慢性重型乙型肝炎人工肝血浆置换疗法并发症的防治

Prevention and treatment of the complications of massive plasma exchange in patients with chronic severe hepatitis B

目的 了解人工肝大量血浆置换治疗慢性重型乙型肝炎时的并发症,探讨其防治对策。方法 113例慢性重型乙型肝炎患者接受人工肝大量血浆置换(每次交换同型冰冻血浆3 000ml)疗法共235治疗次,对出现的并发症及其防治措施进行分析。结果 本组患者在大量血浆置换治疗的235治疗次中,发生全身不适、肌肉抽搐19疗次(8.1％),恶心、呕吐5疗次(2.1％),过敏反应48疗次(20.4％),一过性低血压6疗次(2.6％),穿刺部位淤斑和出血42疗次(17.9％),分别通过补充钙剂和凝血因子、给予甲氧氯普胺和抗过敏药、调整进出体内血液流速等能够防治。结论 及时预防与处理慢性重型乙型肝炎人工肝大量血浆置换疗法的并发症,有利于提高治疗的安全性。

Objective To observe the complications occurring in the patients with chronic severe hepatitis B treated by massive plasma exchange and to search the methods for preventing and dealing with such complications. Methods 113 cases with chronic severe hepatitis B were treated by plasma exchange. 3000ml frozen plasma with same blood group was used for each of 235 times of the treatment. The complications induced by the therapy and how to prevent and manage these problems were analyzed. Results During the treatment there were about 8. 1% (19/235) of the patients having malaise and muscle twitch;2. 1%(5/235), vomit and nausea; 20. 4%(48/235), allergic reaction; 2. 6%(6/235), temporary hypotension; 17. 9%(42/235), ecchy-mosis and hemorrhage on the puncture sites. Such complications can be prevented or treated by using calcium a-gents, metoclopramide, anti-allergy drugs, by adjusting the rate of blood flow-in or -out of the body or supplementing coagulative factors, accordingly. Conclusions Preventing and dealing with the complications in time is benefit to the safety of using the massive plasma exchange in treatment of the patients of chronic severe hepatitis B.