膜型双重血浆滤过治疗重症肌无力危象患者的护理

目的:探讨膜型双重血浆滤过(DFPP)治疗重症肌无力危象患者时的护理方法.方法:对16例重症肌无力危象患者进行DFPP治疗67次,护理措施包括做好治疗前的准备；治疗过程中做好血管通路护理,正确使用抗凝剂,严格无菌操作；对患者进行健康指导.结果:痊愈4例,好转7例,显效2例,无效1例,中途放弃治疗2例,总有效率81.25％.结论:DFPP治疗可以显著缓解重症肌无力危象患者的临床症状,规范专业的护理措施可保证患者的安全.     

双重血浆滤过治疗狼疮性肾炎并发血栓性微血管病患者的护理

目的探讨双重血浆滤过(double filtration plasma pheresis,DFPP)治疗狼疮性肾炎(lupus nephritis,LN)并发血栓性微血管病(thrombotic microangiopathy,TMA)患者的护理方法。方法回顾性分析2010年12月至2011年3月在南京军区南京总医院血液净化中心治疗的8例LN并发TMA患者的临床资料,所有患者均行DFPP治疗。结果本组患者共行17次DFPP。所有患者经治疗后免疫学指标均明显下降,均顺利完成该项治疗,无一例患者发生低血压、导管感染、出血等并发症。结论 DFPP可以较好地改善LN患者TMA样病变,在治疗中需加强护理,防止各种合并症。     

双重血浆置换治疗抗肾小球基底膜病患者的护理

目的探讨双重血浆置换（DFPP）的临床效果及护理方法。方法对8例抗肾小球基底膜病（GBM）患者进行DFPP治疗,总结DFPP的护理要点,包括治疗前加强心理护理,治疗过程中密切观察患者生命体征,有无并发症的发生,及早发现、及早纠正,严密观察机器各种参数的变化,尤其是血浆入口压和跨膜压,从而保证DFPP顺利进行。结果8例患者共进行53例次DFPP,治疗后血清抗GBM抗体全部下降至阴性（〈20RU／ml）;8例患者症状均有所改善,仅有1例次发生体位性低血压反应。结论血浆置换治疗能迅速降低血浆中抗肾小球基底膜抗体的滴度改善患者预后,护理干预可提高该治疗的寄伞件．     

双重膜滤过式血浆置换治疗巨球蛋白血症近期疗效观察

目的探讨双重膜滤过式血浆置换(double filtration plasmapheresis,DFPP)治疗巨球蛋白血症的临床疗效。方法回顾性分析在中国医科大学附属第一医院住院治疗的巨球蛋白血症患者16例,按照治疗方式的不同分为DFPP组(8例)与常规化疗组(8例),观察2组患者的近期疗效。结果治疗3个月后,DFPP组比常规化疗组患者血清免疫球蛋白IgM显著下降(t=4.192,P0.01)。疗效评价:DFPP组8例中,7例DFPP同时联合化疗,2例完全缓解,5例部分缓解;1例因肝功能严重异常未联合化疗,未缓解;常规化疗组8例患者仅予MPT方案化疗,0例完全缓解,5例部分缓解,3例未缓解。结论DFPP是治疗巨球蛋白血症的安全、有效、快捷的治疗方法之一。DFPP联合化疗可以迅速缓解巨球蛋白血症患者的临床症状,快速改善血生化指标,取得较好的近期疗效。     

高脂血症患者行二重滤过血浆置换治疗的护理

目的　探讨高脂血症患者行二重滤过血浆置换疗法 (doublefiltrationplasmapheresis,DFPP)的疗效及护理。方法　DFPP前后抽血查全套血脂、分析血脂的变化、DFPP操作及护理措施。结果　 5 3例患者 1次DFPP后 ,总胆固醇下降 97.5 % ,甘油三酯下降 91.3%。DFPP过程中 1例一级膜发生凝血 (占 1.89% ) ,2例出现低血压 (占3.77% ) ,3例出现发冷、心慌 (占 5 .6 6 % )。结论　DFPP能显著降低血脂水平 (P <0 .0 1)。护理上注意置换液的平衡 ,血流量和分浆量不宜过快 ,跨膜压 (TMP)、血浆入口压 (Ps)值不能过高 ,另注意肝素的合理应用     

