血浆置换治疗高胆红素血症患者的护理

目的探讨血浆置换治疗高胆红素血症的疗效.方法采用免疫吸附系统(KM-8900系统)对5例高胆红素血症患者进行血浆置换,血浆交换速度30 ml/min,以等量的同型血浆或4%白蛋白稀释液为置换液,每次血浆交换量2 500～3 000ml,每例血浆置换次数为1～3次.结果血浆置换前直接胆红素(278.3±74.2)μmol/L,间接胆红素为(637.4±122)μmol/L,总胆红素(915.8士182.8)μmol/L,血浆置换后直接胆红素(228.4士78.3)μmol/L,间接胆红素(428.4士175.8)μmol/L,总胆红素(656.8士178.2)μmol/L,治疗后明显低于治疗前(P＜0.05).结论血浆置换可有效治疗高胆红素血症.     

血浆置换治疗高胆红素血症患者的护理

目的　探讨血浆置换治疗高胆红素血症的疗效。方法　采用免疫吸附系统 (KM - 890 0系统 )对 5例高胆红素血症患者进行血浆置换 ,血浆交换速度 30ml/min ,以等量的同型血浆或 4 %白蛋白稀释液为置换液 ,每次血浆交换量 2 5 0 0～ 30 0 0ml,每例血浆置换次数为 1～ 3次。结果　血浆置换前直接胆红素 (2 78.3± 74 .2 ) μmol/L ,间接胆红素为 (6 37.4± 1 2 2 ) μmol/L ,总胆红素 (91 5 .8±1 82 .8) μmol/L ,血浆置换后直接胆红素 (2 2 8.4± 78.3) μmol/L ,间接胆红素 (4 2 8.4± 1 75 .8) μmol/L ,总胆红素 (6 5 6 .8± 1 78.2 ) μmol/L ,治疗后明显低于治疗前(P <0 .0 5 )。结论　血浆置换可有效治疗高胆红素血症。     

血浆置换术205例护理体会

2000年3月~2005年5月,我院对205例血浆置换患者进行系统护理,取得满意效果,现将护理体会报告如下。1临床资料本组205例,男178例,女27例,12~58岁,平均35岁。乙型慢性重型肝炎192例,药物性重型肝炎10例,酒精性肝炎3例。每次血浆置换后,总胆红素较术前平均下降90~110mol/L,与普通药物治疗组对比,每血浆置换1次,病程缩短约10d。2护理2·1心理护理术前做好耐心细致的解释工作,使患者对血浆置换术有充分的认识,以消除顾虑,缓解紧张情绪;患者担心术后穿刺部位出血、疼痛,护士应及时给予安慰、解释。使患者了解血浆置换术治疗疗效好、病程短、可减…     

