关键词: 双重血浆分子吸附, 血浆置换, 报警, 血管通路

Abstract: Objective To analyze the common factors affecting the adsorption capacity of patients with liver failure or severe hyperbilirubinemia during dual plasma molecular adsorption (DPMAS) and lower volume plasma exchange (LPE) treatment.Methods A total of 161 cases of liver failure or hyperbilirubinemia treated with DPMAS and LPE from January 1,2021 to May 31,2022 were collected. The common conditions, alarm and influencing factors of the adsorption reduction (less than 4000ml) caused by various reasons were analyzed.Results Of the 161 patients treated with DPMAS combined with LPE, 24 had the adsorption volume less than standard dose, accounting for 14.9% of the total treatment. The decrement of bilirubin level was lower than that in the standard treatment group, but there was no significant statistical difference (P=0.337). The vascular access varied greatly between the two groups (χ²=6.463, P=0.039), the proportion of peripheral arteriovenous imparements (AVIs) was higher in the low adsorption group than the standard group (62.5% vs 42.5%), and the flow velocity in the low adsorption group was lower than that in the standard group (t=-2.344, P=0.02). Among the 24 patients in the low adsorption group, all had uncorrected instrument alarm occurred, which included 11 transmembrane pressure (TMP) alarms (45.8%) and 8 venous pressure (VP) alarms (33.3%). In the low adsorption group, there were 4 cases of coagulation in vevous and multi-seperator, 7 cases of coagulation in single separator, 3 cases of fat deposition, and 1 case of hypotension.Conclusion When patients with severe liver disease are treated with DPMAS and LPE, peripheral arteripuncture and low blood flow rate are more likely to cause unplanned suspension of adsorption. The alarm mode is mainly transmembrane pressure alarm and venous pressure alarm, with blood clot and fat deposition as the main reasons.

Key words: Dual plasma molecular adsorption, Plasma exchange, Alarm, Vascular access