双重滤过血浆置换治疗难治性重症肌无力患者的护理

对31例难治性重症肌无力患者采用双重滤过血浆置换（DFPP）治疗。结果痊愈5例，基本痊愈8例，显效12例，好转4例，无效2例。提出治疗前做好心理护理及常规准备，治疗中建立有效的血管通路、密切观察病情变化、严格无菌操作、正确输入置换液、加温置换液等，是保证治疗效果的主要措施。     

双重滤过血浆置换治疗难治性重症肌无力患者的护理

对31例难治性重症肌无力患者采用双重滤过血浆置换(DFPP)治疗.结果 痊愈5例,基本痊愈8例,显效12例,好转4例,无效2例.提出治疗前做好心理护理及常规准备,治疗中建立有效的血管通路、密切观察病情变化、严格无菌操作、正确输入置换液、加温置换液等,是保证治疗效果的主要措施.     

血浆置换治疗重症皮肤病68例

目的：观察血浆置换疗法在治疗重症炎症性和自身免疫性疾病中的作用。方法：选择68例经过皮质类固醇激素和／或免疫抑制剂等治疗后仍难控制病情的结缔组织病、大疱性皮肤病及重型银屑病等患者，采用COBE Spectra血液成分分离机连续性血浆置换方式。结果：91．18％获得满意疗效(62／68)，2例出现不良反应。结论：血浆置换疗法有助于病情的缓解及稳定并维持药物疗效，不失为一种较为理想的辅助治疗方法。     

阿维A治疗重症银屑病的疗效观察

目的:观察阿维A治疗重症银屑病的临床疗效.方法:33例患者采用口服阿维A30-40mg/d治疗,3-4周见效后减为20mg/d,疗程12-16周.结果:红皮病型银屑病及脓疱型银屑病有效率分别为80%和95.65%.结论:阿维A对重症银屑病有较好的治疗效果.     

血浆置换联合连续性血液滤过治疗重症医学科患者的应用观察

目的 探讨血浆置换联合连续性血液滤过治疗重症医学科患者的应用观察.方法 所有患者均采用股静脉留置单针双腔导管建立体外循环.血浆置换、连续性血液滤过采用GAMBRO-PRISMA血液净化机,血浆置换采用Prisma TPE 2000膜式血浆分离器,流速为50～ 150ml/min,每次以30 ～40ml/kg体重计算置换量;连续性血液滤过采用Prisma M 100血液滤过器(AN69HF),滤器面积为0.9m2,流速为180 ml/min.在体外循环连接前采用肝素100 mg加入0.9％氯化钠溶液500ml中预冲洗血液滤过器及通路30 min;置换液配方按照南京军区总医院的配方,并结合患者情况适当调整.结果 7例患者中抢救成功5例.共行血浆置换治疗12次,每次血浆置换、连续性血液滤过后行生化、肝功能、血脂检查.妊娠合并高脂血症性急性胰腺炎患者治疗前血清甘油三酯为21.29 mmol/L,总胆固醇为33.79 mmol/L,血浆置换出乳糜样物,治疗后血清甘油三酯为7.98 mmol/L,总胆固醇为5.73 mmol/L,淀粉酶恢复正常,肾脏功能及其他脏器功能恢复.自身免疫性溶血性贫血并急性肾功能衰竭患者治疗前血红蛋白为35 g/L,血肌酐为296 μmol/L,尿潜血(+++～++++),经治疗后血红蛋白为105 g/L,血肌酐恢复正常,尿潜血消失;产后弥漫性血管内凝血并急性肝脏功能衰竭患者治疗前总胆红素为236.72μmol/L,直接胆红素为135.25μmol/L,纤维蛋白原为1.78g/L,治疗后总胆红素为62.91μmol/L,直接胆红素为39.76μmol/L,纤维蛋白原为3.83 g/L;肝肾综合征和系统性红斑狼疮患者经过治疗,患者临床症状明显改善;其他患者治疗后意识转清,肾脏、各器官功能恢复,治疗前,急性生理学及慢性健康状况Ⅱ评分为(57±11)分,治疗后,急性生理学及慢性健康状况Ⅱ评分为(8±6)分,治疗前,C反应蛋白为(98±26) mg/L,治疗后,C反应蛋白为(15±9)mg/L,治疗前、后比较差异有统计学意义(P＜0.01).结论 采用血浆置换联合连续性血液滤过治疗具有以下优点:(1)能有效地将大、中、小分子的毒性物质清除,补充凝血因子等生物活性物质,实现优势互补,改善患者的中毒症状、生化指标,预防多器官功能障碍综合征发生;(2)不良反应少见,术中均未出现严重并发症,证明联合应用血浆置换和连续性血液滤过治疗重症医学科患者较为安全.     

