Therapeutic plasma exchange for hyperlipidemic pancreatitis:Current evidence and unmet needs

With changes in lifestyle and diet worldwide,the prevalence of hyperlipidemic acute pancreatitis(HLAP)has greatly increased,and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol.There are many available therapies for HLAP,including oral lipid-lowering agents,intravenous insulin,heparin,and therapeutic plasmapheresis(TPE).It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides(TG),thus a rapid decrease in serum TG level is the key to the successful management of HLAP.TPE has emerged as an effective modality in rapidly reducing serum TG levels.However,due to its cost and accessibility,TPE remains poorly evaluated until now.Some studies revealed its efficacy in helping to treat and prevent the recurrence,while some studies suggested that TG levels were not correlated with disease severity,mortality,or length of hospital stay.Thus TPE might have no beneficial effect for the outcome.This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors,adverse effects of the procedure,and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis.Future direction of TPE research for HLAP is also discussed in this review.

Therapeutic plasma exchange and continuous renal replacement therapy for severe hyperthyroidism and multi-organ failure:A case report

BACKGROUND Severe hyperthyroidism is a life-threatening exacerbation of thyrotoxicosis,characterized by high fever and multiorgan failure. The most common medical treatments are administration of antithyroid drugs and radioactive iodine, and thyroidectomy. In some patients, antithyroid therapy is limited due to serious adverse effects or failure to control disease progression. In some extreme cases,such as thyroid storm, conventional therapy alone does not yield effective and rapid improvement before the development of multiorgan failure.CASE SUMMARY This report describes a Chinese patient with severe hyperthyroidism accompanied by multiorgan failure, who was transferred to the medical intensive care unit of our hospital. The patient presented with palpitations, vomiting,diarrhea, and shortness of breath for a week. Laboratory tests showed elevation of thyroid hormones. Hepatic failure occurred with high aminotransferase levels and jaundice. Given her abnormal liver function and medication history, we could not exclude diagnosis of propylthiouracil-induced hepatic failure.Moreover, she also suffered from heart failure. Therapeutic plasma exchange(commonly known as TPE) and continuous renal replacement therapy(commonly known as CRRT) were used as life-saving therapy, which resulted in notable improvement of clinical symptoms and laboratory tests.CONCLUSION Combined TPE and CRRT are safe and effective for patients with hyperthyroidism and multiorgan failure.

Therapeutic plasma exchange in liver failure

The multi-organ failure syndrome associated with acute and acute-on-chronic liver failure(ACLF)is thought to be mediated by overwhelming systemic inflammation triggered by both microbial and non-microbial factors.Therapeutic plasma exchange(TPE)has been proven to be an efficacious therapy in autoimmune conditions and altered immunity,with more recent data supporting its use in the management of liver failure.Few therapies have been shown to improve survival in critically ill patients with liver failure who are not expected to survive until liver transplantation(LT),who are ineligible for LT or who have no access to LT.TPE has been shown to reduce the levels of inflammatory cytokines,modulate adaptive immunity with the potential to lessen the susceptibility to infections,and reduce the levels of albumin-bound and water-bound toxins in liver failure.In patients with acute liver failure,high volume TPE has been shown to reduce the vasopressor requirement and improve survival,particularly in patients not eligible for LT.Standard volume TPE has also been shown to reduce mortality in certain sub-populations of patients with ACLF.TPE may be most favorably employed as a bridge to LT in patients with ACLF.In this review,we discuss the efficacy and technical considerations of TPE in both acute and acute-on-chronic liver failure.

Therapeutic apheresis in kidney transplantation: An updated review

Therapeutic apheresis is a cornerstone of therapy for several conditions in transplantation medicine and is available in different technical variants. In the setting of kidney transplantation, immunological barriers such as ABO blood group incompatibility and preformed donor-specific antibodies can complicate the outcome of deceased-or living-donor transplantation. Postoperatively,additional problems such as antibody-mediated rejection and a recurrence of primary focal segmental glomerulosclerosis can limit therapeutic success and decrease graft survival. Therapeutic apheresis techniques find application in these issues by separating and selectively removing exchanging or modifying pathogenic material from the patient by an extracorporeal aphaeresis system. The purpose of this review is to describe the available techniques of therapeutic aphaeresis with their specific advantages and disadvantages and examine the evidence supporting the application of therapeutic aphaeresis as an adjunctive therapeutic option to immunosuppressive agents in protocols before and after kidney transplantation.

