血浆置换在严重肝病患者中的应用及护理

血浆置换（Plasma exchange,PE）是将患者含有毒素或致病物质的血浆分离出来弃去异常血浆或血浆中的病理成分,再将血细胞与其他保留成分及废弃血浆等量的置换液一起回输体内,达到治疗的目的。可以用于急性肝功能衰竭、慢性重型肝炎、肝脏移植及其他免疫性疾病的治疗。2008年1～12月本院感染性疾病科对严重肝病患者在常规治疗的基础上加用PE疗法,为治疗重型肝病患者提供了简便、安全、有效的治疗方法,现将护理工作归纳如下。     

血浆应用与晚期肝病患者并发贫血的相关性研究

慢性肝脏疾病发展至晚期常常并发其它各系统疾病,而贫血是晚期肝病患者并发血液系统异常的常见表现之一.脾功能亢进、血管内溶血性贫血、消化道出血,铁、叶酸和维B12缺乏,慢性疾病性贫血,以及骨髓造血功能抑制等,都可能是引起贫血的潜在原因.     

宁夏第五人民医院2008年-2010年血浆输注情况分析

血浆是血液的液体成分,由蛋白质、脂类、无机盐和大量化合物组成。主要生理功能有补充蛋白质、维持酸碱平衡、运输、调节和维持胶体渗透压等。血浆制品主要有新鲜冰冻血浆（FFP）和普通冰冻血浆（FP）,前者包含全部凝血因子,后者不稳定的凝血因子特别是Ⅴ因子和Ⅷ因子几乎全部失活。血浆输注主要用于凝血因子缺乏如：肝脏疾病、弥漫性血管内凝血、血栓性血小板减少性紫癜、接受大剂量输血病人凝血因子损失、烧伤及其它疾病的血浆置换等。现将我院2008年-2010年血浆应用情况进行分析如下：     

血浆置换联合自血光量子方法在肝病治疗中的应用

血浆置换 ( PE)作为人工肝支持系统的一种方法用于肝病患者的治疗 ,临床已有报道 [1] 。自血光量子 ( UBIO)通过抗感染以及离子化 ,具有阻断肝细胞衰竭等作用 ,也在临床上受到重视 [2 ,3 ] 。但 PE联合 UBIO在肝炎特别是重型肝炎患者中的应用报道较少。本文对 97例肝病患者 (其中重型肝炎84例 )采用 5 1 9次 PE联合 35 0次自血光量子治疗方案 ,现报告如下。材料与方法1　一般材料　治疗组为 1 994年 4月～ 2 0 0 0年 1 2月住院患者 97例 ,男 85例 ,女 1 2例 ,年龄 9～ 60岁 ,平均年龄 35± 1 0岁。临床诊断 :急性重型肝炎3例 ,亚急性…     

缺乏凝血因子Ⅶ基质血浆的制备及在肝病中的应用

凝血因子Ⅶ(coagulation factorⅦ,FⅧ)是外源凝血系统的因子之一。FⅧ的血浆水平降低或升高会导致临床出血或血栓形成。本文报道FⅧ基质血浆的制备及肝病患者测定FⅦ促凝活性(FⅦcoagulant activity,FⅧ: CA)的意义。     

肝病患者几种血浆凝血因子检测的临床意义

大部分血浆凝血因子产生于肝脏、肝细胞损害时,凝血因子的生成减少,其减少的程度与肝病严重性相关。本文检测了100例各种肝病血浆凝血因子的活性,如Ⅱ:CA,Ⅴ:CA,Ⅺ:CA,Ⅹ:CA及因子Ⅱ抗原含量(Ⅱ:Ag),以探讨它们的临床意义。材料和方法一、检测对象(一)正常组:男女各10例,年龄23～54岁。无肝病和维生素K缺乏症史,无出血性与血栓性疾     

