一种新型血浆置换液在治疗高粘滞综合征中的应用

Application of a novel combination of plasma replacement solution in Treatment of hyperviscosity syndrome

目的观察一种新的血浆置换液组合在高粘滞综合征血浆置换(PE)术中的临床效果及安全性。方法运用CS3000plus及COM.TEC血细胞分离机对67例高粘滞综合征患者进行了109例次PE。置换液组合选用0.9%生理盐水500ml+低分子右旋糖酐500ml+6%羟乙基淀粉500ml+5%白蛋白生理盐水溶液500ml,PE术后补充同型新鲜冰冻血浆(FFP)400～600ml。每位患者在治疗一个疗程中1～3周进行1～4次PE、每次间隔时间为2～7d。PE术中观察枸橼酸盐中毒、低血容量反应和过敏反应等主要不良反应。PE一个疗程后检测患者外周血中IgG或IgM下降的程度及评价头痛、胸闷、视力模糊、出血倾向和雷诺氏征等主要临床症状的改善情况。结果PE术中主要不良反应的总发生率较低、仅为7.3%,其中枸橼酸盐中毒、低血容量反应和过敏反应的发生率分别为4.6%、1.8%和0.9%。PE一个疗程后,多发性骨髓瘤患者的IgG平均水平从81.9g/L降至38.5g/L(P<0.05),原发性巨球蛋白血症患者IgM平均水平从41.2g/L降至23.4g/L(P<0.05);头痛、胸闷、视力模糊、出血倾向、和雷诺氏征的发生率较治疗前均明显下降(P<0.05)。结论这种新的置换液组合经济、安全、有效并显著减少了新鲜冰冻血浆的用量,值得临床推广应用。

Objective To investigate the clinical effect and safety of a novel combination of replacement fluid in plasma exchange （PE） in treating hyperviscosity syndrome. Methods One hundred and nine times of PE were performed on 67 patients with hyperviscosity syndrome including 55 cases of multiple myeloma （MM） and 12 cases of Waldenstrom＇s macroglobulinemia （WM） using CS 3000 plus and COM.TEC blood cell separator. 0.9% normal saline solution 500ml, dextran-40 500ml,6% hydroxyethyl starch 500ml and 5% human albumin in saline 500ml were chosen as replacement fluid and supplied each patient with the same type of fresh frozen plasma （FFP） 400ml - 600ml after PE. One to four times of PE were performed in one course of treatment for each patient with an interval of about 2 to 7 days. The main adverse effects were investigated during the course of PE. The degree of decrease of IgM or IgG in peripheral blood of each patient and clinical symptoms such as headaches, chest distress, blurred vision, hemorrhagic tendency and Raynaud＇s symptoms were observed after a course of PE. Results The total incidence of the main adverse reactions during PE were 7.3% and the incidence of citrate intoxation, hypovlemia and allergic response were 4.6%, 1.8% and 0.9% ,respectively. The average level of IgG in MM patients dropped from 81.9g/L to 38.5g/L（P〈0.05） and IgM in WM patients dropped from 41.2g/L to 23.4g/L（P〈 0.05） after one course of treatment. The incidence of clinical symptoms about headaches, chest distress, blurred vision, hemorrhagic tendency and Raynaud＇s symptoms also dropped dramatically comparing to pre-treatment（P〈0.05）. Conclusion This novel combination of replacement fluid in plasma exchange is economic, safe, and effective and can significantly reduce the amount of fresh frozen plasma and worthy of clinical application.