治疗性血浆置换发生过敏反应的危险因素分析——基于单中心的研究

目的 回顾分析治疗性血浆置换(TPE)过程中过敏反应的发生情况,探究TPE过敏反应发生的危险因素。方法 收集2018—2023年由本中心输血医学科完成,且使用了血浆成分的TPE治疗的929例患者的临床资料,采用单因素分析发生过敏反应影响因素,Logistic多因素回归分析发生过敏反应的独立危险因素。结果 929例患者共进行4 071次TPE治疗。其中有198例(21.31%)发生349次(8.57%)过敏反应,其中Ⅰ、Ⅱ、Ⅲ级过敏反应发生率分别为16.33%、81.38%、2.29%,无死亡病例。单因素分析结果显示,患者的年龄、过敏史、是否诊断免疫相关疾病、是否入住ICU、血浆用量、全身血容量、最大血液流速、是否联合使用白蛋白与发生过敏反应有关(P<0.05)。多因素回归分析显示,年轻患者、有过敏史、患免疫相关疾病及非ICU患者容易在TPE中发生过敏反应,而TPE的治疗方案如置换液类别、血浆用量、血液流速等与过敏反应发生无关。结论 TPE发生过敏反应存在明显的个体差异,低龄、有过敏史、患免疫相关疾病及非ICU患者是TPE发生过敏反应的危险因素。TPE治疗前识别出具有危险因素的患者,提前给与相应预防措施,可以降低过敏反应的发生率。

血浆置换在小儿肾脏风湿疾病治疗的应用及护理

目的分析治疗性血浆置换术(therapeutic plasma exchange,TPE)在小儿肾脏风湿疾病中的应用及并发症的观察,探讨相关护理对策。方法回顾2021年1月—2022年12月复旦大学附属儿科医院肾脏和风湿科收治并接受血浆置换治疗的患儿,家属签署知情同意书。经颈内静脉建立血管通路,对9例患儿进行28例次血浆置换治疗。并对患儿的原发病、治疗前后指标、并发症进行分析。结果9例患儿28例次TPE治疗期间患儿出现过敏反应9例次(32.1%)、低钙血症9例次(32.1%)、低血压4例次(14.2%)、体外循环凝血1例次(3.6%)、导管功能不良1例次(3.6%),28例次通过相应的护理干预后,均顺利完成血浆置换治疗。无其他危及生命的并发症出现。结论在血浆置换过程中,应对不同疾病儿童临床疗效进行观察,并对出现的常见并发症进行分析,采取相应的护理干预,最大限度的降低并发症带来的副作用,提高临床疗效,确保血浆置换临床运用的安全性。

三种血浆置换方式改善肾移植后肾功能不全的疗效及引发置换副反应的对比研究

目的 对比研究双重滤过血浆置换(DFPP)和离心式治疗性血浆置换(cTPE)以及离心-膜滤过式血浆置换(CFPP)3种不同的血浆置换(TPE)方式在改善肾移植后肾功能不全方面的疗效,以及在引发置换相关副反应方面的差异。方法 回顾性收集本院肾移植术后行TPE的46例患者的临床资料,依据TPE方法的不同分为DFPP组(33例)、cTPE组(7例)、CFPP组(6例),对比分析3组TPE前后患者外周血肌酐、白蛋白、血红蛋白、血小板、纤维蛋白原水平及尿量的变化。结果 DFPP组、cTPE组、CFPP组TPE前后肌酐下降率分别是(31.40±25.38)%、(58.91±19.75)%、(39.44±28.64)%,cTPE组高于DFPP组(P<0.05),cTPE组与CFPP组比较无差异(P>0.05)。DFPP组、cTPE组、CFPP组TPE前后尿量增加率分别是(49.33±30.03)%、(54.62±39.32)%、(68.89±23.00)%,3组间两两比较无差异(P>0.05)。DFPP组、cTPE组、CFPP组血TPE后血红蛋白降低率分别是(11.97±5.94)%、(20.17±5.75)%、(9.65±8.75)%,cTPE组高于DFPP组和CFPP组(P<0.05),DFPP组与CFPP组比较无差异(P>0.05)。DFPP组、cTPE组、CFPP组TPE前后血小板数降低率分别是(37.88±18.39)%、(24.56±12.36)%、(21.40±12.51)%,3组间两两比较无差异(P>0.05)。DFPP组、cTPE组、CFPP组TPE前后纤维蛋白原降低率分别是(0.57±0.20)%、(0.14±0.06)%、(0.26±0.22)%,DFPP组高于cTPE组(P<0.05),DFPP组、cTPE组与CFPP组比较无差异(P>0.05)。DFPP组、cTPE组、CFPP组TPE前后白蛋白降低率分别是(11.41±5.97)%,(14.67±6.52)%、(25.18±5.10)%,cTPE组、DFPP组低于CFPP组(P<0.05),DFPP组与cTPE组比较无差异(P>0.05)。结论 3种TPE方式对肾移植后患者肾功能、贫血、凝血功能等方面的影响存在一定差异,在选择TPE方法时,应根据患者的具体病情特点和治疗需求,并结合实验室自身技术条件及血浆供应情况综合考虑。

