血浆置换在重型肝炎肝移植术前应用的临床观察

目的观察和评价术前血浆置换对重型肝炎肝移植的作用。方法回顾性分析连续35例接受原位肝移植的重型肝炎病人的临床资料,并按术前是否行血浆置换分为术前血浆置换组(PE组)19例和术前无血浆置换组(对照组)16例。观察PE组血浆置换前后临床生化指标及内毒素水平的变化;比较两组手术时间、出血量、输血量和应用血制品情况;对两组病人术后恢复过程、并发症生存率进行比较。结果PE组患者血浆置换后,肝功能生化指标明显好转,内毒素水平及血氨较置换前显著下降,凝血酶原时间、凝血酶原国际标化比值较置换前明显好转(P<0.01)。PE组患者手术时间明显缩短,出血量和输血量少于对照组。血浆置换组病人ICU住院时间短、胃肠功能恢复早,与对照组相比差异有显著性。血浆置换组病人呼吸道感染发生率、胆道并发症少于对照组,但差异无显著性;术后半年生存率血浆置换组为78.9%,对照组为56.3%,统计学也无显著性差异(P=0.273)。而死亡病例终末期肝病模型(MELD)评分显著高于生存组病例(P<0.01)。结论重型肝炎患者肝移植术前行血浆置换治疗能改善术前肝功能、凝血功能和减少术中出血。但血浆置换并不能降低围手术期并发症和提高存活率。     

血浆置换治疗重型肝炎两种血管通路的选择比较

目的探讨血浆置换不同血管通路治疗重型肝炎的效果.方法将45例重型肝炎患者随机分为血管穿刺组(n=22例)和股静脉置管组(23例),各42例次.血管穿刺组采用动-静脉血管通路或静-静脉血管通路进行治疗;股静脉置管组采用双腔导管经皮穿刺股静脉进行治疗,监测两组治疗前后的总胆红素(TBIL)、直接胆红素(DBIL)、总胆固醇(TC)及凝血酶原活动度等生化指标变化,并判断临床疗效.结果两组治疗前后各生化指标比较,差异有显著性意义(均P<0.01);治疗后两组各生化指标比较,差异无显著性意义(均P>0.05).结论建立良好的血管通路是血浆置换治疗成功的关键,采用两种血管通路均能显著改善重型肝炎患者的临床症状及生化指标,但应根据患者病情选择不同的穿刺方法.     

低分子肝素在血液透析中的应用

我们于１９９５年５月至１９９５年６月对３３例长期血液透析患者使用低分子肝素（ＬＭＷＨ）抗凝，现报告如下。一、资料与方法选择３３例维持性血液透析患者，年龄３１～６４岁（平均４６．３岁）。透析治疗每周２～３次，每次４～５小时，超滤量２～４ｋｇ。治疗前无高...     

血浆置换治疗慢性乙型重型肝炎疗效评价及其影响因素

目的探讨血浆置换（PE）治疗慢性乙型重型肝炎的治疗效果及其影响因素。方法回顾性对比分析104例慢性乙型重型肝炎患者PE＋药物（治疗组）与60例单纯药物治疗（对照组）治疗前后病情变化和疗效影响因素。结果治疗组有效率为67．31％,明显高于对照组41．67％（P〈0．05）。慢性乙型重型肝炎早、中、晚期患者PE治疗的有效率分别为86．21％、47．06％和33．33％（P〈0．01）;凝血酶原活动度（PTA）在30％-40％的患者疗效明显高于PTA低于20％和20％～30％的患者（P均〈0．01）;年龄〈50岁患者PE治疗的有效率为78．78％（52／66）明显高于年龄≥50岁患者的有效率47．37％（18／38）（P〈0．01）;肝硬化基础上发生的慢性乙型重型肝炎的治疗有效率（36．36％）明显低于非肝硬化基础上发生的慢性乙型重型肝炎有效率（81．69％）,两组差异显著（P〈0．01）。结论血浆置换是慢性乙型重型肝炎安全有效的治疗方法。年龄≥50岁、低凝血酶原活动度和肝硬化基础是PE治疗慢性乙型重型肝炎疗效的阴性预测因子。此外,PE治疗早晚和次数也是影响疗效的重要影响因素。     

低分子肝素和利伐沙班在髋膝关节置换中的应用

下肢深静脉栓塞是髋膝关节置换术后常见并发症,危险性大。目前对临床应用广泛的低分子肝素的有效性及安全性存在一定的争议,对其不良反应研究报道较少。大规模临床试验显示,逐渐应用于临床的利伐沙班作为一种新型口服抗凝药,具有较好的疗效及安全性。该文就低分子肝素和利伐沙班在预防髋膝关节置换术后下肢深静脉栓塞形成中的作用作一简要综述。     

