血浆置换治疗血栓性血小板减少性紫癜的疗效观察

目的 进一步了解血浆置换治疗血栓性血小板减少性紫癜(TTP)的疗效. 方法 对4例确诊为TTP的患者给予糖皮质激素治疗联合血浆置换,深静脉置管建立体外循环,用贝朗Diapact CRRT机及费森尤斯P2S血浆分离器进行血浆置换,新鲜冰冻血浆为置换液,血浆置换量35～ 40 mL/kg,置换速度15 ～20 mL/min,血流速度120～150 mL/min,小剂量低分子肝素抗凝.血浆置换每日或隔日治疗1次.观察血液检验指标和临床症状改善情况. 结果 4例TTP患者每例完成3～5次血浆置换,治疗后血小板计数(PLT)、血红蛋白(Hb)上升,尿素(BUN)、总胆红素(IBIL)、乳酸脱氢酶(LDH)降低,治疗前后的结果经统计学处理,P＜0.01,随访6个月全部治愈.结论 血浆置换治疗TTP效果明显,TTP病人应争取早期血浆置换治疗,提高疗效,降低病死率.

Curative Effects on Plasma Exchange Treatment for Thrombotic Thrombocytopenic Purpura

ObjectiveTo further explore the curative effect of plasma exchange treatment for thrombotic thrombocytopenic purpura(TTP).MethodsApply the treatment of glucocorticoid combined with plasma exchange therapy to 4 patients diagnosed as TTP,building extracorporeal circulation with deep venipuncture.Adopt the plasma exchange with Braun Diapact CRRT and Plasmaflux P2S plasma separator,with fresh frozen plasma as replacement liquid,the volume of substitute fluid between 35 and 40mL/ kg,the replacement speed between 15 to 20 mL/min,and blood flow velocity between 120 to 150 mL/min.Take anticoagulation with small doses of low molecular heparin.Apply the plasma exchange daily or on the second day for 1 time,Observing the improvement of blood testing index and clinical symptom.ResultsThe PLT,Hb,BUN,IBIL and LDH were significantly improved (P<0.01) for every patients after being taken 3 to 5 times of plasma exchange,and all the 4 patients were cured for 6 months of follow-up.ConclusionsPlasma exchange treatment should be applyed as soon as possible for TTP patient as the obvious treatment effect.