血浆置换在ICU的应用及疗效分析

Application of plasma exchange applied in ICU and analysis of its curative effect

目的分析血浆置换技术在重症医学科（ICU）的应用现状和疗效。方法对ICU 73例行血浆置换患者的临床资料进行回顾性分析。结果 1血浆置换常见适应证依次为自身免疫性疾病、肝功能衰竭并高胆红素血症、高脂血症性胰腺炎和中毒。2凝血功能和血象发生变化：血浆置换使活化部分凝血活酶时间（APTT）和凝血酶时间（TT）略延长,纤维蛋白原（Fib）轻度下降,而对凝血酶原时间（PT）、白细胞（WBC）、血红蛋白（HGB）、血小板（PLT）无影响。3经过1~2次血浆置换治疗即可有效降低高脂血症性胰腺炎患者体内血脂水平。4血浆置换治疗过程中未出现重大不良事件,其总体治愈缓解率为63.0%,疗效最好者依次为中毒、横纹肌溶解和高脂血症性胰腺炎,疗效最差者则为肝功能衰竭并高胆红素血症。结论血浆置换安全可靠、疗效好,在ICU具有广泛的应用前景。

ObjectiveTo analyze application condition and curative effect by plasma exchange in ICU. MethodsA retrospective analysis was made on clinical data of 73 patients receiving plasma exchange.Results① Common indications of plasma exchange included autoimmune disease, hepatic failure complicated with hyperbilirubinemia, hyperlipidemic pancreatitis and toxication. ② Changes of coagulation function and hemogram： plasma exchange prolonged activated partial thromboplastin time （APTT）, thrombin time （TT） and slightly reduced fibrinogen （Fib）. It had no influence on prothrombin time （PT）, white blood count （WBC）, hemoglobin （HGB）, and platelets （PLT）. ③ Blood lipid level in hyperlipidemic pancreatitis patients was effectively reduced by 1~2 plasma exchange. ④ No severe adverse reactions occurred during plasma exchange, and the total cure remission rate was 63.0%. This method showed good effect in toxication, rhabdomyolysis, and hyperlipidemic pancreatitis, while its poor effect was in hepatic failure complicated with hyperbilirubinemia.ConclusionPlasma exchange is creditable, along with good curative effect. Its application prospect is bright in ICU.