血浆置换治疗重症肝炎的临床观察

目的观察人工肝血浆置换（PE）治疗重症肝炎的疗效。方法使用金宝PRASMA连续性肾替代治疗机,对2006年1月～2010年3月的32例重症肝炎使用血浆置换治疗,每次置换2500～3000ml,每例治疗2～3次,观察临床症状和生化指标（黄疸指数、肝功酶学、凝血酶原时间）以及不良反应。结果 32例中治愈14例（43.75%）,好转10例（31.25%）,治愈好转率75%,无效8例（25%）,治疗前后比较黄疸指数、转氨酶、凝血酶原时间均有显著差异,15例次发生不良反应,经及时处理很快消失。结论血浆置换治疗重症肝炎疗效确切,是重症肝炎重要治疗手段之一,并发症轻、少,治疗重症肝炎是安全可行的,同时发现PE治疗对急性、亚急性重症肝炎效果优于慢性重症肝炎,建议确诊重症肝炎后及早实施,有条件实施的医院应作为常规治疗手段。

Clinical observation of treatment of serious hepatitis by plasma exchange

Objective To observe the therapeutic effect of plasma exchange（PE）in patients with serious hepatitis.Methods A total of 32 cases wi th serious hepatitis were enrolled with 2～3 times of treatment each case and 2500～3000ml frozen plasma was used for each time.The clinical symptoms,biochemical indexes（eg：icteric index,liver enzyme,thrombin time）,as well as side effects were examined before and after treatment.Results Of the 32 cases 14 were cured（43.75%）and 10 were improved（31.25%）,the improvement rate was 75%,8 cases were ineffective.The biochemical indexes（eg：icteric index,liver enzyme,thrombin time）had significant differences aftertreatment.15 cases developed adverse reaction that quickly disappeard after promptly managed.Conclusion Therapeutic effect of plasma exchange in patients with serious hepatitis is quite certain,it is one of the important therapeutic tools for serious hepatitis.