血浆置换辅助治疗慢性重症乙型肝炎的护理

目的探讨血浆置换辅助治疗慢性重症乙型肝炎的护理方法。方法对68例慢性重症乙型肝炎患者在常规治疗的基础上行血浆置换。结果治愈率58．82％，总好转率79．41％，病死率20．59％；肝功能及凝血功能指标治疗前、后比较．差异有显著性意义（P〈0．05，P〈0．01）。结论血浆置换辅助治疗慢性重症乙型肝炎疗效肯定，严密的术前、术中及术后护理是保证治疗顺利、预防并发症的基础。     

局部枸橼酸抗凝在单重血浆置换治疗中的应用研究进展

血浆置换治疗通过清除致病因子和调节免疫系统功能等作用治疗多器官系统重症免疫病和重症肝病。局部枸橼酸抗凝不影响体内凝血功能,不增加出血风险,是血浆置换治疗的可选抗凝方式之一。本文对国内外的单重血浆置换治疗实施局部枸橼酸抗凝的研究进行综述,为临床医师开展该类治疗提供参考。     

血浆置换和免疫吸附在器官移植中的应用

本文对血浆置换和免疫吸附在器官移植后各种排斥防护和治疗中的作用作了全面的综述。认为血浆置换和免疫吸附可预防或治疗超急、加速和急性排斥，改善或稳定慢性排斥患者的移植物功能；介绍了血浆置换和免疫吸附在肝移植指征的确定、术中无肝期内毒素血症、术后肝功能不全以及ＡＢＯ血型不相容和异种间移植中的作用。并介绍了作者近２年来在肾移植患者中应用血浆置换的经验。     

血浆置换辅助治疗慢性重症乙型肝炎的护理

目的探讨血浆置换辅助治疗慢性重症乙型肝炎的护理方法。方法对68例慢性重症乙型肝炎患者在常规治疗的基础上行血浆置换。结果治愈率58.82%,总好转率79.41%,病死率20.59%;肝功能及凝血功能指标治疗前、后比较,差异有显著性意义(P<0.05,P<0.01)。结论血浆置换辅助治疗慢性重症乙型肝炎疗效肯定,严密的术前、术中及术后护理是保证治疗顺利、预防并发症的基础。     

Plasma Exchange for Treatment of Intractable Psoriasis

Abstract: Hemofiltration and plasma exchange, using a plasma separator with membranes, were used in 14 psoriatic patients. The efficacies of the treatments were compared. Among the patients, 13 were treated with hemofiltration and/or direct hemoperfusion, 5 experienced complete remission, 5 improved, and 3 remained unaffected. In these 3 cases, plasma exchange was performed. The first patient, who suffered from psoriasis pustulosa with arthropathica, achieved complete remission with only two treatments of 2-L plasma exchange. Joint pain was also eliminated. Both skin lesions and joint pain were markedly improved in the second patient, who suffered from psoriasis vulgaris with arthropathica. The third patient showed marked improvement with only two plasma exchanges, and is under continuing observation.     

