血浆置换疗法治疗重症大疱性皮肤病及药疹47例疗效观察

目的 探讨血浆置换疗法在重症大疱性皮肤病、药疹中的应用价值。方法 对不能耐受糖皮质激素和（或）免疫抑制剂等治疗或经过这些疗法仍难以控制的15例天疱疮、17例大疱性类天疱疮、15例重症药疹患者，采用COBE Spectra血液成分分离机分离患者血液为血浆和细胞成分，将置换液和细胞成分回输，进行连续性血浆置换，每例治疗1 ～ 3次。结果 47例患者中44例（93.62%）获得满意疗效，置换2 ～ 3 d后临床症状减轻，实验室检查结果逐渐改善。11例（23.4%）出现不良反应，包括发热、寒战、四肢麻木、瘙痒、抽搐。结论 血浆置换疗法有助于缓解重症药疹、大疱性皮肤病的病情。

Clinical efficacy of plasma exchange in 47 patients with severe bullous dermatoses or drug eruption

Objective To estimate the therapeutic value of plasma exchange (PE) in severe bullous dermatoses and drug eruption. Methods Plasma exchange was carried out to treat 47 patients with severe dermatoses including 15 cases of pemphigus, 17 cases of bullous pemphigoid and 15 cases of drug eruption who were intolerant or unresponsive to glucocorticosteroids and or immunosuppressants. Cobe Spectra blood cell separator was utilized to collect plasma and cell components from patients' blood, and the replacement fluid and cell components were infused back into patients. Patients received 1 to 3 sessions of plasma exchange. Results Of the 47 patients, 44 (93.62%) achieved satisfactory efficacy with relief of clinical symptoms and improvement of laboratory parameters 2 to 3 days after the plasma exchange. Side effects occurred in 11 (23.4%) patients, which included fever, shivering, numbness of limbs, pruritus and convulsion. Conclusion Plasma exchange is beneficial for the control of severe drug eruption and bullous dermatoses.