多种吸附剂对血浆胆红素和细胞因子吸附性能比较:新型生物材料的体外筛选实验

背景:人工肝治疗重型肝炎要达到有效的治疗效果,必须具有吸附性能特异性强、吸附率高、血液相容性好等特性的吸附材料.目的:观察8种新型吸附剂对重型肝炎患者血浆中的胆红素和细胞因子的吸附性能.设计:对比观察.单位:天津医科大学研究生院,天津海河医院,天津市第三中心医院和南开大学高分子化学研究所.对象:全部血浆来自2004-11/2005-11天津市第三中心医院住院的重型肝炎患者30例.患者对治疗和实验均知情同意且该实验经医院伦理委员会批准.将上述患者随机分为2组:实验1组10例和实验2组20例.两组总胆红素水平分别为(377.3±147.5),(327.6± 140.1)μmol/L.方法:①吸附剂:实验选用的壳聚糖由山东青岛利中壳聚糖厂生产,相对分子质量97 000,脱乙酰度85%.1#～3#吸附剂为以质量浓度1%,3%,5%相对分子量为600的聚乙二醇为致孔剂制备的壳聚糖,4#为胺基化壳聚糖,5#为苯乙烯/二乙烯苯聚合物,6#为后交连苯乙烯/二乙烯苯聚合物,7#为壳聚糖-苯乙烯/二乙烯苯聚合物,8#为壳聚糖-后交连苯乙烯/二乙烯苯聚合物.②指标检测:第一步:收集实验1组重型肝炎患者的血浆各 3 mL,以8种不同的吸附剂各1 mL进行吸附.采用钒酸盐氧化法测定吸附前后血浆中总胆红素、直接胆红素、间接胆红素浓度,计算血浆吸附率,筛选出两种吸附率较高的吸附剂.第二步:用以上筛选出吸附率较好的两种吸附剂各1 mL对实验组患者血浆(各3 mL)进行胆红素和白细胞介素6、肿瘤坏死因子α的吸附实验,后两者的测定采用ELISA法.主要观察指标:吸附前后血浆中胆红素的浓度和细胞因子水平.结果:①第一步实验显示4#和5#吸附剂吸附后患者血浆总胆红素、直接胆红素、间接胆红素浓度明显降低,差异有显著性意义(P < 0.01);其余6种吸附剂吸附前后比较,差异无显著性意义(P > 0.05).②第二步实验显示,4#和5#吸附剂吸附后实验2组患者血浆总胆红素、直接胆红素、间接胆红素浓度和白细胞介素6 和肿瘤坏死因子α水平均明显下降,差异有显著性意义(P < 0.01).4#吸附剂吸附后前述5项指标低于5#吸附剂,差异有显著性意义(P < 0.01).结论:胺基化壳聚糖体外吸附重型肝炎患者血浆中胆红素、细胞因子效果有明显优势.     

树脂吸附治疗高胆红素血症所致并发症的探讨

目的 清除胆汁酸、胆红素、游离脂肪酸及酰胺类等有毒物质,缓解患者的全身中毒和皮肤瘙痒症状.方法 以常规血液透析方法建立血管通路,分离血浆,血浆以25～35ml/min速度序贯通过吸附器,经吸附后的血浆与血细胞混合同步回输体内.结果 经血浆吸附治疗严重胆汁淤积的患者,总胆红素水平明显下降,各种中毒症状及皮肤瘙痒症状明显缓解.结论 血浆吸附能有效清除体内胆汁酸、胆红素、游离脂肪酸及酰胺类等有毒物质,是辅以治疗各种原因所致重症胆汁淤积病患者,提高存活率,降低病死率的有效方法.     

试用成本-效果分析方法评价人工肝血浆置换的临床意义

目的通过人工肝血浆置换治疗慢性重型肝炎患者的成本-效果分析,探讨血浆置换疗法的经济学意义.方法以直接医疗收费代替成本,以病死率,转氨酶、总胆红素、凝血酶原活动度基本恢复正常的时间作为效果指标,计算成本-效果比.结果在内科治疗的基础上配合人工肝血浆置换治疗,使总住院费用平均降低14271.38元,住院天数平均减少16.36天;平均使一例患者的转氨酶、总胆红素、凝血酶原活动度基本恢复正常的费用,与单纯药物治疗的费用比分别为1∶1.40、1∶1.42和1∶1.41.结论对诊断明确的重型肝炎,在现有内科治疗的基础上及时配合人工肝血浆置换治疗,可缩短病程,降低费用,具有较好成本-效果比.     

Depmas双重血液净化治疗急性百草枯中毒的疗效观察

目的探讨Depmas双重血液净化治疗急性百草枯中毒的临床疗效。方法回顾性研究我科2011年3月至2013年11月急性百草枯中毒患者,将其分为四组:常规治疗组未行血液净化治疗,只采用药物治疗;血液灌流组除了采用药物治疗外,还行HA230/330血液灌流治疗,血液灌流联合血浆置换组除了采用药物治疗,还行HA230/330血液灌流及血浆置换联合治疗;Depmas组除采用药物治疗外,通过血浆分离器,对分离的血浆再串联HA230/330及BS330血液灌流治疗。观察四组患者的存活率、平均存活时间,血液中百草枯浓度、胆红素及炎性介质的变化。结果血液灌流组、血液灌流联合血浆置换组及Depmas组较常规治疗组存活率提高,平均存活时间延长,周围血液中的百草枯、胆红素及炎症介质浓度明显降低,差异具有统计学意义(P<0.01);血液灌流联合血浆置换组及Depmas组较血液灌流组存活率提高,平均存活时间延长,周围血液中的百草枯、胆红素及炎症介质浓度降低,差异具有统计学意义(P<0.05);血液灌流联合血浆置换组与Depmas组存活率、平均存活时间、周围血液中的百草枯、胆红素及炎症介质浓度未见明显异常,差异不具有统计学意义(P>0.05)。结论 Depmas双重血液净化治疗急性百草枯中毒有显著疗效。     