人工肝血浆置换并发症观察与处理

目的探讨人工肝血浆置换术治疗各类型重型肝炎的相关并发症及处理。方法建立血液回路。平均每例2次,最多进行8次血浆置换术。治疗过程中严密监测生命体征及相关并发症的发生。治疗后仍需注意观察相关并发症的发生。结果人工肝血浆置换术治疗安全有效,但有一定的并发症,只要综合全面地预防,及时处理,就能有效提高人工肝血浆置换术治疗的安全性,取得预期效果。结论熟悉人工肝血浆置换术治疗的相关并发症,加强预防,及时处理,能有效减少并发症的发生,保证治疗的顺利进行,提高成功率。     

血液灌注和血浆置换联合熊去氧胆酸治疗慢性重型肝炎疗效观察

在人工肝研究领域,血液灌注、血浆置换等技术和方法被称为非生物人工肝,系主要通过其机械性血液净化原理清除患者体内的毒性物质,达到治疗肝衰竭的目的.研究发现,熊去氧胆酸具有拮抗巯水性胆酸的细胞毒性作用,促进内源性胆汁酸排泄并抑制其吸收,抑制细胞凋亡、抗氧化、调节免疫和抑制炎症等作用.本研究对血液灌注和血浆置换两种典型非生物型人工肝联合熊去氧胆酸,通过清除重型肝炎患者体内的损肝物质达到改善肝脏功能进行初步观察.     

低分子肝素钙在特殊类型断指再植中的应用

低分子肝素(low molecular weight heparin，LMWH)是肝素裂解得到的小分子片段，问世后在临床上得到广泛的应用。我们于1997年11月～2003年8月对45例特殊的断指再植患者术后23例应用低分子肝素钙，取得了良好的疗效，现对比分析如下。     

Cholesterol crystal embolisation in the course of treatment with low-molecular-weight heparins

Cholesterol crystal embolisation is a rare complication of anticoagulant treatment of ulcerative atheromatosis to the great arteries. The embolisation is susceptible to affect both, the somatic and the visceral territory; clinical diagnosis is difficult, mainly because of the similarity between the embolisation symptoms and those produced by a complication of primary disease. The diagnosis is certain when the pathological examination reveal the presence of cholesterol crystal in arteriolar lumen, surrounded by inflammatory- cellular reaction (foreign-body reaction). This paper presents three cases in which we noticed clinical manifestation suggestive for cholesterol crystal embolisation, at patients in treatment with low-molecular weight heparins. The complications which were reported in case of cholesterol crystal embolisation could be extremely severe, specially visceral embolisation, they may lead to patient's death.     

静脉注射人免疫球蛋白治疗重型肝炎的临床研究

目的探讨治疗重型肝炎（SH）的有效药物，研究静脉注射人免疫球蛋白（IVIG）治疗SH的临床价值，评估其安全性。方法62例SH患者分为治疗组（30例）和对照组（32例）。对照组给予卧床休息、能量补充、调节水电解质平衡、保肝、血浆蛋白支持等综合治疗。治疗组在此基础上给予IVIG静脉注射，5g／次，1次／d，共5d。治疗前和治疗后分别检测两组患者的血常规、尿常规、便常规，应用全自动生化分析仪检测肝肾功能、心肌酶、血生化；应用普利生全自动血凝仪检测凝血4项指标（PT、APTT、TT和FIB）。观察时间最长6周，对生存病例随访3个月。结果治疗后两组患者在血生化学方面（TBil、PT、PA和CHE），经比较后差异具有统计学意义（P均〈0．05）。治疗组30例患者中有效24例，有效率为80．00％；对照组32例患者中有效12例，有效率为37．50％，两组差异具有统计学意义（P〈0．01）。不良反应：治疗组出现1例胸闷、轻度气短不适，经对症处理后症状消失，不良反应发生率为3．33％。结论应用IVIG治疗多种原因引起的SH，可以有效改善SH患者的血生化指标，显著提高SH患者的存活率，降低其病死率，且不良反应轻微，是SH安全、有效的治疗手段。     

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。     

Immunoglobulin treatment versus plasma exchange in patients with chronic moderate to severe myasthenia gravis

The purpose of this study was to compare the efficacy of high-dose intravenous immunoglobulin (IVIG) treatment with plasma exchange in patients suffering from moderate to severe myasthenia gravis (MG) in a stable phase. There are no controlled studies comparing IVIG with plasma exchange in patients who despite immunosuppressive treatment have persistent incapacitating MG symptoms. This was a controlled crossover study. Twelve patients with generalized moderate to severe MG on immunosuppressive treatment for at least 12 months were included. The patients were evaluated clinically using a quantified MG clinical score (QMGS) before and at follow-up visits after each treatment. One week after the treatments, the patients who received plasma exchange treatment showed a significant improvement in QMGS compared to baseline but although some improvement was seen after IVIG this did not reach statistical significance. Four weeks after both plasma exchange and IVIG treatments, there was a significant improvement in QMGS compared to baseline. One week and 4 weeks after treatment, no significant difference between the 2 treatments was found. Both treatments have a clinically significant effect 4 weeks out in patients with chronic MG, but the improvement has a more rapid onset after plasma exchange than after IVIG.     

