血浆置换辅助治疗劳力性热射病合并早期严重肝损害的疗效

Therapeutic Effect of Plasma Exchange on the Auxiliary Treatment of Exertional Heat Stroke with Early Severe Hepatic Lesions

目的探讨血浆置换(PE)对劳力性热射病(EHS)合并早期严重肝损害患者的疗效。方法对2013年6月～2016年8月本院收治的12例E H S患者(年龄18～30岁,均为男性),除采用常规治疗方案外,进行早期血浆置换治疗。观察治疗前后、出院前各项生命体征、急性生理学及慢性健康状况(APACHEⅡ)评分和ALT、AST、TBIL、CK、Cr及D-Dimer,并判断预后。结果治疗后生命体征趋于平稳,血清学指标及APACHEⅡ评分均下降;与治疗前相比差异有统计学意义(P <0.05或P <0.01,除外TBIL);12例患者中7例痊愈出院,无明显后遗症,3例好转回当地医院康复治疗,2例因转院较晚死亡。结论应用PE治疗EHS合并早期严重肝损害患者,是改善预后、降低病死率的一种有效方法。

Objective To observe the effect of plasma exchange(PE)on the treatment of patients with exertional heat stroke(EHS)underlying severe injuries of liver function.Methods Twelve male patients with EHS between the ages of 18 and 30 received plasma exchange therapy at early stage of the disease in addition to routine treatments from June 2013 to August 2016.The vital signs and health scoring(APACHEⅡ)of pre-and post-treatments were evaluated and ALT,AST,TBIL,CK,Cr,and D-Dimer were detected for prognosis judgement during the hospital stay.Results The life signs tended to be stable,the level of serum markers and APACHEⅡscores decreased when compared with those before the novel therapy(P<0.05 or P<0.01).Seven of 12 patients were recovered without any sequelae,three were improved and two died due to delayed transference to other hospital for further treatment.Conclusion The treatment strategy of plasma exchange may effectively improve the prognosis and reduce the mortality of EHS underlying severe hepatic lesions.