血浆置换治疗重型肝炎的疗效及影响因素分析

目的回顾分析血浆置换在重型肝炎治疗中的疗效以及影响因素.方法应用血浆置换治疗江苏省苏州市第五人民医院80例重型肝炎患者,回顾分析患者的临床特点、治疗效果和影响疗效的相关因素.结果80例重型肝炎患者经血浆置换治疗后存活率为51.3%.该方法对晚期重型肝炎疗效差,存活率只有9.5%.临床好转组与死亡组血浆置换前血清总胆红素分别为(369.9 113.1) μ mol/L、(429.9 95.9)μ mol/L(P＞0.05),两组治疗后血清总胆红素清除率分别为51.5%、42.6%(P＞0.05),治疗2～4天后胆红素的反弹率死亡组49.2%、临床好转组30.5%(P＜0.05).死亡组治疗前后PTA均明显低于临床好转组(P＜0.001).合并肝性脑病和肝肾综合征者存活率分别为23.5%、25%.结论血浆置换可明显改善重型肝炎患者的生化指标,可以提高存活率,但重型肝炎的预后仍然取决于患者病情特点和整体性、个体化治疗.     

功能基化天然生物多糖吸附剂制备及对血浆胆红素的清除

背景:目前临床上应用的血液/血浆灌流吸附剂主要为活性炭和化学合成高分子大孔树脂.活性炭微末会造成栓塞,树脂致孔剂多为甲苯类溶剂不易洗脱干净引起不良反应.用天然高分子材料修饰交联制备吸附剂意义重大. 目的:用天然生物多糖-壳聚糖作为胆红素吸附剂的骨架基质,经胺化修饰交联,以蔗糖为致孔剂制备功能基化交联壳聚糖吸附剂,比较该吸附剂与市售BL-300型血浆灌流吸附剂对血浆胆红素吸附性能.方法:用功能基化交联壳聚糖吸附剂和市售BL-300型血浆灌流吸附剂,分别对高胆红素血浆进行灌流吸附试验,全自动生化分析仪测定不同吸附剂对血浆胆红素的吸附率.结果与结论:功能基化交联壳聚糖吸附剂和市售BL-300吸附剂对不同浓度的胆红素血浆均具有良好的吸附效果,功能基化交联壳聚糖吸附剂对胆红素的吸附率可达50.2%,BL-300吸附剂对胆红素的吸附率可达56.8%,与文献报道基本一致.结果证实,功能基化交联壳聚糖吸附剂血浆灌流清除胆红素效果明显且安全可靠,有望作为生物医用血浆灌流材料.     

枸橼酸抗凝在妊娠合并重型肝炎患者血浆胆红素吸附治疗中的作用及护理

目的 探讨枸橼酸抗凝在妊娠合并肝炎患者血浆胆红素吸附治疗中的作用.方法 对该院25例妊娠合并重型肝炎患者用枸橼酸抗凝行血浆胆红素吸附串联血浆灌流进行治疗.结果 25例患者经治疗与护理85次,除1例治疗1 h后出现过1次滤器Ⅲ度凝血需更换血路管及灌流器,其余84次均顺利完成.全部患者痊愈或好转出院,其中17例肾功能恢复正常,15例产前发病的患者中2例围生儿死亡,5例早产儿预后良好.结论 应用枸橼酸抗凝行血浆胆红素吸附治疗与血液灌流治疗相互结合后,各项肝功能指标均有明显改善.     

