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.     

双重血浆置换治疗类风湿性关节炎的临床应用及护理

通过对45例类风湿性关节炎(RA)患者110例次的双重血浆置换(DFPP)治疗及护理,表明双重血浆置换对类风湿关节炎患者减轻症状、减少复发、改善预后有重要的临床意义。强调充分做好治疗前的心理护理,治疗时加强患者生命体征的观察,治疗后注意穿刺部位的压迫止血,同时加强营养并注意休息。     

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。     

双重滤过血浆置换治疗高脂血症的护理

总结了25例高脂血症患者应用双重滤过血浆置换（DFPP）治疗的护理措施：包括在治疗过程中,加强病情观察、心理护理,掌握技术操作要点、积极预防并发症;在治疗后做好饮食指导和健康教育一认为双重滤过血浆置换治疗高脂血症安全、有效,精心的护理是治疗成功不可或缺的重要条件。     

双重滤过血浆置换与血浆置换治疗重症自身免疫性疾病的比较研究

目的比较双重滤过血浆置换(DFPP)和血浆置换(PE)治疗重症自身免疫性疾病(SAID)的差异。方法 27例SAID患者分为两组,分别采用DFPP和PE进行治疗,对疗效、并发症、费用、住院时间、实验室指标等进行比较。结果 PE组平均治疗2.2次、住院时间42.5d、治疗费用3.95万元,DFPP组平均治疗2.88次、住院时间41.94d、治疗费用4.99万元。PE组显效50%,好转30%,无效20%;DFPP组显效52.94%,好转35.29%,无效11.76%;两组疗效相当。PE组并发症发生率45.45%,DFPP组并发症发生率8.16%,DFPP组并发症明显少于PE组(P0.05)。PE后白细胞、血红蛋白、血小板、血钾、血肌酐、尿素氮、谷丙转氨酶、白蛋白、球蛋白、免疫球蛋白A(IgA)、IgG、IgM、C3没有差异(P均0.05),只有血钠略有上升(P0.05)。DFPP后白细胞、血红蛋白明显升高,白蛋白、球蛋白、IgA、IgG、IgM、C3明显降低(P均0.05),血小板、血钾、血钠、血肌酐、尿素氮、谷丙转氨酶变化不大(P均0.05)。结论 DFPP在治疗SAID中的作用与PE相当,并发症和风险较小,治疗更有保障。     

双重血浆置换联合高容量血液滤过治疗高脂血症合并重症胰腺炎的观察及护理

重症急性胰腺炎（Severe Acute Pancreatitis,SAP）是一种全身性炎症反应综合征（SIRS）,炎症介质的过度生成是主要因素。高脂血症（Hyper—lipidemic HL）是急性胰腺炎的危险因素之一,急性胰腺炎与高脂血症的并存率约为12％～38％,且常常在病程中互相导致或者加重。     

血浆置换治疗难治性类风湿性关节炎的观察与护理

我院2002年12月～2004年8月，对12例难治性类风湿性关节炎（RA）患进行血浆置换治疗（PE），收到较好效果，零将临床观察和护理报告如下。     

双重滤过膜式血浆置换联合化疗治疗多发性骨髓瘤

选择性双重滤过膜式血浆置换是将血液分离出的致病血浆进行二级分离,弃除致病因子,达到治疗疾病的目的.笔者用该法联合化疗治疗高粘滞度、高免疫球蛋白和肾功能不全的多发性骨髓瘤11例,疗效显著.     

双重滤过血浆置换联合激素冲击治疗狼疮性脑病1例的护理

正系统性红斑狼疮是(SLE)是一种累及全身的自身免疫性疾病~([1])。当病变累及中枢神经系统时称为狼疮性脑病或中枢神经系统红斑狼疮~([2])。病人可发生各种精神障碍,如躁动、抽搐、幻觉、妄想等,重者出现癫痫发作。糖皮质激素通过强大的抗炎及免疫机制,降低病人体内的自身抗体水平,达到SLE的治疗目的。双     

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。     

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.     

Double filtration plasmapheresis for a case of Crimean-Congo hemorrhagic fever

Crimean-Congo hemorrhagic fever (CCHF), is a fatal viral infection transmitted to humans through a tick bite or exposure to blood or tissues of viremic hosts. The clinical presentation is characterized by sudden onset high fever, headache, myalgia, abdominal pain and nausea–vomiting followed by gastrointestinal, urinary, respiratory tract and brain hemorrhage. Laboratory findings include leucopenia, thrombocytopenia, elevated liver enzymes, prolonged prothrombin time and activated partial thromboplastin time. We report a case of CCHF who was treated with a combination of DFPP and ribavirin therapy. As a result of this multimodal treatment, patient’s clinical symptoms and laboratory findings improved gradually.     

Double filtration plasmapheresis in the treatment of inflammatory polyneuropathy.

