血浆置换治疗重型肝炎的生化指标变化

重型肝炎病情严重，愈后极差，以前没有特效治疗方法。近年来，人工肝血浆置换治疗重型肝炎的应用广泛，作通过观察分析本院2002至2004年首次行血浆置换的重症肝炎的治疗情况，现报告如下。     

血浆置换联合血浆灌流治疗重型肝炎病人不良反应的观察及护理

重型肝炎是我国常见传染病之一，由于病情发展迅速，预后极差，尽管保肝支持治疗和监护技术不断进步，病死率仍高达70％-80％。近年来，人们不断探索治疗重型肝炎的新疗法，取得了一定的效果。我科于2004年2月-2007年5月在内科综合治疗的基础上，采用血浆置换联合血浆灌流治疗慢性重型肝炎35例，取得较好疗效。现将不良反应的观察及护理总结如下。     

人工肝支持系统中血浆置换治疗重型肝炎的疗效

目的 评价人工肝支持系统中血浆置换治疗重型肝炎的疗效。方法 选取48例行血浆置换治疗的重型肝炎(重肝)患者为研究对象，比较血浆置换前后患者病情及生化指标等变化，评价血浆置换的疗效。结果 人工肝支持系统中血浆置换治疗重型肝炎总有效率为63％，尤以急性重型肝炎和亚急性重型肝炎的好转较明显。结论 血浆置换治疗重型肝炎较为安全有效。     

血浆置换治疗重型病毒性肝炎临床分析

目的 探讨重型肝炎的有效治疗手段。方法 用等量冰冻鲜血浆进行血浆置换。结果 11例重型肝炎中慢性重型病毒性肝炎早、中期好转4例，2例晚期患者自动出院后死亡。亚急性重型肝炎5例，全部治愈。结论 血浆置换是一种有效的人工肝支持疗法，对重型病毒性肝炎肝功能衰竭有肯定和可靠的辅助支持与治疗作用。掌握治疗时机是提高疗效的关犍。     

50例重型肝炎血浆置换治疗前后生化指标变化分析

重型肝炎病情凶险,死亡率高,目前内科治疗尚无特效方法。近来,血浆置换能暂时辅助和部分替代衰竭的肝脏功能,清除体内各种有毒物质,补充生物活性物质,改善内循环,促进肝细胞再生而恢复肝脏功能。2009年1月至2010年10月我院肝科对50例重型肝炎患者做血浆置换治疗,现将     

血浆滤过吸附的临床应用及护理

为了探讨非生物型人工肝技术血浆滤过吸附治疗各种重型肝炎的临床应用及护理。我院2005年6月-2006年2月对8例重型肝炎病人实行血浆滤过吸附治疗10例次，观察治疗前后总胆红素，凝血酶原时间，钙、磷、血红蛋白的变化，并进行统计学处理，总结血浆滤过吸附的操作规范及护理应急预案。取得一定疗效，现将其应用与护理介绍如下。     

血浆置换辅助治疗重型肝炎的临床观察

血浆置换(PE)是通过用正常新鲜血浆置换出患者体内血浆,以去除患者血液中有害物质的治疗方法.笔者通过回顾性观察分析本院1998年1月～2000年10月行血浆置换的重型肝炎患者的治疗情况,现报告如下.     

血浆置换治疗32例重型肝炎疗效分析

2001年3月～2003年10月，我们用血浆置换治疗重型肝炎32例，临床疗效肯定，但也受相关因素的影响，现报告如下。     

血浆置换治疗晚期慢性重型肝炎疗效观察

目的探讨血浆置换活疗重型肝炎的疗效及安全性。．方法对72例重型肝炎患者在综合治疗的基础上进行血浆置换（PE），对治疗前后的症状、肝功能、肾功能、电解质、凝血酶原活动度、总胆汁酸及并发症发生情况进行分析。结果PE治疗后患者症状均有不同程度缓解，胆红素、总胆汁酸及转氨酶下降明显，凝血酶原活动度升高显著，总有效率达82．85％，且首次治疗时间不同，治愈率差异有统计学意义（早期82．98％，中期53．33％，晚期1250％）。血浆置换的并发症少。结论PE治疗重型肝炎安全有效，以早、中期治疗为宜。     