心脏手术后重度机械性溶血再次体外循环手术中血浆置换

目的总结心脏手术后发生重度机械性溶血、再次体外循环(CPB)手术期间进行血浆置换(plasma exchange,PE)的临床经验。方法2001年1月至2005年12月,对5例严重机械性溶血患者在CPB支持期间进行了PE,其中3例为心瓣膜置换术后发生瓣周漏和感染性心内膜炎;1例为肺动脉瓣狭窄、右心室流出道疏通不满意;1例为体外膜式氧合(ECMO)期间出现严重血液破坏。结果5例患者置换液中血浆用量2.2±0.8L,输血量0.6±0.3L,置换血浆量3.9±1.8L,超滤液量2.4±1.3L。所有患者水电解质和血气分析均维持在正常水平,血流动力学稳定,心脏复苏后顺利停CPB;术后超声心动图复查提示:瓣周漏消失,右心室流出道疏通满意,术后24h内拔除气管内插管,术后第12～53d痊愈出院,尿液清亮,体温恢复正常。3例患者出院前测定游离血红蛋白(FHb),除1例FHb轻度增高(68mg/L)外,其它2例FHb均<40mg/L。结论在CPB期间进行PE是一项安全的技术,其有效的血液净化作用可防治心脏手术后重度机械性溶血所致的急性肾功能衰竭。     

Therapeutic Plasma Exchange in Patients With Severe Hypertriglyceridemia: A Multicenter Study

Extremely high plasma triglyceride (TG) concentration is a recognized risk factor for acute pancreatitis (AP). In order to evaluate the therapeutic efficacy of plasma‐exchange plasmapheresis in treating patients with severe hypertriglyceridemia (sHTG), 17 patients who had not responded to conventional medical therapy (fat‐free diet plus pharmaceutical interventions) were referred for therapeutic plasma exchange (TPE) in a multicenter frame case series study. Two hundred seventeen TPE sessions were performed, and therapy is ongoing for five (30%) of the patients. After treatment, the mean plasma TG and total cholesterol concentrations were significantly reduced from 1929 and 510 mg/dL, to 762 and 227 mg/dL, respectively (P ≤ 0.001 in both cases). In most cases, the interval between treatments was related to the clinical presentation and individual circumstances. The removal of TG‐rich lipoproteins prevented relapses of AP. In this case series, TPE is confirmed as a safe and reliable method for treating patients with refractory sHTG when a severe complication, such as AP, is clinically demonstrated or can be actively prevented. Therefore, in cases where standard medical approaches fail to promote the clearance of TGs from plasma and a high risk of first or second hypertriglyceridemic pancreatitis persists, TPE provides a therapeutic option for preventing life‐threatening sHTG.     

血液净化在儿童重症过敏性紫癜中的应用

过敏性紫癜作为血清免疫球蛋白A介导的自身免疫性疾病,患者的基本表现就是出现全身性小血管炎,如腹痛、皮肤紫癜、蛋白尿、关节肿痛、血尿,偶见颅内出血情况。这一病症容易复发,病情反复发作与重症肾脏损害也属于治疗的难点问题,对患儿的实际预后效果产生一定影响。如果患者的病症无法在短时间内得到缓解,可能会引发肠套叠、皮肤感染坏死的情况,直接影响患者的生命健康,导致临床治疗的难度加大。过敏性重症紫癜的传统治疗方式,主要就是将致敏因素清除,并且进行对症处理与干预,但是可能存在无法有效逆转患儿病情的情况。近几年,血液净化技术得到了广泛的利用,临床效果确切。本文对儿童重症过敏性紫癜诊断进行论述,并结合血液净化在儿童重症过敏性紫癜的应用进展作一综述,旨在为治疗儿童重症过敏性紫癜提供参考。     

