关键词: 肝衰竭, 血管通路, 治疗, 双重血浆分子吸附

Abstract: Objective To investigate the impact of vascular access on the clinical efficacy and safety of double plasma molecular adsorption system (DPMAS) therapy in patients with liver failure. Methods A total of 133 patients with liver failure who underwent DPMAS therapy at the Fifth Medical Center of the PLA General Hospital between January 2021 and June 2022 were enrolled. They were divided into a catheter group (internal jugular vein catheter) and a puncture group (direct arteriovenous puncture) based on vascular access type. Pre- and post-treatment biochemical, coagulation, and safety parameters were compared. Results Both catheterization and puncture groups achieved favorable clinical outcomes, with response rates of 72.46% and 73.44% respectively (P=0.764). INR increased markedly, whereas ALT, DBil, and TBil levels decreased significantly after treatment in both groups; however, the between-group differences in changes from baseline were not statistically significant (P>0.05). During artificial liver treatment, blood flow rate and plasma adsorption volume were lower in the puncture group than in the catheterization group (P=0.001 and 0.007 respectively). Regarding adverse reactions and safety indicators, the incidence rate in the puncture group reached 78.00%, markedly higher than the catheter group (39.13%). Puncture-site bleeding and insufficient blood flow/puncture failure were significantly more frequent in the puncture group than in the catheter group (P values 0.012 and 0.009, respectively). Conclusion Both internal jugular vein catheterization and arteriovenous puncture are viable options for DPMAS therapy in patients with hepatic failure. Healthcare professionals should select the optimal access route based on the patient′s vascular condition, treatment frequency, coagulation status, and their own technical proficiency and preferences.

Key words: Hepatic failure, Vascular access, Therapy, Double plasma molecular adsorption system