单纯血浆置换治疗重型肝炎常见并发症的观察及护理（附131例分析）

Observing and Nursing the Common Complication of Serious Hepatitis treated by Piasmapheresis （PE） analysis of 131 cases

目的总结血浆置换治疗重型病毒性肝炎的常见并发症，探讨其护理方法。方法131例重型肝炎，在内科综合治疗的基础上，采用日本旭医疗公司生产的plasato IQ型人工肝治疗机，中空纤维膜型血浆分离器op-08W型连接pT900管路，进行血浆置换（pE）治疗。每次治疗时间2-3h，血浆置换量为3000mL，间隔3～7d治疗1次，每例酌情治疗1-6次。观察临床疗效，记录并发症的发生情况，并给予相应护理措施。结果131例重型肝炎病人经262次血浆置换治疗，有效110例（83．9％），共发生并发症100例次（38．1％），计有过敏反应82例次（3113％）其中有68例次（25．9％）轻微皮肤瘙痒，12例在治疗中、2例在治疗后出现直径0．5—1．0cm大小的荨麻疹（约2～10个）。18例次（6．8％）发生低血压，均在治疗中出现，血压平均下降（16＋6）mmHg左右，28例次（10．6％）出现口唇、下肢麻木及轻度手足抽搐等症状。跨膜压（TMP）增高2例次（0．7％），动脉压（Pa）增高5例次（1．9％），所有并发症经及时对症处理后均消失，无因此加重病情情况发生。结论PE治疗安全有效，但有较高（38．1％）并发症的发生率，如能遵循其发生的内在规律适时恰当处理，不影响病人的PE治疗及预后。

objective To summarize the common complication of serious hepatitis treated by plasmapheresis （PE） and approach the nursing method about that. Methods Using the Artificial liver therapeutic machine, plasato IQ-type, produced by Japanese Asahi Kasei, which was hollow fiber blood plasma separator,op-08W-type,connecting pT 900 channel, to treat 131 patients who was in Serious Hepatitis by plasmapheresis at the foundation of combined therapy, Time of therapy was 2-3h, and once every 3-7d. The volume of plasmapheresis was 3000ml. plasmapheresis was used 1-6 times. Observing the effect and the occurrence of complication, and then giving corresponding nursing. Result In 263 times of plasmapheresis in 131 patients, effective rate was 83.9% （110/131）, complication incidence rate was 38,1% （100/263）, anaphylactic response rate was 31.3% （82/263）. Symptoms of lightly Itch of skin were found in 68 samples （25.9%）, urticaria were found in 12 patients during treatment and 2 after treatment And hypopiesia happended in the course of treatment at 18 samples （6.8%）, descended （16±6）mmHg average, Symptoms of labia otis, the lower limbs anaesthesia and light limbs hyperspasmia et al, were found in 28 samples（10.6%）. Transmembrane pressure （TMP） was increased in 2 samples （0.7%）, arterial pressure （Pa） was increased in 5 samples （1.9%）. All the complications were disappeared during treatment in time, Conclusions plasmapheresis （PE） is safe and effective, but the complication incidence rate was high （38,1%）, given effective management at the proper time, it would not affect plasmapheresis （PE） and prognosis.