血浆置换术在41例重症肝炎治疗中的应用

The Use of Plasmapheresis Method in Treating 41 Patients of Serious Hepatitis

目的：探讨应用血浆置换术治疗重症肝炎的疗效。方法：全部41例重症肝炎患者均在综合治疗的基础上给与血浆置换术，先后101次，每次置换血浆2700mL，输新鲜血浆3000ml，平均每次置换时间1．5—3．0小时，间隔时间1—6天，平均4天。结果：每次置换后ALT下降为10-2145u／L，平均168±31u／L，AST27—2769U／I，平均133±24／L，γ-GT下降为5—380u／L，平均60±30u／L，SB26—380μmoL／L，平均106±19mol／L，SB111—186μmol／L，平均54±10mol／L，血浆总蛋白及白蛋白变化不明显或略增高，血氨均恢复正常肾功能恢复不明显，41例患者中7例伴有肝性脑病的患者，血浆置换后5例清醒，病情暂时缓解，其中2例患者永久性缓解，2例患者仍未清醒至致死亡，1例肝性脑病伴上消化道出血者出血停止，41例患者中有32例患者（亚急型重症肝炎10例，慢性重症肝炎22例）临床治愈或好转出院，其它9例先后死亡，1例亚急型重症肝炎患者在血浆置换2次后因消化道出血合并肝性脑病死亡，另外8例慢型重症肝炎均因肝功能衰竭而再次出现肝性脑病而死亡。结论：血浆置换术是较为成熟的肝脏替代疗法。

Objective： To evaluate the effect of plasmapheresis method in treating serious hepatitis. Methods： Besides the routine therapy, the total 41 patients of serious hepatitis were treated with plasmaphcresis method,which comprised 101 replacements. In each replacement,we drew 2700 nd plasma from a patient and rephced it with 3000 ml fresh plasma. It took 1.5 ± 3.0 hours, and the patients were given a replacement every 1 ± 6 days. Results： After each replacement,the patients＇ ALT dropped 10 ±2145 u/L average 168 ±31 u/L;AST 27 ± 2769 u/L, average 133 ±24 u/L;γ-GT dropped 5 ± 380 u/L, average 60 ± 30 u/L; SB dropped 26 ± 380 p±mol/L, average 106 ± 19 mol/L, SB1 dropped 11 ± 186μmol/L,avcragc 54 ± 10 mol/L. Albumin and gross protein of plasma had no change or a little increase. The ammonia in plasma dropped to normal level. The kidney function had no remarkable change. The patients of hepatic cncephalophathy came around and enjoyed a temporary alleviation. 32 of 41 patients recovered and 9 died. Conclusions：Plasmaphcresis method is relatively a mature hepar substitution therapy.