血浆置换疗法治疗重型肝炎的不良反应137例临床分析

目的观察血浆置换治疗重型肝炎时的不良反应,探讨其相应的防治措施。方法通过记录、分析我院2001年3月1日～2008年12月31日近8年间住院的137例各型重型肝炎患者208次应用血浆置换疗法治疗过程中出现的不良反应资料,探讨各种不良反应的发生机率及处理方法。结果本组208例次应用血浆置换疗法过程中,累计发生不良反应202例次（97.12%）,其中过敏反应198例次（95.2%）,最为常见,1例次发生过敏性休克（0.48%）。其余依次为低血钙样表现178例次（85.58%）;血压下降21例次（10.1%）;穿刺部位渗血19例次（9.14%）,其中经桡动脉或股静脉穿刺者为15例次（11.54%）,78例次改为锁骨下静脉穿刺,穿刺部位加8字型缝合后,仅4例次（5.13%）有局部轻微渗血;导管感染4例次（1.93%）。结论运用血浆置换疗法治疗重型肝炎不良反应的发生机率较高,但在操作过程中如能密切观察,妥加应对,可使治疗顺利完成,对患者治疗的依从性和临床疗效无不良影响。

Clinical observation of advises reaction of plasma exchange for 137 cases of severe hepatitis

Objective To research the advise reaction of plasma exchange on severe viral hepatitis, and to study its corresponding prevetion meaasures. Methods To record and study the advise reaction of 208 times plasma exchange for 137 cases of severe hepatitis between March 2001 and December 2008, then to study various advise reaction of occured rate and treatment method. Results The group 208 cases were with plasma exchange, accumulative 202 cases occurred advise reaction, the incidence rate was（97.11%）. In 198 cases were allergic reaction （95.2%）, which was the most common, 1 case was occurred allergic shock（0.48%）. The other in sequence of 178 cases were hypocalcemia（85.58%）~21 cases were blood pressure decrease（10.1%）;19 casese were blood ozzing at puncture site（9.14%）, in 15 cases were radial artery or femoral vein puncture（11.54%）, 78 cases were changed to subclavian vein punture, after the punture site was sutured with 8 type, only 4 cases（5.13%） were slightly blood ozzed in local site, 4 cases were catheter infection（1.93%）. Conclusions The incidence rate probabily of advise reaction with plasma exchange was higer, ff it will be observed during the opreation process, careful and skillful coping with, then the treatment will be successful completed, there was not advise reaction for patients therapeutic complicance and clinical effect.