双重滤过血浆单采清除肾移植术前群体反应性抗体临床疗效及安全性观察

目的 观察双重滤过血浆单采(double filtration plasmapheresis,DFPP)在清除肾移植术前群体反应性抗体(panel reactive antibody,PRA)的临床疗效及安全性。方法 回顾分析2021年1月—2023年6月,本院11例肾移植术前PRA阳性患者行DFPP治疗后PRA变化情况,监测治疗前后血常规、肝功能和止凝血等参数。结果 11例终末期肾衰竭患者经DFPP治疗后PRA明显下降,由阳性转为阴性或者弱阳性,除1例患者因一般情况较差,放弃肾移植手术,其余患者顺利进行肾移植手术。患者共进行了62次DFPP治疗。分析显示,患者在行DFPP治疗前后相比,RBC、HB、PLT、ALB、TBIL、PT、APTT、K、Na、Cl、HCO₃^-,差异无明显变化(P>0.05)。结论 DFPP有效地降低了患者肾移植术前高PRA指标和降低肾移植术后急性排斥反应的风险,且治疗过程安全。     

双重滤过血浆置换治疗难治性类风湿关节炎的疗效观察

目的 探讨双重滤过血浆置换(DFPP)治疗难治性类风湿关节炎(RA)的临床疗效.方法 经两或三种改善病情的抗风湿药(DMARDs)规范治疗3～6月以上、病情不能缓解的活动性RA患者82例,随机分为DFPP组42例和非DFPP组40例.均给予柳氮磺胺吡啶+甲氨堞呤治疗;DFPP组在此治疗的基础上予以DFPP治疗.随访12～24个月.DFPP治疗结束后次日及随访结束时进行评估,通过疾病活动指标及类风湿因子、功能评估(HAQ)及美国风湿病学会推荐RA病情改善ACR标准判断临床疗效.结果 ①DFPP组ACR20、ACRS0和ACR70分别为100%、92.9%和81.0%,明显高于非DFPP组(17.5%、0、0,P<0.001),并于随访1～24个月后保持不变.②DFPP组功能评估明显改善,非DFPP组无变化,两组相比差异有统计学意义(P<0.001).③DFPP组疾病活动指标、类风湿因子明显下降,变化显著高于非DFPP组(P<0.001).结论 DFPP可迅速控制难治性RA患者的病情,明显改善功能,提高生活质量,临床疗效显著.     

双重血浆置换在临床危重症疾病18例的疗效观察

目的观察双重血浆置换(DFPP)在两类临床危重症疾病中的疗效和安全性。方法回顾分析2011年1月至2013年12月在血液净化室进行DFPP治疗18例患者的临床资料,其中急性高脂血症性胰腺炎9例,重症自身免疫性疾病(SAID)9例(包括格林巴利综合征2例,重症肌无力1例,难治性类风湿关节炎2例,重症狼疮性肾炎2例,多发性肌炎重叠系统性硬化症1例,抗中性粒细胞胞浆抗体相关性血管炎1例)。结果 (1)18例患者共进行DFPP治疗27次,发生过敏反应2例次,低血压2例次,血浆分离器破膜1例次,经对症处理后均能完成治疗;(2)急性高脂血症性胰腺炎9例DFPP治疗后胆固醇、甘油三酯、白细胞计数、中性粒细胞、C-反应蛋白水平均较治疗前显著下降(P<0.05或P<0.01);8例单次DFPP治疗后腹部症状,体征缓解,1例重症患者死亡。(3)SAID 9例DFPP治疗后免疫球蛋白(Ig G、Ig A、Ig M、Ig E)、补体(C3、C4)、C-反应蛋白、血沉均较治疗前显著下降(P<0.05或P<0.01),3例患者因病情过重死亡。结论 DFPP是临床多种危重疾病的有效治疗方法,其机制可能与快速降低血浆中大分子致病因子(如脂蛋白、免疫球蛋白、补体、免疫复合物等)有关,可为相关危重疾病的进一步治疗创造机会。     

血浆二重滤过治疗激素无反应性视神经炎疗效分析

目的:探讨血浆二重滤过(DFPP)对激素无反应性视神经炎的治疗效果。方法:回顾性总结7例(10眼)激素无反应性视神经炎患者的临床资料,分析DFPP的治疗效果。结果:7例患者中,复发性视神经炎(RON)3例,首次发作视神经炎(ON)4例,转化为视神经脊髓炎(NMO)1例。男∶女=2∶5,年龄分布17~51岁,中位发病年龄31岁。7例患者均表现为急性或亚急性视功能严重受损,共10眼受累,9眼(90%)视力0.01,单眼∶双眼=4∶3。抗核抗体阳性3例,AQP4抗体阳性3例。7例患者均在甲强龙冲击治疗无效后接受DFPP治疗,随访6月后治疗治愈2例、有效2例、失败3例,有效率57.14%。结论:激素无反应性视神经炎的急性期采取DFPP治疗可取得一定的临床疗效。     

