治疗性血浆置换术295例及其血浆使用情况分析

A retrospective study of clinical application and plasma usage of therapeutic plasma exchange in 295 cases

目的分析治疗性血浆置换术(TPE)的临床应用效果和血浆使用情况。方法对本院6年间的295例行TPE患者的治疗效果与血浆使用情况作回顾性分析。结果 1)基本情况:295名患者共作TPE 688次,(1～19)次/人,平均(2.26±2.13)次/人,治疗人数逐年增加,治疗数最多的病种为肝脏疾病,占总数的80.3%(237/295),其他包括肾脏疾病22例(7.5%)、药物和食物中毒14例(4.7%)、热射病4例(1%)、自身免疫性疾病12例(4.1%)、血栓性血小板减少性紫癜4例(1.0%)、HELLP综合征1例、格林-巴利综合征1例。2)置换液:以血浆(经滤白及病毒灭活处理)为主,297例688次TPE共用血浆1 523 380 mL,平均每次用量(2 184.62±395.59)mL。3)治疗情况:总体治疗有效率由2007年的30%上升至2012年65.9%;TPE不良反应率3.0%(21/688),主要为心血管反应4例、低钙血症5例、过敏11例。结论随着TPE适应证和治疗范围的扩大,临床合理使用血浆能从量和质上保障TPE技术的展开,对于确保TPE安全、有效显得更为重要。

Objective To investigate the clinical application and usage of plasma in therapeutic plasma exchange（TPE）. Methods A total of 295 cases were recruited from patients who were treated with TPE in Fuzhou General Hospital from Jan 2007 to Dec 2012 in our study. The clinical characteristics and plasma supply of TPE treatments were analyzed retrospectively. Results 1） Clinical characteristics ： a total of 688 TPE were done in all 295 patients （ranged from 1 ~ 19 times for each patient） ,with an average of 2. 33 times per patient. TPE was mostly used in liver and gallbladder diseases （78.9%） ,followed by kidney disease, drug and food poisoning ,＇severe heat stroke, autoimmune disease, TFP, HELLP Syndrome and Guillain-Barre Syndrome. 2） Substitute fluids： plasma was used as the major substitute fluid for TPE. During the period from 2007 to 2012, a total of i 523 380 mL plasma were used in 684 TPE,with an average of 2 214ml for each treatment. 3） Therapy situation： the therapeutic effect was increased year by year from 30% in 2007 to 65.9% now. 21 adverse reactions occurred in 688 TPE, mainly as cardiovascular reactions, hypocalcemia and allergies. Conclusion Rational clinical use of plasma could meet the need of TPE effectively,promote the clinical application of TPE and ensure the safety and therapy effect.