血浆置换治疗慢性乙型重型肝炎91例疗效与其影响因素

慢性乙型重型肝炎是在慢性乙型肝炎或乙型肝炎肝硬化的基础上，肝脏发生大块或亚大块坏死而使肝功能严重受损，病情进行性加重并逐渐出现严重并发症，使用药物综合治疗，预后较差，病死率高。近年来，血浆置换广泛应用于各型重型肝炎的治疗，收到了良好的疗效。作对91例慢性乙型重型肝炎患行血浆置换，观察疗效及其影响因素，报告如下。     

Fresh-frozen plasma, pathogen-reduced single-donor plasma or bio-pharmaceutical plasma?

Three types of therapeutic plasma are available that differ in their manufacturing processes, composition, clinical efficacy, and side effects. Quarantine-stored, not pathogen-reduced fresh-frozen plasma (QFFP) is prepared from single whole blood or plasma donations. The manufacture of pathogen-reduced single-donor plasmas such as methylene blue-light treated (MLP) or amotosalen-ultraviolet light treated plasma (ALP) involves the addition of a chemical followed by irradiation and subsequent removal of the chemical. Both plasma types show substantial fluctuation of clotting factor and inhibitor levels according to interindividual variations, and both carry the risk of inducing transfusion-associated lung injury (TRALI). Photo-oxidation in pathogen-reduced single-donor plasmas reduces clottable fibrinogen and other clotting factors markedly, and there is a lack of clear evidence showing whether this is harmful or not. MLP also appears to be less effective clinically than QFFP. Like clotting factor or inhibitor concentrates, solvent/detergent-treated plasmas (SDP) are bio-pharmaceutical preparations derived from large plasma pools, and variations in plasma protein levels from batch-to-batch are for that reason low. The SD manufacturing process inevitably involves a considerable reduction of plasmin inhibitor (PI), and moderate reduction of all other clotting factors and inhibitors in the final plasma bags. Clinical studies and broad clinical use have however shown that this does not significantly reduce clinical efficacy or increase adverse events. SDPs obviously do not induce TRALI and the risk of allergic reactions is significantly lower than for QFFP. Common to all three plasma types is that the time between donation and freezing the plasma, and whether plasma from whole blood or apheresis plasma is used as starting material, are decisive determinants for the clotting factor and inhibitor potencies in the final bags. Plasma frozen 3-6h after donation, and apheresis plasma, contain markedly greater amounts of clotting factors and inhibitors than plasma frozen 15-24h after collection or plasma from whole blood. Lyophilisation and the pooling of single-donor plasma units with ABO blood group in suitable proportions (Uniplas) facilitate SDP handling and logistics without loss of clinical efficacy. SDP is obviously at least as cost-effective as QFFP if non-infectious adverse events including TRALI are taken into account, at least in younger patients and patients with good prognosis.     

Partial plasma protein replacement in therapeutic plasma exchange

We wished to determine whether subtotal replacement of protein in plasma removed at plasma exchange would be adequate to prevent hypovolemia and hypoproteinemia. Seven well nourished outpatients with chronic progressive multiple sclerosis underwent 60 plasma exchanges in which two liters of plasma were replaced with 750 ml saline followed by 1250 ml of a 5% albumin solution (62.5% albumin replacement). Total serum protein, protein electrophoresis, and immunoglobulin levels were measured before and after each exchange. Clinically, the exchanges were well tolerated. Total serum protein dropped by a mean of only 18% during the study and mean preexchange serum albumin levels were unchanged, even though immunoglobulins decreased by 57–72%. We conclude that in well nourished patients, partial albumin replacement of this magnitude is an adequate substitute for plasma removed in a plasma exchange.     