1例ECMO联合双重滤过血浆置换治疗危重型新型冠状病毒肺炎并发成人呼吸窘迫综合征的护理

对1例危重型新型冠状病毒肺炎病人应用体外膜肺氧合(ECMO)联合双重滤过血浆置换治疗(DFPP)的护理经验进行总结,认为ECMO联合DFPP治疗操作复杂且并发症较多,需要严密监测病人生命体征及做好ECMO及DFPP参数观察及管路护理,预见性地采取有效护理措施,以预防并发症。     

PRA阳性受体肾移植前行二重滤过血浆置换治疗的护理

探讨肾移植术前二重滤过血浆置换疗法(double filtration plasmapheresis,DFPP)对反应性抗体百分比（percent reactive antibody,PRA)阳性的受体术后排异反应的改善程度及护理。方法 用二重血浆置换林对35例PRA阳性的受体于肾移植术前作DFPP,观察手术前后PRA的改变及排异反应,另设34例作DFP的PRA阳性受体作对照;并分析DFPP的操作及护理措施。结果 35例PRA阳性DFPP后PRA水平均降低,肾移植术后仅16％出现急性排异反应;未作DFPP的阳性受体接受肾移植术后29％出现排异反应。DFPP过程中1例一级膜发生凝血,另1例出现虚脱症状,35例均无热原反应。结论 DFPP能明显改善PRA阳性受体肾移植术后的排异反应发生率。护理上应注意血浆置换量与补浆量的平衡,避免血容量波动;维持水电解质平衡,保持血浆胶体渗透压恒定;DFPP时血流量不宜过快,且须注意肝素的合理应用。     

Ability to remove immunoglobulins and antiganglioside antibodies by double filtration plasmapheresis in Guillain-Barré syndrome: is it equivalent to plasma exchange?

The value of plasma exchange (PE) in Guillain-Barré syndrome (GBS) is well established. In Japan, patients with GBS and related diseases often receive double filtration plasmapheresis (DFPP) as well as PE. No comparative trials between PE and DFPP, however, have been conducted. We compared their abilities to remove immunoglobulins and antiganglioside antibodies to find out whether DFPP is equivalent to PE. The ability to remove immunoglobulins and antiganglioside antibodies was compared between PE and DFPP using plasma samples from 41 patients with GBS and related diseases before and after each treatment session. The ability of DFPP to remove both IgGs and antiganglioside IgG antibodies were significantly inferior to those of PE. There is a less theoretical basis for selecting DFPP as the first choice of plasmapheresis for GBS and related disorders.     

Double filtration plasmapheresis for the treatment of bullous pemphigoid: a three case report.

Bullous pemphigoid (BP) is an autoimmune disease caused by an antidermal basal lamina antibody. In recent years double filtration plasmapheresis (DFPP) has been reported to be an effective therapy for BP. We experienced 3 cases of BP treated by DFPP. DFPP resulted in an improvement in clinical symptoms and remission allowing a decrease in the required dose of corticosteroid. DFPP was found to be an effective treatment for all 3 patients without noticeable adverse events resulting from DFPP. From these results it is concluded that DFPP is worth considering as an option as treatment for BP patients who were unresponsive to conventional steroid therapy, those in whom corticosteroids should be reduced or discontinued because of complications such as diabetes mellitus and/or osteoporosis.     

Plasma exchange versus double filtration plasmapheresis in the treatment of Guillain-Barré syndrome.

Previous studies have shown that both plasma exchange (PE) and double filtration plasmapheresis (DFPP) are effective treatments in Guillain-Barré syndrome (GBS). Whether PE and DFPP have similar effects in GBS is not clear. This report compares the therapeutic effectiveness of PE and DFPP in GBS patients treated in 3 major hospitals in northern Taiwan. A total of 102 patients were included in this survey, including 39 with PE (hereafter PE group) and 63 with DFPP (hereafter DFPP group). Both groups showed significant improvement of disability scores after treatment. However, time to onset of effect was shorter (5.6 +/- 3.5 versus 7 +/- 3.4 days, p < 0.05), and changes of disability scores were more prominent (1.3 +/- 0.8 versus 0.8 +/- 0.8, p < 0.05) in the PE group than the DFPP group. Mortality and outcome after 6 months were not different between the 2 groups. In conclusion, both PE and DFPP are effective treatments in GBS. PE was superior to DFPP in short-term effectiveness. The long-term effectiveness was not different.     