Do low-molecular-weight heparins influence the healing process in colon anastomosis?

Anastomosis leakage is one of the most serious complications of colorectal surgery. A role for extracellular matrix remodelling in the healing process of the colon wall has been recently postulated. Changes in matrix metalloproteinase (MMP) activity in the intestinal wall occurring prior to elective resection and primary anastomosis appear to be responsible for dehiscence leading to anastomosis. Thrombophylaxis using low-molecular-weight heparins is routinely administered to all patients during the perioperative period. However, adverse antiproliferative and proapoptotic effects such as limitation of bioavailability of growth factors and angiogenesis inhibition have been characterized in various cell types as a result of heparin administration. It is also likely that relationships exist between extracellular matrix homeostasis and the coagulation/fibrinolysis system. We hypothesize that subcutaneous administration of LMWHs (low-molecular-weight heparins) may influence matrix metalloproteinase activity in the colon wall and increase the risk of postoperative leakage.     

血液灌流联合血浆置换治疗重度有机磷农药中毒的疗效观察

目的 研究血液灌流联合血浆置换治疗重度有机磷农药中毒的治疗效果.方法 将61例重度急性有机磷农药中毒患者按随机数字表法分为3组,血液灌流联合血浆置换19例为治疗组;血液灌流18例为对照Ⅰ组;常规治疗24例为对照Ⅱ组,比较治疗组和对照组在昏迷至清醒时间、胆碱酯酶活力恢复时间、住院时间、病死率等方面的差异.结果 治疗组患者昏迷至清醒时间、血清胆碱酯酶活力恢复时间、住院时间与对照组比较差异有统计学意义(P＜0.05).结论 血液灌流联合血浆置换治疗重度有机磷农药中毒的疗效显著.     

Cyclosporin A and therapeutic plasma exchange in the treatment of severe systemic lupus erythematosus

Despite treatment with intensive immunosuppressive drug regimens, often the prognosis of patients suffering from systemic lupus erythematosus (SLE) is poor. Side effects such as infections and malignancies often occur. It was the aim of this trial to assess the effect of immunosuppression, in particular with cyclosporin, and the efficacy, safety, and clinical utility of intermittent treatment with therapeutic plasma exchange (TPE) in comparison to previous intensive therapy strategies using corticosteroids, azathioprine, and/or cyclophosphamide. In this prospective trial, 28 patients (24 women, 4 men, aged 36.3 +/- 11.8 years at the diagnosis of SLE) were treated for up to 10 years with drug regimens out of corticosteroids, azathioprine, and/or cyclophosphamide. Then, over a period of up to 8 years, in addition to conventional therapies, especially in active stages of the disease with extremely high concentrations of anti-DNA, anti-nuclear antibodies, and circulating immunocomplexes, TPE sessions were carried out depending on symptomatology. In addition, the patients received cyclosporin. Compared with previous treatment modalities, clinical symptoms improved more quickly and more effectively. During the study period of a mean of 5 years, corticosteroids, azathioprine, and cyclophosphamide were reduced by 40 to 100%. No severe side effects were seen. In acute stages of SLE and in forms with persistently high antibody levels, the addition of TPE sessions and cyclosporin as the basic immunosuppressive drug is mostly very effective with regard to improving clinical symptomatology.     

镁离子制剂治疗重型颅脑损伤的临床研究

目的探讨镁离子制剂治疗重型颅脑损伤的疗效和安全性.方法选择GCS评分5～8分患者60例,采用随机双盲前瞻性临床对照研究方法分组,治疗组在综合常规治疗基础上,在伤后24小时内静滴硫酸镁针,每日应用硫酸镁针20ml,连续治疗10天,对照组给予一般综合常规治疗.分析对比治疗前后和治疗过程中患者的病情和重要辅助检查指标的变化趋势,并同时对比随访结束时患者神经功能恢复情况和生活质量状况,并对结果进行统计学分析.结果治疗组GCS评分在用药后第5天开始明显优于对照组(P＜0.05),治疗结束后和随访结束后治疗组GOS评分明显优于对照组(P＜0.05),治疗组伤残情况、并发症等也明显优于对照组(火0.05).试验过程中未发现用药造成的毒副反应.结论早期及时补充镁离子能促进重型颅脑损伤患者神经功能恢复,降低致残率,改善远期生活质量,并具有相当可靠的安全性.