术前治疗性血浆置换预防ABO血型不合肾移植术后急性排斥反应的回顾性分析

目的 探讨术前治疗性血浆置换(therapeutic plasma exchange,TPE)预防ABO血型不合肾移植(ABO incompatible kidney transplantation,ABOi-KT)术后急性排斥反应的临床疗效。方法 我们搜集了2022年4月至2024年4月在本院肾移植科室住院的9名ABO血型不合肾移植患者进行回顾性分析,9名患者在肾移植手术前共进行了28次TPE,总结治疗方案:根据入院时患者的ABO血型系统抗体效价水平、性别、身高、体重、红细胞压积等指标制定置换液的比例、置换次数和置换量。同时监测患者入院时及TPE后相关实验室指标,如:血红蛋白、血小板、白细胞、凝血功能、总蛋白、白蛋白、球蛋白、白球比、肌酐、尿素氮,并对其进行统计学分析。在移植术后检测ABO血型系统抗体效价变化,肌酐和尿量变化等肾功能指标,观察有无急性排斥反应的临床症状,如:移植肾区肿胀、疼痛、水肿等表现。结果 9名ABOi-KT患者术前平均血浆置换次数约为3次,平均每次置换液总量约为2 500~3 500 mL,大约为1.01~1.16血浆容量(plasma volume,PV),数次TPE后在移植术前抗体效价水平较前可平均下降3倍。Hb、PLT、PT、PTA、INR、TBil、ALB、Cr、BUN无统计学差异(P>0.05),WBC、APTT、Fbg、TP、GLB、A/G具有统计学意义(P<0.05)。术后9名患者肌酐可降至100~140μmol/L左右,尿量正常,尿蛋白下降至弱阳性或阴性,9名患者均未发生急性排斥反应。结论 TPE可有效降低ABO系统血型抗体水平,可有效预防ABO血型不合患者肾移植急性排斥反应的发生。

血浆置换介入时机与肝损伤分期对劳力性热射病患者预后的影响研究

目的 探讨血浆置换(TPE)介入时机及肝损伤分期辅助治疗劳力性热射病患者(EHS)的预后影响及临床应用价值。方法 收集2011年1月—2023年12月在中国人民解放军总医院第一医学中心收治的EHS患者127例,根据临床结局分为死亡组与生存组2组,根据ALT、AST、TBIL、DBIL指标动态变化分为5期;经倾向性评分匹配分析,生存组11例、死亡组12例被纳入统计分析。行TPE辅助治疗20例;观察治疗前后指标变化及临床结局,评价介入时机对预后的影响。结果 23例患者中,没有肝损伤和可进展到肝脏修复期的共14例,死亡3例、病死率21.43%;不能进展到肝脏修复期9例,死亡9例,病死率100%,2者比较有差异(P<0.05)。首次TPE如在肝损伤第3期之前介入的病死率为23.08%(3/13),达到或超过第3期才介入的病死率85.71%(6/7),2者比较有差异(P<0.05)。结论 EHS合并肝损伤的患者应在肝损伤第3期之前积极行TPE治疗,阻断其病理生理过程,使之跃过第3期,从而改善预后和降低病死率。