大连地区血浆临床应用调查分析

目的了解大连地区血浆应用情况,提高临床血浆合理输注水平。方法按照国家颁布的相关技术规范,对大连22家医院临床血浆应用进行回顾性研究。结果二级医院和三级医院血浆合理输注比例均偏低,不合理分类中血浆输注无指征占比例最大。结论无论是二级医院还是三级医院,在血浆临床输注方面还存在误区,临床医生还未完全掌握血浆输注适应征。     

重型肝炎患者血浆置换治疗前后凝血功能变化的研究

目的观察重型肝炎患者采用血浆置换治疗前后凝血功能的变化情况。方法 46例重型肝病患者在综合治疗的基础上经血浆置换,通过观察凝血功能的变化,判断分析血浆置换治疗重型肝炎的临床疗效。结果经血浆置换治疗后凝血酶原时间(PT)、部分凝血酶原激活时间(APTT)、凝血酶原凝固时间(TT)均有不同程度的缩短(P<0.05),纤维蛋白原(Fib)无显著改变(P>0.05)。结论在综合治疗的基础上血浆置换是治疗重型肝病一种有效的手段。     

重型肝病血浆置换术的临床观察与护理

目的观察血浆置换治疗重型肝炎的临床疗效并总结护理体会。方法对42例重型肝炎患者进行血浆置换138次置换，比较置换前后患者临床症状、肝肾功能、凝血功能、内毒素等指标的变化，观察不良反应，总结护理体会。结果置换后患者症状明显缓解，总胆红素、转氨酶、总胆汁酸、内毒素均较治疗前显著下降；血浆白蛋白较置换前升高，凝血酶原时间缩短。结论血浆置换能显著改善重型肝炎患者临床症状及生化指标。全面的术前准备、针对性的心理护理以及严密细致的术后观察与护理，有助于保证血浆置换的顺利进行，从而提高疗效和减少并发症。     

血浆置换治疗肝病出现并发症的循证护理

人工肝支持系统是重症肝炎、肝衰竭的重要治疗措施,包括血浆置换、血液灌流、血液滤过、血液透析、血浆吸附等方法单用或联合应用[1].本院采用血浆置换(PE)治疗肝炎患者,疗效显著.但在治疗中及治疗后不同程度地发生了并发症.     

某院2007～2011年临床输血情况调查分析

目的：通过相关资料调查分析,了解临床输血情况,为提高合理用血提供参考。方法对成都市第三人民医院2007～2011年临床输血总量、成分用血情况、内科及外科用血情况等进行调查分析。结果成都市第三人民医院临床用血总量呈逐年上升趋势,成分血使用比例一直维持在99％以上;存在血浆用量偏高现象。结论虽临床成分输血比例高,但仍存在用血不合理现象,需加强相关人员培训,以期进一步提高临床输血质量。     

某院2008～2010年成分输血分析

目的 分析该院过去三年成分输血情况,指导临床科学、合理用血.方法 对该院2008～2010年用血量进行统计,计算出各种成分输血率.结果 成分输血使用量逐年增加,以红细胞、血浆为主,血浆的应用比例逐年下降.结论 该院成分输血率已达较高水平(≥99.9%),但是临床血浆的滥用情况应该得到进一步遏制,仍需继续加强对成分输血的监督管理,强调血小板和冷沉淀的配合使用,以便节约有限的血液资源.     

Blood exchange transfusion in viral hepatitis in a small infant: a case report

We report a case of blood exchange transfusion to treat acute liver failure following hepatitis B infection at the Infectious Disease Department of Children's Hospital No.2 in Ho Chi Minh City, Vietnam. A 3.5-month old baby boy was admitted to the hospital with a presentation of progressively worsening jaundice for the past one month. The patient was diagnosed with hepatitis B infection with a positive HBV DNA quantitative assay. Plasma exchange was indicated in view of progressive liver failure and gradually increasing hepatic coma. However, it was impossible to perform plasmapheresis in this case because the patient was small (in terms of age and weight) and there was no suitable plasma exchange filter. Accordingly, the patient was treated with 3 times of blood exchange transfusion in combination with an antiviral drug, lamivudine. After each blood exchange transfusion, the biochemical values (bilirubin, liver enzymes, and coagulation profile) gradually improved and he was discharged after 1 month of treatment. Blood exchange transfusion is an effective procedure for managing acute liver failure, where plasma exchange is not possible while waiting for the recovery of liver functions or liver transplantation.     

