不同血浆吸附容积在双重血浆分子吸附系统治疗高胆红素血症中的疗效分析  

The effect of different plasma adsorption volume in the treatment of hyperbilirubinemia using the double plasma molecular adsorption system

作　　者：叶慧 雷鸣[1] 许开亮 韩耀国 袁维方 孙玉霞 YE Hui;LEI Ming;XU Kai-liang;HAN Yao-guo;YUAN Weifang;SUN Yu-xia(Department of Critical Care Medicine,The Seventh People’s Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)

机构地区：[1]上海中医药大学附属第七人民医院重症医学科,上海200137

出　　处：《中国血液净化》2023年第10期730-733,共4页Chinese Journal of Blood Purification

基　　金：上海市卫健委科研课题青年项目(20194Y0191);浦东新区卫生科研青年项目(PW2020B-3);七院新星(XX2021-13)。

摘　　要：目的观察不同血浆吸附容积在双重血浆分子吸附系统治疗高胆红素血症患者中的临床疗效。方法分析于上海中医药大学附属第七人民医院行双重血浆分子吸附系统治疗的40例高胆红素血症患者,根据单次治疗的血浆吸附容积分组,比较各组患者的血常规、凝血功能、C反应蛋白、胆红素清除率等指标。结果40例患者共行60次双重血浆分子吸附系统治疗,其中显效4例,有效50例,无效6例,总有效率为90%。单次治疗的血浆吸附容积C组(1.0 L≤血浆吸附容积<1.4 L)或E组(1.8 L≤血浆吸附容积<2.2 L)相较于B组(0.6 L≤血浆吸附容积<1.0 L)胆红素下降率更显著(t=-2.403,P=0.023;t=-2.405,P=0.032)。C组患者治疗后总胆红素差值高于B组(t=-2.068,P=0.048)。治疗后,患者凝血酶原时间和活化部分凝血活酶时间延长(t=-3.662,P=0.001;t=-2.828,P=0.008),国际标准化比值升高(t=-3.092,P=0.004),血浆纤维蛋白原降低(t=4.786,P<0.001),血小板计数减少(t=4.963,P<0.001),C反应蛋白下降(t=3.088,P=0.004)。结论双重血浆分子吸附系统单次治疗的血浆吸附容积达到1.0~1.4 L时胆红素的清除效果最具优势,延长吸附柱的治疗时间仍存在一定的吸附能力,可以增加胆红素的清除效率,推荐单次治疗血浆吸附容积为3.5~5.5倍个体血浆容积。Objective To observe the clinical effect of different plasma adsorption volume in the treatment of hyperbilirubinemia using the double plasma molecular adsorption system.Methods A total of 40 patients with hyperbilirubinemia treated with double plasma molecular adsorption system in the Seventh People's Hospital of Shanghai University of TCM were enrolled in this study.According to the plasma adsorption volume in a single treatment they were divided into groups.Blood routine,coagulation function,C-reactive protein,bilirubin clearance rate and others were compared among groups.Results A total of 60 times of double plasma molecular adsorption treatment were performed in the 40 patients,in which 4 times of the treatment were significant effective,50 times were effective,and 6 times was ineffective,with the total effective rate of 90%.After the treatment,the reduction rate of bilirubin was more significant in the patients using plasma adsorption volume of 1.0~1.4L(group C)or 1.8~2.2L(group E)in a single treatment than in the patients using plasma adsorption volume of 0.6~1.0L(group B)(t=-2.403 and-2.405,P=0.023 and 0.032),and was more significant in group C than in group B(t=-2.068,P=0.048).After the treatment,prothrombin time and activated partial thromboplastin time prolonged(t=-3.662 and-2.828,P=0.001 and 0.008),the international normalized ratio increased(t=-3.092,P=0.004),and plasma fibrinogen(t=4.786,P<0.001),platelet count(t=4.963,P<0.001)and C-reactive protein decreased(t=3.088,P=0.004).Conclusion The double plasma molecular adsorption system reaches the maximum clearance of bilirubin when the plasma adsorption volume ranges between 1.0 to 1.4 L in a single treatment.The efficient of bilirubin clearance can be further increased if the treatment time in the adsorption column is prolonged.It is recommended that the suitable plasma adsorp-tion volume in a single treatment is 3.5~5.5 times of the plasma volume in a patient.

关 键 词：双重血浆分子吸附系统 胆红素 吸附 疗效 血液净化 

分 类 号：R459.5[医药卫生—治疗学]