The plasma exchange treatment was conducted on 64 cases of severe hepatitis. The average volume of plasma exchanged was 2300mL at a balanced speed with the addition of replacement fluid and plasma separation. Heparin, calcium, and other supplements were appropriately administered during the replacement process according to the separation needs. Each plasmapheresis session involved a volume of 2000-2500mL, with treatments occurring two to four times at intervals of 3-4 days.
1.3 Laboratory tests included liver function, blood ammonia, and prothrombin time (in seconds), with prothrombin activity (PTA) calculated using the formula = [the PI control - 8.7] / [patients with PI - 8.7] × 100%.
1.4 Statistical methods: Measurement data are presented as mean ± standard deviation, using t-tests for analysis. Data analysis was performed using SPSS Version 12. A P value <0.05 was considered statistically significant.
2 Results: After treatment, clinical symptoms in the 64 patients improved to varying degrees. Changes in liver function, blood ammonia, and prothrombin time are shown in Table 1. Comparison of liver function, blood ammonia, and original prothrombin time changes (x ± s) before and after plasma exchange therapy revealed significant improvements in liver function, plasma ammonia, and prothrombin time (P <0.01). Among the 10 cases of acute and subacute severe hepatitis, 4 cases survived (40.00%). In the 54 cases of chronic severe hepatitis, 25 cases survived, including 5 patients who successfully underwent liver transplant surgery (46.30%).
Discussion: Severe hepatitis is a dangerous disease that progresses rapidly, with complex pathogenesis. Besides immunopathological damage caused by viruses, it also involves inflammatory mediators induced by endotoxins and TNF-α-induced inflammatory responses. ALSS can be divided into toxic substance adsorption for artificial liver removal and bioartificial liver methods. Plasma exchange is one of the more mature ALSS methods, whose mechanism clears multiple toxic substances in plasma such as bilirubin, endotoxin, fresh blood type-specific plasma proteins, coagulation factors, opsonin, and other biologically active substances, as reported in the Medical Journal 2007, Volume 21, Issue 1. It provides auxiliary and partial substitution for failed liver functions, removes certain toxins from the body, improves the internal environment, and gains time for fulminant hepatitis patients awaiting liver regeneration, thus improving the survival rate of patients with severe hepatitis and providing rescue opportunities for patients, which supports their recovery from short-term liver failure and buys precious time for those waiting for liver transplantation.
From the observation and treatment results, the patient’s liver function significantly improved after the plasma exchange treatment ended, with TBIL, DBIL, ALT, AST, PT, blood NH3, and others decreasing significantly (P <0.01). Liver function in ALB, CHE, and PTA increased significantly, consistent with reports by Li Lanjuan. Adverse reactions observed in this group of patients included: 1) Allergic reactions: facial, chest, and limb congestion rash, chills, fever, nausea, vomiting, chest tightness, and shortness of breath; 2) Low blood pressure; 3) Electrolyte imbalance: hypocalcemia, with clinical manifestations including mouth numbness, hand numbness, and severe symptoms like convulsions; 4) Silt plaques and oozing bleeding at the cannulation site. However, these adverse reactions were controlled successfully through measures such as dexamethasone administration, slowing down blood flow velocity, bolus injection of calcium gluconate, local gauze application, ensuring the successful completion of plasmapheresis.