血浆置换用于治疗重症肌无力的研究进展

重症肌无力(myasthenia gravis,MG)是主要由自身抗体介导的骨骼肌神经肌接头处兴奋传递障碍的自身免疫性疾病。其首发临床症状为肌肉波动性无力和易疲劳性,绝大部分MG患者发病早期仅轻微累及眼外肌和四肢骨骼肌,少部分患者在短期内会出现病情的迅速进展,累及咽喉肌和呼吸肌等重要肌群,发生肌无力危象,从而严重威胁患者生命。临床上常采用治疗性血浆置换(therapeutic plasma exchange,TPE)或静脉注射免疫球蛋白(intravenous immunoglobulins,IVIG)对这类患者进行救治,可以快速缓解肌无力症状、改善呼吸功能。近年来,关于TPE的临床研究大量涌现,TPE在改善MG症状、发挥早期疗效、缩短ICU住院时间及安全性方面的临床价值被逐渐阐明。我们通过检索近5年国内外TPE应用于MG治疗的临床研究文章,从MG和TPE的概括,TPE在MG治疗临床有效性及安全性,TPE延伸技术在MG治疗中的应用等方面,总结当前TPE在MG治疗中的临床研究进展,为TPE更好地应用于MG提供参考价值。

血浆置换治疗视神经脊髓炎相关性视神经炎的研究进展

血浆置换是一种重要的临床治疗手段,广泛地应用于神经病学、血液病学及代谢紊乱性疾病等多种临床疾病的治疗,但治疗视神经脊髓炎相关性视神经炎国内暂时未普遍使用。本文就视神经脊髓炎相关性视神经炎发病机制与临床表现等特点,对血浆置换治疗方法及其对视神经脊髓炎相关性视神经炎治疗机制、注意事项及不良反应情况进行综述,为临床诊断治疗及预后判断提供一定参考依据。

血浆置换术辅助丙种球蛋白在小儿病毒性脑炎治疗中的应用

目的观察血浆置换术辅助丙种球蛋白短程强化疗法对小儿病毒性脑炎的应用效果。方法选取113例病毒性脑炎患儿作为研究对象,按照计算机随机分组法将患者分为常规组56例和置换组57例。常规组予以常规治疗及丙种球蛋白短程强化治疗,置换组在常规组的治疗基础上,联合实施血浆置换术治疗,比较两组患儿的炎症反应、免疫功能、神经功能及治疗安全性。结果治疗后,置换组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)的水平均低于常规组,差异具有统计学意义(P<0.05);免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)的水平均高于常规组(P<0.05);神经元轴突轻链(NF-L)、中枢神经特异蛋白(S100β)、神经元特异性烯醇化酶(NSE)的水平均低于常规组(P<0.05)。置换组不良事件发生率略高于常规组,但无统计学差异(P>0.05)。结论血浆置换术辅助丙种球蛋白能改善病毒性脑炎患儿的炎症反应和神经功能,并增强免疫功能,安全性较高。

Integrated therapeutic plasma exchange and traditional Chinese medicine treatment in a patient with severe COVID-19:A case report

This report presents the case of a 59-year-old man with severe COVID-19 that gradually progressed to cytokine release syndrome and then acute respiratory distress syndrome;he was successfully treated via integration of therapeutic plasma exchange and traditional Chinese medicine.The patient initially presented with a sore throat,severe muscle aches,productive cough and fever.On the worsening of symptoms,remdesivir was administered.However,as the symptoms continued to worsen and a cytokine release syndrome was suspected,oxygen was provided through a high-flow nasal cannula(50 L/min)and therapeutic plasma exchange was performed to prevent worsening of the acute respiratory distress syndrome.On the same day,a course of traditional Chinese medicine was introduced in consultation with the infectious house staff.The patient’s symptoms gradually improved;the levels of C-reactive protein and D-dimers reduced,and the patient was weaned to a simple oxygen mask and eventually to room air.This is the first reported case of the integration of these treatments.Together,they prevented the patient from requiring intubation,played a role in cytokine management,and also improved the clinical symptoms,including productive purulent sputum,cough,frequent stool passage and intermittent fever,with no adverse effects.As a result,the patient was discharged within two weeks of the integration of these treatments.Therefore,the integration of therapeutic plasma exchange and traditional Chinese medicine is an effective therapy for patients with severe COVID-19.

