血细胞分离机行血浆置换在危重病人中的应用研究

Plasma exchange by use of corpuscle separator in intense care patients ICU

目的 观察血细胞分离机COBESPECTRA血液分离系统在危重病人中行血浆置换的有效性和安全性。方法 利用COBESPECTRA血液分离系统为27例重症病人共行59次血浆置换，置换液为新鲜冰冻血浆，抗凝剂为3％枸橼酸钠溶液（ACD—A），观察治疗过程的生命体征变化，治疗前后的血常规、电解质、凝血指标变化，记录治疗时间、置换量、血流速度、抗凝剂用量等参数。结果 治疗过程中患者生命体征平稳，临床症状改善；治疗时间180±30min，置换量3．2±0．9L，血流速度40～80ml／min，ACD—A用量800±50ml。治疗后凝血指标改善明显，但出现血钠升高，血小板下降的情况．结论 应用血液分离系统在危重病人中行血浆置换有效，安全性高，但仍需注意并发症的发生。

Objective To investigate the effectiveness and safety of plasma exchange in intense care patients by use of blood corpuscle separator （ COBE SPECTRA system）. Methods 59 times of plasma exchange were performed in 27 patients in intense care unit by use of COBE SPEC- TRA system. Frozen plasma was used as substitution fluid, 3% sodium citrate was used as anticoagulant. Changes in vital signs during treatment, and blood routine tests, blood electrolytes, blood coagulation index were observed before and after treatment ; Therapeutic time, substitution quantity, blood flow rate, anticoagulant used were recorded. Results Stable vital signs were maintained in all patients during treatment, clinic symptoms improved. Treatment lasted 180±30 min, substitution quantity was 3.2 ±0.9 L, blood flow rate 40 -80 mL/min, ACD -A used 800 ±50 ml. After treatment, coagulation index improved significantly, but there was a rise in blood sodium concentration and a fall in blood platelet count. Conclusion Plasma exchange in intense care patients by use of COBE SPECTRA system is effective and safe, but careful attention must be paid to side effects.