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。     

血浆置换治疗血栓性血小板减少性紫癜疗效观察

目的 观察血浆置换治疗血栓性血小板减少性紫癜(TTP)的疗效。方法 15例TTP患者,其中7例予肾上腺皮质激素和抗血小板药物治疗;另8例患者除上述治疗外,以新鲜冰冻血浆为置换液,进行血浆置换,隔日1次,血浆置换次数中位数为4次(2～6次),平均血浆交换量为(2316±28)ml。结果 血浆置换治疗患者的存活率为75％,明显高于非血浆置换治疗患者的14.3％(P<0.05)。血浆置换治疗后12～72 h,6例存活患者神经精神症状减轻;血浆置换4次后发热消退,皮下无新鲜出血点和瘀斑,黄疸消失,红细胞压积和血小板数逐渐升高。停止血浆置换后,2例病情反复,需再次血浆置换治疗。结论 血浆置换是治疗TTP的有效方法。     

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。     

血液灌流对重度有机磷农药中毒疗效的临床观察

目的探讨血液灌流治疗重度有机磷农药中毒的疗效及对胆碱酯酶(cholinesterase,ChE)活性恢复和炎症介质包括C反应蛋白(C-reactive protein,CRP)及白细胞介素6(interleukin-6,IL-6)的影响。方法回顾性分析四川省眉山市人民医院2013年6月至2016年1月期间收治的重度有机磷农药中毒患者64例,其中32例行血液灌流,32例未行血液灌流。2组患者均于入院后采用常规治疗,对照组给予阿托品和氯解磷定治疗,观察组在对照组基础上联合血液灌流治疗,灌流器为HA330。比较2组患者治疗前、后血清ChE水平变化,ChE活性恢复时间、中枢神经症状持续时间、N样症状持续时间、M样症状持续时间、住院时间及治疗前、后血浆CRP和IL-6水平变化。结果 2组治疗后血清ChE水平增加(P0.05);观察组治疗后血清ChE水平高于对照组(P0.05);观察组ChE活性恢复时间短于对照组(P0.05);观察组中枢神经症状持续时间、N样症状持续时间、M样症状持续时间及住院时间和病死率均短于对照组(P0.05);2组治疗后血浆CRP和IL-6水平下降(P0.05);观察组治疗后血浆CRP和IL-6水平低于对照组(P0.05)。结论血液灌流治疗重度有机磷农药中毒效果明显,明显促进ChE活性恢复,且可降低血清CRP和IL-6水平,成功率高,具有重要临床应用价值。     

血浆置换联合连续性血液净化治疗重症溶血性尿毒症综合征患儿的护理

目的探讨血浆置换(PE)联合连续性血液净化(CBP)治疗小儿重症溶血性尿毒症综合征的疗效及护理方法。方法对11例重症溶血性尿毒症综合征患儿进行PE联合CBP治疗53例次,平均4.7(3～7)次/例。治疗前准确进行护理评估;治疗中密切监护,建立及维护好血管通路,积极防治并发症。结果 8例好转或治愈,2例死亡,1例放弃治疗出院失访。结论 PE联合CBP治疗小儿重症溶血性尿毒症综合征疗效好,密切观察病情及合理的护理措施能保证治疗的安全及有效。     

Nursing care of children suffering from severe hemolytic uremic syndrome treated with plasma exchange and continuous blood purification

目的 探讨血浆置换(PE)联合连续性血液净化(CBP)治疗小儿重症溶血性尿毒症综合征的疗效及护理方法.方法 对11例重症溶血性尿毒症综合征患儿进行PE联合CBP治疗53例次,平均4.7(3～7)次/例.治疗前准确进行护理评估;治疗中密切监护,建立及维护好血管通路,积极防治并发症.结果 8例好转或治愈,2例死亡,1例放弃治疗出院失访.结论 PE联合CBP治疗小儿重症溶血性尿毒症综合征疗效好,密切观察病情及合理的护理措施能保证治疗的安全及有效.     

血浆置换疗法在临床的应用及疗效

目的观察血浆置换疗法（PE）救治某些急危重症的临床疗效。方法采用离心式血浆分离机或改良膜式血浆分离法,对41例药物治疗效果不佳的多种疾病进行血浆置换,置换液采用新鲜冰冻血浆或5％白蛋白,每例平均治疗2～3次,最长者每天1次,连续7d。结果总有效率80．05％,其中重症肌无力、药物中毒及高敏肾移植受者疗效较好,但对伴有肝脏严重受损的患者效果较差。结论PE比药物治疗能更迅速清除体内致病因子,尤其对严重的免疫性疾病具有独特的治疗效果。     