Effects of therapeutic plasma exchange on survival in patients with postoperative liver failure:a retrospective single-center study

Background:Recent decreases in the incidence of postoperative liver failure(POLF)have been attributed to advances in surgical techniques,critical care,and postoperative management.However,POLF management remains a challenge,and worsening POLF is a significant cause of morbidity and mortality.Therapeutic plasma exchange(TPE)is used as a salvage strategy for POLF in some countries,and several studies conducted between 1980 and 1990 have reported the use of TPE for POLF.We conducted this retrospective single-center study to investigate the outcomes of patients with POLF treated with TPE.Methods:We retrospectively reviewed the charts of patients with POLF admitted to the intensive care unit who underwent TPE between November 2010 and March 2017.POLF was defined as the presence of persistent hyperbilirubinemia.Data on patient demographics,Glasgow Coma Scale score,platelet count,prothrombin time,and serum total bilirubin level were collected,and their Sequential Organ Failure Assessment scores were calculated.The lengths of postoperative hospital stays,lengths of post-TPE hospital stays,and patient outcomes were also analyzed.Results:TPE was performed in 20 patients with POLF during the study period.TPE was initiated on the 49th postoperative day and was performed for a median of five sessions.TPE improved hyperbilirubinemia and coagulopathy but had no effect on neurological and clinical symptoms.All 20 patients treated with TPE died after the 36th day(median)from the initial TPE.Conclusions:Although TPE may improve laboratory values in patients with POLF,the current study suggests that it has no survival benefit.

治疗性血浆置换术救治重症急性有机磷中毒

目的 探讨治疗性血浆置换术 (TPE)在救治重症急性有机磷中毒中的作用。方法 对常规治疗中毒症状缓解不明显的 10例重症有机磷中毒患者施行TPE ,观察患者TPE前后各主要生化指标变化、患者神志开始和完全恢复时间 ,以确保疗效。结果 ①患者TPE后ChE、BUN、CK、CK -MB、ALT、AST、ALB、TC、TG等各项指标均较TPE前有明显改善 ;② 10例患者均在一次TPE后 8h内神志开始恢复 ,9例在 2 4h内完全恢复 ,其中 3例分离中即开始恢复 ,1例完全恢复。另有 1例行二次TPE后 4h完全恢复。结论 TPE救治重症急性有机磷中毒疗效显著 ,具有常规疗法无可比拟的优势 ,可及时、有效去除毒素 ,补充有活力胆碱酯酶及某些血浆正常成分 ,改善患者症状。

胆红素吸附联合血浆置换对治疗肝衰竭近期疗效影响的相关性研究

目的:探究胆红素吸附联合血浆置换对治疗肝衰竭患者近期临床疗效的影响效果。方法:收集85例肝衰竭患者的临床资料,在防止肝细胞坏死、促进肝细胞再生的综合治疗基础上,根据人工肝治疗模式的不同分为观察组和对照组,观察组42例患者行胆红素吸附联合血浆置换治疗;对照组43例患者行单纯血浆置换治疗。比较两组患者治疗前后及两组之间谷丙转氨酶(ALT)、总胆红素(TBIL)、凝血酶原时间(PT)、谷草转氨酶(AST)的变化以及人工肝治疗过程中的不良反应。结果:经过胆红素吸附联合血浆置换后,观察组与对照组的好转率分别为85.7%(36/42)、88.4%(38/43),两组比较差异无统计学意义(P>0.05);两组患者血清主要生化指标中ALT、AST、TBIL较治疗前下降明显,二者比较差异有统计学意义(P<0.01);PT较治疗前下降明显,二者比较差异有统计学意义(P<0.05)。观察组治疗前后血清ALT、PT、TBIL、AST值与对照组治疗前后血清ALT、PT、TBIL、AST值对应性比较,二者差异无统计学意义(P>0.05)。观察组患者接受胆红素吸附联合血浆置换共103例次,最少1例次,最多5例次,人均2.45次,发生不良反应36例次(34.95%);对照组43例患者接受单纯血浆置换共99例次,最少1例次,最多4例次,人均2.3次,发生不良反应25例次(25.3%)。结论:胆红素吸附联合血浆置换能有效改善肝衰竭患者的肝功能,与单纯血浆置换比较,能减少血浆的用量,减少输血传播疾病的风险。

