红细胞联合血浆置换治疗脑型疟疾患者的经验总结  

Therapeutic erythrocytapheresis combining plasmapheresis for the patients with cerebral malaria and nursing experience

作　　者：李桂平[1] 张环环 张素珍 吴美灵 刘盈盈 张敏[1] 刘萍 LI Gui-ping;ZHANG Huan-huan;ZHANG Su-zhen;WU Mei-ling;LIU Ying-ying;ZHANG Ming;LIU Ping(Department of Hematology, Affiliated Hospital of Jining Medical College, Shandong Jining 272029, Chin)

机构地区：[1]济宁医学院附属医院血液科,山东济宁272029

出　　处：《中国医刊》2018年第6期671-673,共3页Chinese Journal of Medicine

摘　　要：目的探讨应用红细胞联合血浆置换治疗恶性脑型疟疾的效果,总结护理体会。方法纳入2014年12月至2016年1月本院收治的3例恶性脑型疟疾患者,在常规抗疟疾药物治疗的基础上,加用红细胞联合血浆置换治疗,先进行红细胞置换再进行血浆置换,单次治疗时间4.0~5.0小时,采用去白细胞悬浮红细胞10~11单位、病毒灭活冰冻血浆1500~2000ml+4%白蛋白1250ml。每次治疗后观察患者意识状态、生命体征,检测肝肾功能、血常规、凝血功能等。结果 3例患者经3~6次血液置换后,意识恢复,血疟原虫检查阴性,肝肾功能、凝血功能、血常规、生命体征等明显改善,病情痊愈或好转出院。结论在常规抗疟疾药物治疗的基础上,采用红细胞联合血浆置换治疗脑型疟疾安全有效,可作为重型疟疾的辅助治疗措施。Objective To investigate the therapeutic effect of erythrocytapheresis and plasmapheresis on 3 patients with cerebral malaria and summarize nursing experiences. Method Three patients with severe cerebral malaria were given therapeutic erythrocytapheresis followed by plasmapheresis at the basement of anti-malarial chemotherapy. The duration of exchange transfusion of each time was about 4 to 4.5 h, during which leukocyte-reduced erythrocyte suspension（10-11 units）, frozen plasma（1500-2000 ml） and albumin（1250 ml） were involved in. consciousness, vital signs, liver and kidney function, routine blood test and Coagulation function were determined. Result After 3-6 times of therapeutic erythrocytapheresis followed by plasmapheresis, all of the patients recovered consciousness quickly and presented negative parasitemias. Clinical symptoms and laboratory abnormalities were also improved. The hospital stay of the patients were 3-19 d, with complete recovery or improvement. Conclusion Based on antimalarial chemotherapy, erythrocytapheresis in combination plasmapheresis would be an effective and rapid approach to treat severe falciparum malaria.

关 键 词：脑型疟疾 红细胞置换 血浆置换 护理 

分 类 号：R531.3[医药卫生—内科学]