双重血浆分子吸附联合血浆置换治疗慢加急性肝衰竭的疗效分析

目的 观察双重血浆分子吸附系统（DPMAS）联合血浆置换（PE）治疗慢加急性肝衰竭（ACLF）的疗效及安全性。方法 回顾性分析2016年1月至2018年12月我科收治并行人工肝治疗的乙型肝炎ACLF患者69例,其中DPMAS联合PE组32例,单纯PE组37例。观察两组治疗前后血清生化指标、凝血指标和血小板（PLT）的变化,观察疗效及不良反应。结果 两组4周总有效率和12周生存率差异无统计学意义。两组治疗后总胆红素（TBil）、白蛋白（ALB）、总胆汁酸（TBA）差异有统计学意义。两组治疗后与治疗前比较,肝功能及凝血功能均明显好转,差异有统计学意义;联合组PLT治疗前后差异有统计学意义。两组不良反应发生率差异无统计学意义（P＞0.05）。结论 DPMAS联合PE治疗ACLF疗效确切,能减少血浆用量,安全性较高。     

Whole blood versus red cells and plasma for exchange transfusion in ABO haemolytic disease

Records of 381 neonates who underwent exchange transfusion (ET) due to ABO haemolytic disease at the Division of Neonatology of Hacettepe University, Ankara, Turkey, between January 1977 and December 2003 were reviewed. Records were kept for the type of blood used in ET, the number of ETs for each infant, adverse event attributable to ET and bilirubin levels before, and 4 and 8 h after each ET. Of 381 infants, 300 were transfused with whole blood, whereas 81 infants were transfused with O red cells suspended in A or B plasma. The re-exchange rate was higher in the whole blood group, compared with the erythrocyte and plasma group. Use of erythrocyte and plasma provided 30% reduction in the number of ETs per patient. Eight hours after the first ET, mean bilirubin levels were 84% of the pre-exchange values in the whole blood group and 73% of the pre-exchange values in the erythrocyte and plasma group (P = 0.001). As the use of O group red cells re-suspended in AB plasma decreased the re-exchange risk compared with O group whole blood, we suggest the use of O red cells re-suspended in AB plasma for the ET in cases of ABO haemolytic disease.     

Effect of packed red blood cells transfusion on plasma fibronectin during liver resection

Our study aimed at evaluating the effect of blood transfusion - allogeneic or autologous - on plasma levels of fibronectin during liver resections. Thirty-five patients scheduled for liver resection were randomly allocated to receive autologous (group autologous blood transfusion (ABT), n= 19) or allogeneic (homologous) (homologous blood transfusion (HBT), n= 16) packed red blood cell to maintain serum haemoglobin concentration above 9 g. Serum levels of fibronectin were measured before induction of anaesthesia, at the end of operation and at first, third and sixth postoperative day. Perioperative morbidity and survival rate were also recorded. Serum fibronectin levels were significantly higher (P < 0.05) in the autologous group than in the allogeneic, at the first (134 +/- 49 microg mL(-1) vs. 89 +/- 31 microg mL(-1)) and third (178 +/- 51 microg mL(-1) vs. 96 +/- 41 microg mL(-1)) postoperative day. No differences in survival and complication rate between the two groups were observed. Concentrations of serum fibronectin seem to be adversely affected by allogeneic blood transfusion during liver resection surgery, although this does not seem to affect patients' morbidity and mortality.