血浆置换治疗重型肝炎中不良反应临床探究.docVIP

血浆置换治疗重型肝炎中不良反应临床探究[摘要] 目的：回顾性分析血浆置换治疗重型肝炎时不良反应发生的特点并探讨其防治对策。方法：对102例重型肝炎患者进行的326例次血浆置换治疗中发生不良反应的临床资料进行分析。结果：不良反应发生率为34.36%(112/326)，其中，过敏反应最为常见，占69.64%；低血钙占9.82%，低血压占8.9２%，插管处渗血占7.14%，继发感染占4.46%。结论：血浆置换治疗重型肝炎不良反应较为常见，但多为轻、中度反应，经及时治疗，均能缓解；根据不良反应的特点，有针对性地进行术前干预能够有效降低不良反应的发生率。 [关键词] 血浆置换；重型肝炎；不良反应 [中图分类号] R575.1[文献标识码]Ａ [文章编号]1673-7210（2009）03（b）-052－02 The clinical study of adverse reactions of plasma exchange treatment on severe hepatitis HOU Qingshun*, LIU Fuhui (Qingdao Hospital for Infectious Disease, Qingdao266033, China) [Abstract] Objective: To retrospectively analyze the clinical features of adverse reactions of plasma exchange treatment in the patients with severe hepatitis and to discuss the preventions and treatments. Method: The clinical data of the adverse reactions of 326 therapeutic plasma exchange in 102 patients with severe hepatitis was analyzed. Results: The total incidence of adverse reactions was 34.36% (112/326), among which the most frequent adverse reactions was allergic reactions(69.64%), and others were low-calcium, low blood pressure, bleeding in the intubation and secondary infection(9.82%, 8.92%, 7.14%, 4.46%, respectively). Conclusion: Adverse reactions of plasma exchange treatment on severe hepatitis are common, but most of them are mild or moderate reactions, and can be relieved by timely treatments. The incidence of adverse reactions can be effectively reduced by countermeasures according to their characteristics. [Key words] Plasma exchange； Severe hepatitis； Adverse reactions 重型肝炎起病急、病情重、进展快、病死率高，是病毒性肝炎中预后凶险的临床类型[1-2]。目前内科综合治疗对其预后仍无明显改善。近年来，国内外采用人工肝血浆置换(plasma exchange， PE)治疗重型肝炎取得了一定效果，但其不良反应较为多见。为观察血浆置换治疗重型肝炎时发生不良反应的规律和特点，探讨有效的防治对策，笔者对近3年经人工肝血浆置换治疗的重型肝炎患者共102例发生不良反应的情况进行了分析，现报道如下： 1资料与方法 1．1研究对象 本组102例重型肝炎患者均为住院患者，其中，男84例，女1８例，年龄20~71岁，平均43.25岁。诊断符合2000年全国病毒性肝炎会议修订的诊断标准。 1．2治疗方法 1．2．1基础治疗所有病例均按重型肝炎综合治疗方案，予以甘草酸制剂、促肝细胞生长素、前列腺素E、支链氨基酸、人血白蛋白等，并针对相关的并发症积极对症处理。 1．2．2血浆置换治疗在内科综合治疗的基础上，使用日本产Plasan