血浆置换中不同血管通路对重型肝炎治疗的影响

目的：探讨应用两种不同血管通路进行血浆置换治疗重型肝炎的疗效，及两种方法对治疗的影响。方法：将86例重型肝炎患者在常规内科治疗基础上随机分成2组，分别采取股静脉插管(插管组)和前臂动、静脉穿刺(穿刺组)建立血管通路。观察两组患者进行血浆置换后治疗的有效率、感染发生率，以及对血液总胆红素、丙氨酸转氨酶、血氨、凝血酶原时间、补体等指标的影响。结果：插管组和穿刺组治疗有效率分别为75．56％和78．05％，感染发生率分别为15．56％和4．88％；血浆置换后血液总胆红素、丙氨酸转氨酶、血氨、凝血酶原时间、补体C3均得到显著改善，除总胆红素降低幅度在穿刺组更加明显外，其余各值在两组间差异均无显著性。结论：血浆置换治疗能有效改善重型肝炎患者体内各主要异常血液指标；与插管法相比，穿刺法在降低血液总胆红素方面具有更多的优势。

Influence of different vascular accesses in plasma exchange for treating severe hepatitis

Objective To investigate the influence of plasma exchange (PE) for treating severe hepatitis by two different vascular accesses. Methods Eighty-six patients with severe hepatitis were randomly divided into two groups to accept treatment of PE. Double-lumen catheters in the femoral vein were taken in one group (catheter group), while punctures of brachial (or radial) artery and median vein were taken for the other group (puncture group). Recovering rates and infective rates were observed. The results of total bilirubin (TB), alanine transaminase (ALT), blood ammonia (NH 3), prothrombin time (PT), and complement 3 (C 3) after plasma exchange were analyzed. Results The recovering rates were 75.56% and 78.05% in catheter group and puncture group respectively, while the infective rates were 15.50% and 4.88% respectively. After the treatment of PE, TB, ALT, NH 3, PT and C 3 decreased apparently in both groups, there was no significant difference between two groups except TB, which decreased more obviously in puncture group than in catheter group. Conclusion Plasma exchange with two different vascular accesses is effective for treating hepatitis. In decreasing total bilirubin, the treatment of plasma exchange with puncture of the artery and vein in arm is more effective than that with catheter in the femoral vein.