血浆置换抢救致死性药物过敏与毒物中毒的临床应用研究

目的：探讨血浆置换在抢救致死性药物过敏、毒物中毒时作为常规治疗手段的可行性，并阐明其可能机制，为确立血浆置换在急救医学中的地位提供理论依据。方法：所有入选病例均通过深静脉穿刺置管建立临时血液通路，并行紧急血浆置换治疗。实验过程中监测治疗前后肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)、免疫球蛋白E(IgE)、补体3(C3)及循环免疫复合物(CIC)水平。结果：49例不同药物过敏、毒物中毒患者存活45例。治疗后血浆TNF-α、IL-8、IgE均有明显降低，而G则明显回升，并有统计学差异。治疗后CIC水平亦有下降，但无统计学差异。结论：血浆置换因其去除体内药物、毒物及炎症介质、免疫复合物的作用迅速，疗效确切并能稳定患者的免疫状态。可作为危重药物过敏、毒物中毒患者抢救的常规方法，并适用于在基层医院广泛开展。     

Therapeutic Effect of Plasma Exchange with the Biliary Drainage in the Treatment of Obstructive Jaundice

The effect of therapeutic plasmapheresis combined with biliary drainage was evaluated in obstructive jaundice animal models. Plasma exchange (PE) using fresh-frozen plasma was carried out with biliary drainage (BD) on a canine jaundice model created by the ligation and resection of bile duct. Routine biochemical analyses were done following PE and BD. The result was compared with that of a BD only group. Plasma bilirubin level abruptly dropped after PE and was kept at a lower level, whereas the bilirubin level of the drainage alone group decreased gradually. Decreased plasma mitochondrial GOT level in the PE group suggests improvement of liver cell damage in obstructive jaundice. Mitochondrial function of liver tissue was evaluated following partial hepatectomy, which was carried out 2 days after PE along with BD in jaundice rat. Mitochondrial respiratory control ratio and ADP/O ratio following hepatectomy were improved in the PE group. The results suggest the improvement of hepatic functional reservoir by a single PE treatment in addition to BD treatment. These results show that PE can shorten the icteric period and may improve the hepatic functions after the treatment of malignant obstructive lesion in the biliary tract.     

Complications of Plasma Exchange in the Treatment of Polyarteritis Nodosa and Churg-Strauss Angiitis and the Contribution of Adjuvant Immunosuppressive Therapy: A Randomized Trial in 72 Patients

We recorded side effects and other complications of 813 plasma exchanges used in early treatment of polyarteritis nodosa and Churg-Strauss angiitis in a prospective study of 72 patients (22-75 years old). All the patients were also treated with a corticosteroid (1 mg/kg/day), and half were included in a randomized trial of cyclophosphamide (2 mg/kg/day during 1 year). Centrifugation was used in 678 plasma exchange sessions (83.4%) and filtration in 128 (15.7%) (no data were available about the technique used in seven cases). The replacement fluid in 745 sessions was 4% albumin and in 115 was fresh-frozen plasma; eight patients received both (47 sessions). Two hundred and fifty-one complications were reported in 60 patients during 206 (25.3%) of the 813 completed exchanges; 47 sessions (5.8%) were temporarily stopped as a result of complications. The most common problems were technical difficulties (in 90 sessions), moderate or severe hypotension (in 52), and allergy to the replacement fluid (in 51). Hepatitis B antigen appeared in one patient. In four patients, plasma exchange was stopped permanently because of the severe side effects. No patient died during a session. Twelve of the 72 patients died during the study, six in each of the two groups. In the group treated by a combination of corticosteroid and plasma exchange, deaths were related to the deleterious effects of the disease itself and occurred after 12.8 +/- 11.1 months (1-26 months). In the group treated by the same combination plus cyclophosphamide, four of the six deaths were due to severe infections, which were related to leukopenia in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypotensive Effect of Plasma Exchange in Immune Complex Nephritis

