7 ± 24.8)%, and (36.5 ± 5.2)%, respectively, with the conventional method after single treatment and the reduction rate of TBL, DBL, IDBL, and TBA were (54.4 ± 5.2)%, (54.2 ± 5.3)%, (63.8 ± 7.2)%,  and (47.6 ± 14.7)%, respectively, with combined CVVH-bilirubin adsorption after single treatment. The clearance of TBL were (22.3 ± 2.2), (12.2 ± 4.4), and (9.0 ± 2.8) ml/min, respectively, with the conventional treatment at the 0.5h, 2h, and 4h therapy. The clearance of TBL were (28.7 ± 13.1), (21.9 ± 9.1), (16.1 ± 4.3) ml/min respectively, with combination treatment, at the time corresponding to conventional treatment. At the end of treatment, the clearance of TBL were (8.3 ± 3.0) and (9.3 ± 4.1) ml/min, respectively. The clearance of TBL, DBL, and IDBL was decreased with time on the course of treatment weather combined CVVH- bilirubin adsorption or conventional treatment. The concentration of on total protein (TP) , albumin (ALB) were lower than before treatment and APTT, PT, and INR were longer with conventional treatment. But blood BUN, Scr, ALT, and AST were decreased and there were no effect on TP, ALB and coagulation with combination method after single treatment. The survival rate was 69% in ICU at 30 day and 56% in discharging from hospital. During the treatment, the vital signs of all patients were stable and there were no adverse events.  Conclusion: The combined CVVH-bilirubin adsorption therapy is a novel and effective artificial liver support therapy. It can significantly reduce bilirubin levels, improve the biochemical indexes and relieve some clinical symptoms. Moreover it is well tolerated for patients and there were no effect on serum albumin and coagulation. It can improve MELD score of liver function and APACHEII.