Dissemination of contact activation in plasma by plasma kallikrein

The dissemination of contact activation of plasma was examined by measuring the cleavage of Hageman factor (HF) molecules on two separate sets of kaolin particles, one of which contained all of the components of the contact activation system, HF, prekallikrein (PK) and high molecular weight kininogen (HMWK) in whole normal plasma, and the second set of particles containing only HF and HMWK, being prepared with PK-deficient plasma. After mixing of the particles, cleavage of HF on the second set of particles occurred at a rate similar to that occurring on the first set of particles. This indicated that rapid dissemination and burst of activity of the contact reaction takes place in fluid phase. A supernatant factor, responsibel for the dissemination of the contact reaction, was identified as kallikrein. A rapid appearance of cleaved PK (kallikrein) and HMWK on both the kaolin surface and in the supernate was observed. Within 40 s, > 70-80% of the PK and HMWK in the supernate was cleaved. On the surface, approximately 70% of each radiolabeled protein was cleaved at the earliest measurement. Cleavage of PK by activated HF occurred at least 17 times faster on the surface than in the fluid phase, as virtually no cleavage of PK occurred in fluid phase. Each molecule of surface-bound, activated HF was calculated to cleave at a minimum, 20 molecules of PK per minute. It is concluded that the contact activaton of plasma may be divided into three phases: (a) the reciprocal activation of a few molecules of zymogen HF and PK on the surface, with HMWK acting as cofactor to bring these molecules into apposition; (b) the rapid release of kallikrein into the fluid phase and the continued conversion of PK to kallikrein by each surface-bound molecule of activated HF; and (c) the activation by fluid-phase kallikrein of multiple surface-bound HF molecules, and the cleavage of multiple molecules of MHWK both in fluid phase and on the surface by the soluble kallikrein. The evidence suggests that steps b and c account for a great majority of the generation of contact activation of plasma.     

Range of fractionated plasma products to optimize plasma resources

<正>HUMAN PLASMA is a source material that is crucial for the production of unique therapeutic fractionated products.Indeed,plasma contains hundreds of proteins ensuring many physiological functions.The most abundant proteins,albumin and immunoglobulin G (IgG),are present at about 35 and 10 g/L,respectively,representing about 80% of all plasma proteins.However,other important therapeutic proteins include the coagulation factors (factor Ⅷ (FⅧ); FⅨ; Von Willebrand Factor (VWF),fibrinogen) various protease inhibitors (alpha 1-antitrypsin; antithrombin; C1-esterase) and anticoagulants (protein C) which exhibit potent physiological activity.Currently over 10 different protein therapeutics can be extracted from plasma to treat life-threatening diseases or injuries associated to bleeding and thrombotic disorders,immunological diseases,infectious conditions as well as tissue degenerating diseases,thus addressing the clinical needs of many patients.Considering that plasma is a very valuable resources available in limited supply at national levels,it is important,for ethical,medical,and economical reasons,to optimize its use by producing,at satisfactory yields,an appropriate range of safe products meeting the needs of patients.     

The concentration of plasma fibronectin in burns patients treated with fresh frozen plasma or plasma protein fraction

A group of 10 patients with 30-70% burns were given intravenous infusions during the first 48 h following hospital admission either with fresh frozen plasma (FFP) or human plasma protein fraction ( HPPF ). FFP contained 300-400 mg/dl plasma fibronectin whereas none was detectable in HPPF . Circulating plasma fibronectin levels fell quickly in those patients receiving HPPF and levels remained low for 2-3 weeks. In those receiving FFP, plasma fibronectin remained normal during the 48-h transfusion period but fell subsequently. Fibronectin may be an important determinant in the resistance to shock and infections. Consideration should therefore be given to the use of blood products which contain fibronectin and to the monitoring of plasma levels both during the acute and recovery periods after burn injury.