人工肝血液净化联合康复者血浆治疗2例重型新型冠状病毒肺炎的疗效及预后  

Effect and recent prognosis of artificial liver blood purification combined with convalescent plasma in the treatment of 2 cases with severe COVID-19

作　　者：马沙沙 翟蕙[1] 高春明[1] 胡俊锋[2] MA Sha-sha;ZHAI Hui;GAO Chun-ming;HU Jun-feng(Department of infectious diseases,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of respiratory medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China)

机构地区：[1]蚌埠医学院第一附属医院感染科,安徽蚌埠233004 [2]蚌埠医学院第一附属医院呼吸科,安徽蚌埠233004

出　　处：《暨南大学学报（自然科学与医学版）》2021年第1期88-93,共6页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：蚌埠医学院第一附属医院临床医学研究基金项目(2020KY010)。

摘　　要：目的:探讨人工肝血液净化联合康复者血浆治疗对新型冠状病毒肺炎(COVID-19)重型患者的疗效.方法:2例COVID-19重型患者按照《新型冠状病毒肺炎诊疗方案(试行第六版)》给予呼吸支持、抗病毒、抗全身炎症反应等综合治疗,同时进行人工肝血液净化和康复者血浆输注治疗,2例COVID-19患者均行1次血浆置换(PE)联合连续性肾脏替代治疗(CRRT),并输注COVID-19康复者恢复期血浆200 mL.观察治疗前后白介素-6(IL-6)、C反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR)、氧合指数(PaO2/FiO2)等指标变化及肺部病变吸收情况.结果:治疗后患者IL-6、CRP、NLR明显降低,前白蛋白(PA)明显升高,肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)逐渐降低,氧合指数明显改善,肺部病灶逐渐吸收.结论:PE+CRRT联合COVID-19康复者血浆能明显抑制重型COVID-19患者细胞炎症因子水平,促进疾病康复,是治疗COVID-19重型患者的有效方法.Objective:To investigate the effect of artificial liver blood purification combined with convalescent plasma therapy on severe patients with Corona Virus Disease 2019(COVID-19).Methods:Two patients with COVID-19 were given comprehensive treatment including respiratory support,antiviral and anti-systemic inflammatory response under the guidelines,and at the same time were treated with artificial liver blood purification and convalescent plasma,including plasma exchange(PE)and continuous renal replacement therapy(CRRT).Both patients received 1 time of artificial liver blood purification and infusion of 200 mL of COVID-19 convalescent plasma.Changes in interleukin-6(IL-6),c-reactive protein(CRP),neutrophil/lymphocyte ratio(NLR),oxygenation index(PaO2/FiO2)and absorption of pulmonary lesions were observed before and after treatment.Results:After the treatment,IL-6,CRP and NLR were significantly reduced,PA was significantly increased,creatine kinase(CK),creatine kinase-MB(CK-MB)and lactate dehydrogenase(LDH)were gradually reduced,oxygenation index was significantly improved,and pulmonary lesions were gradually absorbed.Conclusion:PE and CRRT combined with convalescent plasma can significantly inhibit the level of cytokines in patients with severe COVID-19 and promote the recovery of disease,which is an effective method for patients with severe COVID-19.

关 键 词：新型冠状病毒肺炎(COVID-19) 血浆置换 连续肾脏替代治疗 康复者血浆 

分 类 号：R457.1[医药卫生—治疗学]