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目的:探讨应用血浆置换术治疗重症肝炎的疗效。方法:全部41例重症肝炎患者均在综合治疗的基础上给与血浆置换术,先后101次,每次置换血浆2700mL,输新鲜血浆3000ml,平均每次置换时间1.5~3.0小时,间隔时间1~6天,平均4天。结果:每次置换后ALT下降为10~2145u/L,平均168±31u/L,AST27~2769U/l,平均133±24/L,γ~GT下降为5~380u/L,平均60±30u/L,SB26~380μmol/L,平均106±19mol/L,SB111~186μmol/L,平均54±10mol/L,血浆总蛋白及白蛋白变化不明显或略增高,血氨均恢复正常,肾功能恢复不明显,41例患者中7例伴有肝性脑病的患者,血浆置换后5例清醒,病情暂时缓解,其中2例患者永久性缓解,2例患者仍未清醒至致死亡,1例肝性脑病伴上消化道出血者出血停止,41例患者中有32例患者(亚急型重症肝炎10例,慢性重症肝炎22例)临床治愈或好转出院,其它9例先后死亡,1例亚急型重症肝炎患者在血浆置换2次后因消化道出血合并肝性脑病死亡,另外8例慢型重症肝炎均因肝功能衰竭而再次出现肝性脑病而死亡。结论:血浆置换术是较为成熟的肝脏替代疗法。
Objective: To investigate the application of plasma exchange in the treatment of severe hepatitis. Methods: All 41 patients with severe hepatitis were treated with plasmapheresis on the basis of comprehensive treatment. They were successively treated with plasmapheresis for 101 times, each time replacing 2700 mL of plasma and losing 3000 ml of fresh plasma. The average time of each replacement was 1.5 to 3.0 hours and the interval time was 1 ~ 6 days, an average of 4 days. Results: After each replacement, ALT decreased to 10 ~ 2145u / L with an average of 168 ± 31u / L, AST27 ~ 2769U / l with an average of 133 ± 24 / L and γ ~ GT decreased from 5 ~ 380u / L with an average of 60 ± 30u / L, SB26 ~ 380μmol / L, with an average of 106 ± 19mol / L, SB111 ~ 186μmol / L, an average of 54 ± 10mol / L, plasma total protein and albumin changes were not significantly or slightly increased, blood ammonia returned to normal, The recovery was not obvious. Of the 41 patients with hepatic encephalopathy in 7 cases, 5 patients were awake after temporary plasma exchange. The patient’s condition was temporarily relieved. Two patients were permanently relieved, two patients remained awake and died, and one patient had hepatic encephalopathy. Encephalopathy accompanied by upper gastrointestinal bleeding stop, 41 patients, 32 patients (subacute severe hepatitis in 10 cases, 22 cases of chronic severe hepatitis) were cured or improved clinical discharge, the other 9 cases have died, 1 subacute Severe hepatitis patients after plasma exchange 2 times due to gastrointestinal bleeding combined with hepatic encephalopathy death, and the other 8 cases of chronic severe hepatitis are due to liver failure and re-occurrence of hepatic encephalopathy and death. Conclusion: Plasmapheresis is a more mature liver replacement therapy.