Modified method of exchange transfusion in sickle cell disease

The treatment of various complications of sickle cell disease has included red cell exchange in the past, and the development of automated pheresis equipment has greatly simplified such exchanges. Traditionally, the patient's red cells have been exchanged while their plasma was returned to them. Recently, plasma factors have been thought to play a role in the pathogenesis of vasoocclusive events. Therefore, we performed whole blood exchange, which consisted of replacement of the patient's plasma with albumin and saline in addition to the usual replacement of erythrocytes. A total of 32 whole blood exchanges were performed on 12 patients with a variety of complications of their disease. The procedure was done using standard pheresis equipment and was relatively simple to perform. There were no serious complications and the clinical outcome was good with 10 out of 12 patients experiencing improvement.     

Influence of plasma exchange pheresis on plasma elimination of ceftriaxone.

The plasma elimination rates of serial 2-g intravenous injections of ceftriaxone were studied in a patient who also was treated with therapeutic plasma exchange pheresis. Plasmapheresis had negligible influence on the total clearance of ceftriaxone.     

中间型人工肝对重型肝炎肝功能支持的效果评价

目的　评价中间型人工肝支持方法血浆置换对重型肝炎肝功能的支持效果和安全性。方法　对 17例重型肝炎患者进行血浆置换治疗 ,观察治疗前后患者临床症状、体征变化 ,比较治疗前后肝、肾功能 ,血常规 ,凝血酶原时间 (PT)和凝血酶原活动度 (PTa)变化。结果　血浆置换治疗后 ,患者的临床症状均有不同程度改善 ,总有效率为 5 8.8% ,最终存活率仅为 11.8%。检测指标中转氨酶、总胆红素、凝血酶原时间、凝血酶原活动度和总蛋白治疗前后差异均有显著性 (P<0 .0 5或 P<0 .0 1) ;血尿素氮、血肌酐和血常规各指标治疗前后差异均无显著性 (P均 >0 .0 5 ) ;而且不良反应较轻。结论　中间型人工肝对重型肝炎患者肝功能有肯定的支持效果。     

Long-term plateletpheresis of a donor

A 25-year-old woman underwent plateletpheresis 101 times over a 33- month period. The equivalent of 5.8 to 7.5 units of platelet concentrate was removed during each pheresis. Two machine-related complications occurred, resulting in the loss of one unit of blood and 150 milliliters of plasma. Other complications included a mild anemia consistent with iron deficiency. The donor's platelet count decreased but remained in the normal range. There were no significant changes in the serum proteins or immunoglobulins. Serum hepatic enzymes became elevated and were consistent with a mild, subclinical hepatitis. These returned toward normal during continued pheresis.     

Practical issues in therapeutic apheresis.

Although therapeutic plasma exchange is known to be the most effective and efficient therapeutic modality for some disorders such as thrombotic thrombocytopenic purpura and hyperviscosity syndrome, no standard protocol of plasma exchange has been developed. A protocol based on evidence needs to be established for standard of care. It should include exchange volume, replacement fluid, frequency, and end point. Indication of plasma exchange is not always clear because prospective randomized clinical trials, especially blinded trials, are difficult to perform. The standard guideline is now available from Category 1 to Category 4 and is published by the American Association of Blood Banks and the American Society for Apheresis. Each institution should establish its own pheresis guideline and protocol for each disorder.     

Use of plasmapheresis and partial plasma exchange in the management of patients with cryoglobulinemia

The management of patients with cryoglobulins often meets with limited success. Reported here is the use of plasmapheresis and/or partial plasma exchange in the management of five patients with cryoglobulinemia. The procedure was carried out at room temperature with reinfusion through a blood warmer. Circulating levels of mixed cryoglobulins and monoclonal IgM cryoglobulins were more easily reduced than were IgG cryoproteins. Improvement in symptoms was associated with removal of the cryoprotein. Pheresis can be used as primary therapy for reduction of cryoglobulin levels in cases of symptomatic essential cryoglobulinemia. Where an etiology for cryoglobulinemia is known and specific treatment exists, pheresis can be used as effective adjunct therapy.     

Improvement of platelet function following plateletpheresis in patients with myeloproliferative diseases

Four patients with myeloproliferative diseases and acute hemorrhagic or thrombotic complications of thrombocytosis were treated with plateletpheresis by discontinuous-flow centrifugation. Reduction of platelet counts was achieved rapidly, without complications and was associated with clinical improvement. In all four cases, abnormal platelet aggregation testing was present before pheresis, but improved immediately after pheresis. Platelet-sizing data obtained in one case suggested that during the pheresis procedure, a population of larger volume platelets was selectively removed. The efficacy of plateletpheresis in these clinical situations may be related to the selective removal of a large abnormal platelet population.     