Twelve cases of recognized inflammatory polyneuropathy were treated by plasmapheresis (PP) at Shin-Kong Wu Ho-Su Memorial Hospital from November 1993 to November 1995. These include 6 cases of acute inflammatory demyelinating polyneuropathy (AIDP), 4 cases of chronic inflammatory demyelinating polyneuropathy (CIDP), one case of Fisher syndrome, and one case of Sj?gren's syndrome with polyneuropathy. The patients chosen for PP met the inclusion criteria of severely disabled, i.e., Grade 4 (bed or chair bound) or Grade 5 (required assisted ventilation), or an unremittingly progressive course. Plasmapheresis was carried out by the double filtration method. Each patient received a standard course of at least 4 sessions of pheresis. All the patients receiving PP showed a beneficial response. The treatment for 10 patients was judged to be effective. The other 2 patients (one AIDP and one CIDP), though improved, were unable to reach Grade 2. Among the complications of PP, only 4 episodes of symptomatic hypotension were noted in a total of 73 sessions of PP. In conclusion, PP is safe and effective in treating inflammatory polyneuropathy.     

二重血浆分离治疗高脂血症及急性高脂血症性胰腺炎

目的探讨二重血浆分离治疗高脂血症以及急性高脂血症性胰腺炎的临床效果。方法应用二重血浆分离对17例高脂血症患者（其中7例为急性高脂血症性胰腺炎患者）进行治疗,观察治疗前后临床症状及血脂的变化,对于急性胰腺炎患者评定治疗前后的APACHEII评分。结果17例高脂血症患者总共接受二重血浆分离治疗22次,治疗后临床症状改善,每接受一次治疗血清甘油三酯平均下降55.37%,血清胆固醇平均下降43.26%;7例急性高脂血症性胰腺炎患者每次治疗后48hAPACHEII评分平均下降35.53%。结论二重血浆分离是治疗高脂血症高效、安全的方法;对急性高脂血症性胰腺炎患者,用其早期干预对改善预后有重要意义。     

Cascade use of plasmapheresis and plasma filtration in the treatment of rheumatoid arthritis

The effect of incorporation of cascade plasmapheresis and plasma filtration in multimodality therapy was studied in 4 patients with rheumatoid arthritis (RA). The result was estimated as "excellent" (complete disappearance of clinical symptoms of the articular syndrome and normalization of the activity laboratory indices) in one patient; "good" (the reduction of clinicolaboratory activity) in 2 patients and "satisfactory" (the reduction of symptoms of the articular syndrome without changes of a degree of general activity of disease) in one patient. Cascade plasmapheresis and plasma filtration significantly improved clinical and many laboratory indices of RA activity and humoral immunity indices during treatment. A long period of observation is required to assess long-term results of the effect of this method. A great advantage of the method is a possibility of decreasing substitution protein solutions without negative effects with relation to the blood total protein level. The absence of a necessity of catheterization of central vessels, more complete blood separation into plasma and erythrocytes make cascade plasmapheresis and plasma filtration more preferable. Good tolerance of the procedure, fast improvement, a chance to avoid side-effects of drug therapy, a lower risk of allergic reactions to plasma substitutes as compared to those in plasmapheresis and lymphocytoplasmapheresis make the method promising for RA treatment.     

腹水双重滤过浓缩回输治疗肝硬化腹水并严重腹腔感染及尿毒症1例

1 病例介绍 病人,男,51岁.因乙型肝炎表面抗原阳性13年,间断腹胀3年,加重1月,患尿毒症4个月,于2008年6月1日入院.入院查体:病人发热,腹部明显膨隆、张力大,无明显压痛及反跳痛.     

腹水双重滤过浓缩回输治疗肝硬化腹水并严重腹腔感染及尿毒症1例

1 病例介绍 病人,男,51岁。因乙型肝炎表面抗原阳性13年,间断腹胀3年,加重1月,患尿毒症4个月,于2008年6月1日入院。入院查体：病人发热,腹部明显膨隆、张力大,无明显压痛及反跳痛。腹水检查：黄色混浊,李瓦他试验（＋）,细胞总数为2．1×10^9／L,白细胞2．0×10^9／L,其中中性粒细胞0．93。涂片未见异常。血常规：白细胞13．8×10^9／L,中性粒细胞0．92。诊断：肝炎、肝硬化（乙型肝炎活动性）、腹腔积液合并重度腹腔感染、     

A case of liver cirrhosis complicated with endotoxemia and disseminated intravascular coagulation: a case report

A 59-year-old female was admitted to our hospital because of massive ascites and increasing jaundice, suggesting a severe decompensated state of liver cirrhosis. On the third hospital day, she was diagnosed as disseminated intravascular coagulation (DIC) from a coagulofibrinolytic study and developed renal failure. Continuous drip infusion of gabexate mesilate, a synthetic inhibitor of serine-protease, was found to be successful in managing DIC, followed by the restoration of renal function. During the clinical course, blood endotoxin, assayed by the chromogenic method, was initially 11 pg/ml and increased, in accordance with the elevation of serum FDP, to a level of 110 pg/ml when renal failure occurred. A proportional relationship was observed between changes in blood endotoxin and serum FDP throughout the course. This finding may be an important clue in studying the mechanism of DIC and non-septic endotoxemia both developing in liver cirrhosis.