不同血液净化方式治疗各型肝衰竭的临床疗效比较

目的比较3种不同血液净化方式对急性、亚急性或慢加急性、亚急性肝衰竭患者的临床疗效。方法从在昆明医科大学第一附属医院治疗的急性、亚急性或慢加急性、亚急性肝衰竭患者中按随机数字表法抽出150例并分为3组，一组患者采取血浆置换（PE）疗法，另一组患者采取双重血浆吸附（DPMAS）疗法，第3组患者采取PE联合DPMAS治疗。3组均治疗3次后比较临床疗效和肝功能。结果单用PE和DPMAS组总有效率比较差异无统计学意义[56．O％（28／50）比58．0％（29／50），P〉0．05]，而PE联合DPMAS组总有效率明显高于单用PE和DPMAS组[90．0％（45／50）比56．0％（28／50）、58．O％（29／50），均P〈0．05]；单用PE和DPMAS组治疗后肝功能改善方面比较差异无统计学意义（均P〉0．05），但PE联合DPMAS组患者肝功能指标均较单用PE和DPMAS两组明显降低[丙氨酸转氨酶（Au，U／L）：121．5±110．2比143．2±126．5、147．3±122．7，天冬氨酸转氨酶（AST，U／L）：172．5±146．8比193．6±170．2、189．2±171．5，总胆红素（TBil，μmol／L）：277．3±112．4比301．3±132．7、297．4±134．5，白蛋白（Alb，g／L）：22．3±2．5比36．7±3．7、35．6±3_3，凝血酶原活动度（PTA）：（32．7±17．5）％比（57．8±25．4）％、（55．2±25．6）％，均P〈0．05]。结论PE与DMPAS对治疗急性、亚急性或慢加急性、亚急性肝衰竭患者都具有较好的疗效，但如果将两种方法联合应用可以提高治疗效果。

血浆置换术治疗急性重症毒物中毒的疗效观察

目的探讨应用治疗性血浆置换术(therapeutic plasma exchange,TPE)治疗急性重症中毒的效果.方法采用COBE Spectra血细胞分离机,对83例该院收治的急性重症中毒患者进行TPE治疗.平均置换血浆量约35～50ml/kg,置换液1/3为生理盐水,2/3为新鲜冰冻血浆.结果83例患者中,治疗有效56例,有效率67.5%.在中毒早期进行的TPE效果明显.结论TPE是治疗急性重症中毒的一种有效手段.在条件许可的情况下,急性重症中毒患者应尽早进行治疗,以期取得好的疗效.

血浆置换在临床危重疾病治疗中的安全性分析

目的观察治疗性血浆置换术在血液系统、神经系统及内分泌代谢系统等危重疾病临床应用中的安全性问题。方法回顾性分析本院2012年10月~2017年12月行血浆置换术的68例患者,观察患者围治疗期的不良反应,检测血浆置换治疗造成的血细胞丢失和溶血情况,分析10例患者保护性抗体HBs Ab的滴度变化。结果 68例患者共进行了262次血浆置换治疗,33.8%的患者出现不同程度的不良反应,在262次血浆置换中不良反应率为16.8%,予以对症处理后短时间内缓解,并完成后续治疗;每次治疗造成的血细胞丢失少于1%血容量,未造成溶血;置换治疗结束的HBsAb滴度最多下降70%~80%,然后逐渐缓慢恢复。结论大多数不良反应是轻微的、易于处理的;不会造成明显血细胞损失和溶血;治疗过程中HBsAb滴度始终在可检出水平之上;血浆置换术是一种安全、可接纳的治疗方法。

血浆置换中不同血管通路对重型肝炎治疗的影响

目的 探讨应用两种不同血管通路进行血浆置换治疗重型肝炎的疗效 ,及两种方法对治疗的影响。方法 将 86例重型肝炎患者在常规内科治疗基础上随机分成 2组 ,分别采取股静脉插管 (插管组 )和前臂动、静脉穿刺 (穿刺组 )建立血管通路。观察两组患者进行血浆置换后治疗的有效率、感染发生率 ,以及对血液总胆红素、丙氨酸转氨酶、血氨、凝血酶原时间、补体等指标的影响。结果 插管组和穿刺组治疗有效率分别为 75 .5 6 %和78.0 5 % ,感染发生率分别为 15 .5 6 %和 4 .88% ;血浆置换后血液总胆红素、丙氨酸转氨酶、血氨、凝血酶原时间、补体C3 均得到显著改善 ,除总胆红素降低幅度在穿刺组更加明显外 ,其余各值在两组间差异均无显著性。结论 血浆置换治疗能有效改善重型肝炎患者体内各主要异常血液指标 ;与插管法相比 ,穿刺法在降低血液总胆红素方面具有更多的优势。