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目的观察血浆置换治疗重型肝炎时的不良反应,探讨其相应的防治措施。方法通过记录、分析我院2001年3月1日～2008年12月31日近8年间住院的137例各型重型肝炎患者208次应用血浆置换疗法治疗过程中出现的不良反应资料,探讨各种不良反应的发生机率及处理方法。结果本组208例次应用血浆置换疗法过程中,累计发生不良反应202例次(97.12%),其中过敏反应198例次(95.2%),最为常见,1例次发生过敏性休克(0.48%)。其余依次为低血钙样表现178例次(85.58%);血压下降21例次(10.1%);穿刺部位渗血19例次(9.14%),其中经桡动脉或股静脉穿刺者为15例次(11.54%),78例次改为锁骨下静脉穿刺,穿刺部位加8字型缝合后,仅4例次(5.13%)有局部轻微渗血;导管感染4例次(1.93%)。结论运用血浆置换疗法治疗重型肝炎不良反应的发生机率较高,但在操作过程中如能密切观察,妥加应对,可使治疗顺利完成,对患者治疗的依从性和临床疗效无不良影响。
Objective To observe the adverse reactions of plasma exchange in the treatment of severe hepatitis and to explore the corresponding prevention and treatment measures. Methods The records of 137 cases of severe hepatitis treated in our hospital from March 1, 2001 to December 31, 2008 in the past 8 years were analyzed retrospectively. 208 patients were treated with plasma exchange therapy during the course of treatment, The incidence of adverse reactions and treatment methods. Results A total of 208 cases (97.12%) had adverse reactions during the period of plasmapheresis, of which 198 cases (95.2%) were the most common anaphylactic reaction, the most common one was anaphylactic shock (0.48%), . The other followed by low calcium showed 178 cases (85.58%); blood pressure decreased 21 cases (10.1%); puncture site bleeding 19 cases (9.14%), of which 15 cases were transradial or femoral vein puncture (11.54%), 78 cases were changed to subclavian vein puncture. Only 4 cases (5.13%) had local slight bleeding after puncturing the puncture site and 8 cases. Catheter infection was found in 4 cases (1.93%). Conclusions The incidence of adverse reactions in patients with severe hepatitis treated by plasmapheresis is high. However, if observed closely during operation and treated properly, the treatment can be successfully completed without adverse effects on patient compliance and clinical efficacy.