血浆置换在临床危重疾病治疗中的安全性分析  

The Safety of Therapeutic Plasmapheresis in Patients with Critical Diseases

作　　者：杨鹏[1] 闻慧琴[1] 卫玉芝[1] 卞茂红[1] 张循善[1] YANG Peng;WEN Hui-qin;WEI Yu-zhi(Department of Blood Transfusion,the First Affiliated Hospital of Anhui Medical University,Heifei 23002)

机构地区：[1]安徽医科大学第一附属医院,合肥230022

出　　处：《临床输血与检验》2018年第3期242-245,共4页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：安徽省自然科学基金(No.1508085QH162)资助

摘　　要：目的观察治疗性血浆置换术在血液系统、神经系统及内分泌代谢系统等危重疾病临床应用中的安全性问题。方法回顾性分析本院2012年10月~2017年12月行血浆置换术的68例患者,观察患者围治疗期的不良反应,检测血浆置换治疗造成的血细胞丢失和溶血情况,分析10例患者保护性抗体HBs Ab的滴度变化。结果 68例患者共进行了262次血浆置换治疗,33.8%的患者出现不同程度的不良反应,在262次血浆置换中不良反应率为16.8%,予以对症处理后短时间内缓解,并完成后续治疗;每次治疗造成的血细胞丢失少于1%血容量,未造成溶血;置换治疗结束的HBsAb滴度最多下降70%~80%,然后逐渐缓慢恢复。结论大多数不良反应是轻微的、易于处理的;不会造成明显血细胞损失和溶血;治疗过程中HBsAb滴度始终在可检出水平之上;血浆置换术是一种安全、可接纳的治疗方法。Objective To observe the safety of therapeutic plasma exchanges（TPE） in patients with critical diseases such as hematologic,neurologic,and metabolic disorders. Method Data of therapeutic plasma exchanges were collected in patients from Oct 2012 to Dec 2017. Detailed information of adverse events were recorded. Blood cell loss,hemolysis and changes of antibody titers were measured. Result Sixty-eight patients received 262 TPE treatments. Among them,33.8 percent of the patients were seen to have TPE related complications,with 16.8 percent of complication occurrence. After corresponding treatments,the adverse reactions were remitted immediately and follow-up treatments were completed. Blood loss of each TPE session was less than 1% of the patient＇s total blood volume. No obvious hemolysis was noted in waste plasma bag. The maximum decrease in HBsAb was achieved on the final day of TPE sessions（70-80% reduction）. A slow return to baseline for HBsAb was observed. Conclusion The majority of complications were mild and manageable. The TPE may not cause obvious blood loss and hemolysis. HBsAb was detectable during the treatment. The TPE is a safe and well tolerated treatment option in several illnesses.

关 键 词：治疗性血浆置换术 不良反应 安全性 

分 类 号：R457.1[医药卫生—治疗学]