血浆置换术救治急危重血栓性血小板减少性紫癜

Plasma exchange as rescue therapy in critically ill patients with thrombotic thrombocytopenic purpura

目的:提高血浆置换术治疗血栓性血小板减少性紫癜(TTP)的认识及急危重患者抢救成功率。方法:报道2例急危重血栓性血小板减少性紫癜患者主要的临床特征和实验室异常,以血浆置换术为主要措施的救治过程,并进行文献复习。结果:昏迷多日的2例急危重患者通过血浆置换术等主要治疗措施均获成功救治。结论:血栓性血小板减少性紫癜诊断可以通过精神症状、发热和贫血等临床特征及微血管病性溶血、血小板减少等实验室特点早期得到诊断,血浆置换术仍是最有效的主要治疗措施,即使对急危重患者昏迷多日也仍然有效。

Objective： To improve the knowledge on the significance of plasma exchange as rescue therapy in critically ill patients with thrombotic thrombocytopenic purpura（ TTP） for improving the survival of such patients.Methods： Case report was performed in two critically ill patients with TTP concerning clinical pictures,laboratory findings and procedures in life-saving,and related literatures were reviewed.Results： Two patients being coma for several days were successfully treated through plasma exchange.Conclusion： Clinical diagnosis of TTP can rely on psychiatric symptoms,fever and anemia as well laboratory findings including microvascular haemolysis and thrombocytopenia.Plasma exchange serves as important and effective therapeutic strategy for critically ill patients with TTP,even if patient are suffering from coma for several days.