MARS人工肝在治疗重症胰腺炎中的应用

目的探讨MARS人工肝在治疗重症胰腺炎的疗效及其作用机制。方法对4例重症胰腺炎患者进行MARS治疗,对比治疗前后IL-1、IL-6、TNF-α、NO水平及血淀粉酶、脂肪酶、肝肾功能等的改变。结果4例患者,经MARS治疗后,临床症状及体征明显改善;血IL-1、IL-6、TNF-α、NO水平及淀粉酶、脂肪酶、肌酐、尿素氮、血总胆红素、谷丙转氨酶水平均明显降低(P<0.05)。结论MARS人工肝对治疗重症胰腺炎是一种有效辅助治疗手段。     

他克莫司、霉酚酸酯和血浆置换联合应用治疗肾移植术后急性体液性排斥反应

目的　探讨他克莫司 (FK5 0 6 )、霉酚酸酯和血浆置换联合应用治疗急性体液性排斥反应的效果。方法　 6例肾移植后发生急性体液性排斥反应的患者 ,术后采用环孢素A、霉酚酸酯和激素行免疫抑制治疗 ,发生急性体液性排斥反应时经甲泼尼龙和抗胸腺细胞球蛋白治疗无效 ,行血浆置换 4～ 6次 ,并给予FK5 0 6 (0 .2mg·kg-1·d-1)及霉酚酸酯 (由 2 g/d加至 3g/d)治疗。 结果　经 4～ 6次血浆置换和FK5 0 6、霉酚酸酯治疗 ,排斥反应得到逆转 ,6例患者肾功能均恢复良好 ,随诊 3～ 18个月 ,患者的血肌酐水平为 (12 5 .2± 2 6 .5 ) μmol/L。 结论　FK5 0 6、霉酚酸酯和血浆置换联合应用能有效地逆转急性体液性排斥反应     

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.     

皮敏消胶囊联合糠酸莫米松乳膏治疗寻常型银屑病的效果

的 探讨对寻常型银屑病患者采用皮敏消胶囊联合糠酸莫米松乳膏治疗的临床效果。方法 选 取公安县中医医院皮肤科2018年8月-2022年7月收治的100例寻常型银屑病患者为研究对象，通过随机 数字表法分为对照组和观察组，每组50例。对照组采用糠酸莫米松乳膏治疗，观察组采用皮敏消胶囊联 合糠酸莫米松乳膏治疗，比较两组中医症状积分、皮损严重程度、炎性因子水平及不良反应发生情况。 结果 观察组治疗后红斑瘙痒、烦躁乏力、舌红苔白评分及PASI评分均低于对照组（P＜0.05）；观察 组治疗后IL-10、IL-17水平均低于对照组（P＜0.05）；观察组不良反应发生率为2.00%，低于对照组的 18.00%（P＜0.05）。结论 皮敏消胶囊联合糠酸莫米松乳膏治疗寻常型银屑病的效果良好，不仅能够有效 改善患者的临床症状，减轻其皮损严重程度，还能有效抑制炎性因子水平，降低不良反应的发生几率。     

Hemodialysis Therapy for Psoriasis

Twenty-five patients with extensive plaque psoriasis resistant to conventional treatment were evaluated for study of the effects of dialytic therapy on the skin lesions. Twenty patients were dialyzed twice a week for six hours each time with a 1.0 m² Cuprophan membrane dialyzer. Eighteen patients responded to this therapy with regression of skin lesions. Twelve of them have not developed recurrence of lesions during a followup period extending from 6 to 27 months. A few new lesions were observed after two to six months in four patients, but the lesions were not severe enough to justify reinstitution of dialysis. Two patients developed relapse within two months after cessation of dialytic therapy. One of them was started on dialysis a second time and this was followed by remission of lesions. Five patients were taken as controls and were treated with other modes of therapy including sham dialysis, ultrafiltration without dialysis, or systemic heparinization before they were taken on the dialysis program. Whereas sham dialysis and systemic heparinization had no effect on the skin lesions which responded later to dialytic therapy, the ultrafiltration procedure was followed by partial regression of psoriasis. Dialysis appears to have a definite role in the treatment of psoriasis.     

卡泊三醇软膏外用联合司库奇尤单抗注射治疗中重度斑块型银屑病的效果

目的 观察运用司库奇尤单抗治疗中重度斑块型银屑病的效果。方法 选取2021年6月-2023年12月 寿光市皮肤病防治站皮肤科收治的120例中重度斑块型银屑病患者为研究对象,随机分为对照组和研 究组,每组60例。对照组采用卡泊三醇软膏外用治疗,研究组在对照组基础上采用司库奇尤单抗注射治 疗,比较两组银屑病皮损面积及严重程度指数（PASI）评分、临床疗效、不良反应发生情况。结果 两组 治疗后PASI评分均低于治疗前,且研究组低于对照组（P＜0.05）;研究组治疗总有效率为96.67%,高于对 照组的71.67%（P＜0.05）;研究组不良反应发生率为3.33%,低于对照组的16.67%（P＜0.05）。结论 卡泊 三醇软膏外用联合司库奇尤单抗注射治疗中重度斑块型银屑病的效果良好,能有效改善银屑病症状,降 低皮肤病变程度,且治疗后不良反应发生几率较低,应用安全性较高。     