The effectiveness of intravenous human immunoglobulin treatment after plasmapheresis in restoring serum immunoglobulin levels: a preliminary study.

This study was performed to examine the effects of intravenous human immunoglobulin (IVIG) on the level of serum immunoglobulin G (IgG) and its subclasses after plasmapheresis in patients with autoimmune disorders. Twenty-nine patients with predominantly rheumatoid arthritis were enrolled in this study. The plasmapheresis was performed by the use of double-filtration plasmapheresis (DFPP). Immediately after DFPP, IVIG (2.5 g, 50 ml) was intravenously administered. The treatment with IVIG had almost no effect on subjective and objective symptoms. Immediately after DFPP, the total of serum IgG was decreased by approximately 40%. After 24 h, the total of serum IgG recovered to 16% reduction in IVIG-treated patients whereas it remained at 32% reduction in nontreated patients. The beneficial effect of IVIG was significantly observed in patients who had shown 1,000-1,800 mg/dl IgG in their sera. After DFPP, IgG subclasses were decreased without change in the ratio of subclasses. Twenty percent to 30% of IgG subclasses were supplemented by the treatment with IVIG without change in the ratio of subclasses. These results suggested that the treatment with IVIG at minimal amount was safe and effective to supplement IgG for hypogammaglobulinemia after DFPP.     

Double filtration plasmapheresis maintains normal adhesion molecule levels.

Levels of plasma soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and von Willebrand factor (vWF) increase in patients with peripheral vascular or ischemic heart disease. These factors are related to the progression of atherosclerosis. Furthermore, these substances and thrombomodulin (TM) are indicators for assessing the degree of damage to the endothelium. To evaluate the effect of double filtration plasmapheresis (DFPP) on these molecules, the plasma levels of vWF, sICAM-1, sVCAM-1, and TM were measured in 4 familial hypercholesterolemia (FH) patients who underwent treatment with DFPP at 2 week intervals for more than 3 years. The levels of sVCAM-1 and sICAM-1 in hypercholesterolemia patients with ischemic heart disease as a control was 773 +/- 109 and 334 +/- 82 ng/ml. These values were higher than the normal value. In the FH patients who underwent DFPP treatment, the average sICAM-1 levels were 221 +/- 47 and 197 +/- 36 ng/ml before and after, respectively. The average sVCAM-1 levels were 601 +/- 87 and 486 +/- 60 ng/ml. There were no significant differences between the pre- and post-DFPP values. The activities of plasma vWF before and after DFPP treatment were 158 +/- 23 and 45 +/- 9%. The levels of plasma TM before and after treatment were 3.0 +/- 0.3 and 3.4 +/- 0.5 FU/ml. From these results, it is suggested that DFPP treatment does not damage the endothelium and may prevent the progression of atherosclerosis by removing the substances that induce the production of sICAM-1 and sVCAM-1 due to long-term treatment.     

双重血浆置换治疗类风湿性关节炎活动期的作用观察

目的探讨双重血浆置换（DFPP）对类风湿性关节炎（RA）活动期患者类风湿因子（RF）、C反应蛋白（CRP）和血沉（ESR）的影响，评价DFPP对RA的作用。方法RA活动期患者在规范药物治疗的基础上予以DFPP治疗2～3次，比较单次DFPP前后血RF、CRP和ESR的变化，并观察疾病的活动性与置换出血浆颜色的关系。结果DFPP后RF、CRP和ESR下降率分别为22．55％、57．08％和50．48％，均明显低于置换前（P均〈0．001）。活动期RA患者置换出的血浆呈墨绿色、绿色或黄绿色；墨绿色混浊，黄绿色清亮；墨绿色者疾病活动指标（关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、CRP、ESR），均明显高于绿色和黄绿色患者（P均〈0．001）。结论DFPP能明显降低RA活动期患者的RF、CRP、ESR；患者置换出的血浆呈墨绿色、绿色或黄绿色；颜色深浅与疾病活动性相关，疾病活动性越高，颜色越深且越混浊。