Calcium homeostasis during therapeutic plasma exchange

Because the removal of substantial quantities of plasma calcium during plasma exchange is rarely attended by clinically significant hypocalcemia, we evaluated calcium homeostasis during this procedure. Twenty-one procedures were performed on 10 patients with various neurological disorders. The reduction by plasma exchange in the serum concentrations of total calcium, ionized calcium, magnesium, and phosphate was significantly less than predicted (p less than 0.001) based on plasma volume of the patient and size of the exchange. However, N-terminal parathomone (PTH) levels increased to 242 +/- 120 percent midway into the procedure and were 207 +/- 84 percent after plasma exchange; urinary cyclic adenosine monophosphate (cAMP) levels rose by 165 +/- 35 percent. These data demonstrate a rapid compensatory response in N-terminal PTH and urinary cAMP to the reduction by plasma exchange of serum concentrations of total calcium, ionized calcium, and phosphate. The routine administration of supplemental calcium during plasma exchange may therefore be unnecessary in patients with normal parathyroid function.     

A randomized trial of plasma exchange in the treatment of burn shock

Hypovolemia following major thermal injury results from increased capillary permeability with subsequent loss of fluid into the interstitium. Investigations of burn shock have demonstrated the release of circulating factors that effect these fluid shifts. Previous studies have suggested that this process can be altered by the performance of plasma exchange in patients who fail to respond to conventional resuscitation. This study evaluated the effect of plasma exchange during burn shock. Twenty-two adult subjects were randomly assigned to one of two groups. The control group received standard fluid resuscitation guided by the Parkland formula; the treatment group received the same resuscitation in addition to a course of plasma exchange. Seventeen subjects, eight from the control group and nine from the plasma exchange group, completed the study. Control subjects had a mean age of 37 years, a mean burn size of 52.3% total body surface area, and a mean full-thickness injury of 24.6% total body surface area. Plasma exchange patients had a mean age of 38 years, a mean burn size of 49.4% total body surface area, and a mean full-thickness injury of 37.3% total body surface area (p less than 0.01 compared to the control group). Completion of resuscitation was accomplished earlier in the plasma exchange group (20.2 hours versus 30.8 hours; p less than 0.05). There was no difference in the total amount of fluid required to achieve resuscitation. The mean urine output during resuscitation was greater for the plasma exchange group (p less than 0.01). Performance of plasma exchange during the second 8-hour period after the burn did not alter the course of burn shock in this study group.     

Preoperative therapeutic plasma exchange in patients with thyrotoxicosis

The purpose of this report was to determine the effectiveness of therapeutic plasma exchange (TPE) in preoperative preparation of patients with thyrotoxicosis scheduled for either thyroid or nonthyroid surgery. We retrospectively reviewed 11 patients with thyrotoxicosis and those who prepared surgery with plasmapheresis between 1999 and 2008 at our institution. Ten patients underwent thyroid surgery and one patient was operated for femur fracture during antithyroid drug treatment. The indications for plasmapheresis in all patients with severe thyrotoxicosis were poor response to medical treatment (seven patients), agronulocytosis due to antithyroid drugs (three patients), iodine‐induced thyrotoxicosis (Jodd Basedow effect in one patient), and rapid preparation for urgent orthopedic operation (one patient). After TPE, we observed a marked decrease in free thyroxin (FT3) and free triiodothyronin (FT4) levels; however, the decline in the biochemical values were not statically significant (P > 0.62, P > 0.15). Although both FT3 and FT4 levels remained above the normal limits in two of 11 patients, the signs and symptoms of thyrotoxicosis improved in all patients and no thyroid storm observed during the perioperative period. TPE can be considered a safe and effective alternative to prepare patients with thyrotoxicosis for surgery when drug treatment fails or is contraindicated and when emergency surgery is required. J. Clin. Apheresis, 2009. © 2009 Wiley‐Liss, Inc.