Abstract: The effect of plasma exchange (PE) on blood pressure (BP) in 20 hypertensive patients (9 with mixed cryoglobulinemia, 7 with systemic lupus erythematosus, and 4 with idiopathic glomerulonephritis) was evaluated retrospectively. In each PE 1.5–2.5 L of plasma was replaced with an equal volume of 4% albumin polysaline solution. The frequency of PE was three times per week for the first 2 weeks and twice per week subsequently. Sixteen patients were on hypotensive treatment at the onset of PE. Their systolic/diastolic BP was 171 ± 4.7/ 102 ± 3.0 mm Hg ( ± 1 SEM). After 4 weeks, BP decreased to 141 ± 2.8/89 ± 2.3 mm Hg (p < 0.001), although in 10 patients antihypertensive drug therapy had been reduced or discontinued. The most marked decrease of BP occurred after the first week (152 ± 5.3/92 ± 2.9 mm Hg), and this decrement correlated remarkably well with pressure levels before PE despite the great heterogeneity of the individual patients (for diastolic BP, r = 0.87, p < 0.001; for systolic BP, r = 0.60, p < 0.01). A mild decrease of serum creatinine was observed during PE, but its time course was different from that of BP, and did not correlate with this parameter.     

Plasma Adsorption Using Bilirubin-Adsorbent Materials as a Treatment for Patients with Hepatic Failure

In order to achieve a higher degree of improvement in patients with postoperative hepatic failure, the effects of plasma adsorption (PA) using a serial connection of noncoated charcoal (N 350) and a new bilirubin adsorbent material, styrenedivinylbenzene (BR350), were investigated both experimentally and clinically. After in vitro perfusion of high bilirubin containing plasma through these columns for 3 hours, total bilirubin levels were drastically reduced to 21% of the preperfusion level in the serial connection of N 350 and BR 350, while it remained high at over 40% in the single use of each column. Total branched chain and aromatic amino acid levels were also drastically reduced in the serial connection of these columns to 50, 40, and 7%, respectively, while the total amino acid levels remained high at 87% in the single use of BR 350. The combination of these columns enhanced rather than interfered with one another. Patients who received this treatment achieved an initial reduction of plasma total bilirubin and aromatic amino acids of 57 +/- 6 and 84 +/- 7, respectively. Although the long-term prognosis for these patients was negative, improvement of clinical and laboratory findings were actually obtained by this treatment. This PA system could provide a possibility for an improved supportive therapy for hepatic failure, especially for patients with hepatic coma and hyperbilirubinemia.     

The Role of Plasma Exchange in the Treatment of Severe Forms of Hemolytic-Uremic Syndrome in Childhood

Abstract: Therapeutic plasma exchange (PE) or plasma-pheresis has been used in recent years in the treatment of severe hemolytic uremic syndrome (HUS) in children. We analyzed the benefit of PE and peritoneal dialysis (PD) in 9 children, 6 boys and 3 girls, aged 1–10 years, from 1983–1993. All children came from different geographical regions, and all had the sporadic form of the illness. Three patients had the gastrointestinal form, 5 had respiratory prodromes while 1 child developed HUS during the course of varicella. Seven children were hypertensive, but only in 3 was hypertension persistent. The child with varicella had a transient complement decrease. Five children were treated with PE. In 4 children, fresh frozen plasma (FFP) was used as replacement fluid, and human albumin was used in 1 child. Four children were treated with PD and infusions of FFP. Rapid recovery of renal function was observed in 5 patients whereas in 2 oliguric children the recovery of renal function ensued within 1 and 2 months, respectively. Two children developed terminal renal failure (TRF) (in 1 child the treatment was very delayed, and in the other child HUS developed following varicella). Only 1 boy had relapses of the disease followed by impairment of renal function from which he gradually recovered. During the 3–10 year follow-up period, only the child with relapses was hypertensive while the others had normal clinical and laboratory parameters. We suggest that PE plays an important role in the early treatment of severe forms of HUS in children.