Rapid improvement in severe lupus glomerular lesions following intensive plasma exchange associated with immunosuppression

We report our experience of intensive plasma exchange (PE) in the treatment of 12 females with severe diffuse proliferative lupus nephritis. All had active disease with crescentic lesions demonstrated on biopsy immediately before PE. Nine patients were also treated with high dose steroids, three patients with low dose steroids and most patients also received cytotoxic therapy. Eight of the 12 patients were biopsied immediately after a course of PE. All but one patient (low dose steroid group) showed considerable diminution of histologic activity with resolution of crescentic lesions. Plasma exchange may accelerate such resolution over conventional therapy, prevent subsequent sclerosis and preserve functional renal tissue.     

半身式窄谱中波紫外线治疗寻常型银屑病疗效观察

目的:探讨半身式窄谱中波紫外线治疗寻常型银屑病的疗效。方法:将100例寻常型银屑病患者分为A、B两组:A组:采用半身式窄谱中波紫外线照射,起始量为0.4J/cm2,每周3次,每次递加0.1J/cm2,共12次;B组:采用卤米松乳膏、卡泊三醇软膏外涂,每天各1次,共用4周。两组中瘙痒剧烈者均口服盐酸依匹斯汀胶囊10mg,2次/日。结果:A组有效率达58%,B组有效率达30%,两组有效率比较差异有统计学意义(P0.05)。结论:半身式窄谱中波紫外线治疗寻常型银屑病疗效较好,不良反应少,采用起始量为0.4J/cm2,每次递加0.1J/cm2,每周3次的照射起始量,递加剂量安全、有效。     

1540nm Er：glass激光治疗痤疮临床疗效观察

目的探讨1540nmEr：glass激光对痤疮的疗效及安全性。方法应用1540nmEr：glass激光对16例中度痤疮患者进行面部治疗。光斑：4mm;脉宽：3．3ms;6次／疗程,每次间隔2-3周;活动性皮损：10J／cm^2×6pulses,其他部位：10J／cm^2×（3-4）pulses。皮肤冷却：5℃,Constans手柄冷却（QuantelMedical）：结果经6次治疗后,平均疗效指数为85．9％,随访半年后降至80％;患者满意率达90％;皮脂分泌平均减少54,2％。16例患者均无不良反应。结论1540／nm Er：glass激光治疗痤疮安全而有效.     

The Use of Brodalumab in Three Patients with Psoriasis and Psychiatric Comorbidities

Brodalumab, a first-in-class interleukin-17 (IL-17) receptor blocker, carries a black box warning for suicidal ideation and behavior, yet it is also one of the most powerful biologic agents in our armamentarium. We wish to highlight three patients with moderate-to-severe psoriasis and comorbid depression who were successfully treated with brodalumab. The patients were chosen by an expert panel comprising dermatologists, psychiatrists, and psychologists. Psoriasis disease severity was measured using the Psoriasis Area and Severity Index (PASI) score. All three patients experienced PASI 100 after treatment with brodalumab (N=3). Importantly, depressive symptoms improved or resolved in two out of three patients. One patient, who had a history of psychiatric hospitalizations, required in-patient psychiatric treatment during treatment. The use of brodalumab in patients with psoriasis can provide rapid-onset improvement in both skin and depressive symptoms.     

Psoralens used for cosmetic sun tanning: an unusual cause of extensive burn injury

Psoralen combined with long-wave ultraviolt radiation (UV-A) has become a standard, method of psoriasis treatment. A well-known and often appreciated ‘side-effect’ is the hyperpigmentation caused by this treatment. Three patients demonstrating a novel cause of severe skin loss, ‘psoralen burn’, are presented. No patient was afflicted by psoriasis and all three had used psoralen and ultraviolet exposure with the intent to enhance sun tanning. In the case histories presented, it is notable that two of the patients share an alarmingly extensive skin injury (90–95 per cent body surface area), while the third had an extensive but rather superficial injury. In addition, a very similar time-table for the development of the injury could be observed, with a maximum distribution of skin loss not reached until 7 or 8 days after exposure. Psorelen-UV-A can cause life-threatening skin losses when used in an erratic manner. Early recognition of the nature and knowledge of the time-course in the development of these lesions is necessary for optimal treatment. Some principles of treatment are discussed. Dermatologists prescribing PUVA treatment should further increase their warnings of uncontrolled use of psoralens in non-psoriatrics.