摘要
目的观察血浆置换(PE)治疗危重溶血尿毒综合征(HUS)的疗效。方法本院血液净化中心2003年8月-2010年4月收治危重HUS患儿10例,均以溶血性贫血、PLT下降及肾衰竭为首发症状。以新鲜冷冻血浆为置换液进行PE,同时予以糖皮质激素及抗血小板药物等治疗,对其适应证、治疗效果、并发症等进行回顾性分析。结果 10例患儿均存活。出院时临床症状、体征消失,PLT为(125.1±20.5)×109L-1,Hb为(118.6±5.4)g.L-1,LDH降至正常。尿常规正常,血肌酐、尿素氮正常。2例患儿出现血浆过敏反应,1例出现低血压,治疗过程中未见严重并发症。10例HUS患儿中,8例连续进行2～4次PE治疗,2例因经济或血浆短缺等非技术性问题间隔2～3 d进行1次PE,共进行3～5次。PE治疗12～72 h,患者症状减轻,黄疸消失,红细胞比容和PLT计数逐渐升高,LDH明显下降。10例患儿中6例行PE联合血液透析治疗,结果显示患儿PLT、Hb、LDH及肾功能均逐步恢复正常,PE治疗后的恢复时间为5～26 d。结论PE可以短时间内去除循环中的致病物质、补充有用成分,很少出现严重并发症。对于危重HUS患儿,PE是安全、有效的方法,可作为首选治疗方案。
Objective To observe the therapeutic effect of plasma exchange（PE） on children with severe hemolytic uremic syndrome（HUS）.Methods Among admitted patients in blood purification center from Aug.2003 to Apr.2010,10 patients with severe HUS were chosen,of whom presenting symptoms included hemolytic anemia,blood platelet drop and renal failure.PE was carried out on taking fresh frozen plasma as the displacement liquid.At the same time,corticoid and anti-platelet drugs were applied.Their indications,treatment effectiveness and complications were analyzed retrospectively.Results All 10 patients survived after PE treatment.When discharged,their clinical symptoms vanished,their blood platelet were（125.1±20.5） ×10^9 L^-1,their hemoglobin were（118.6±5.4） g·L^-1,lactate dehydroge-nase（LDH）dropped to normal.The routine urine test,creatinine and urea were normal.Two patients showed blood plasma allergic reaction and 1 patient showed hypotension.In the course of treatment,no serious complications appeared.Among the 10 patients with HUS,8 patients were given PE treatment 2-4 times consecutively.Two patients were treated by PE only in 2-3 days and totally 3-5 times duing to financial problems or the blood plasma shortage or other non-technical problems.At 12-72 hours after PE treatment,the patients′ symptoms were alleviated,and jaundice vanished.Hematocrit went up with the platelet elevated as well.LDH significantly dropped.Of all patients,there were 6 patients who were treated by PE united hemodialysis（HD）.The results showed that all patients′platelet,hemoglobin,LDH and renal function recovered gradually with 5-26 days after PE treatment.Conclusions PE is possible to remove pathogenic substances in a short time in the circulation,and supply useful ingredients.Severe adverse events are rare.Thus,PE is a safe and recommendable procedure for the treatment of serious HUS.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第18期1383-1385,共3页
Journal of Applied Clinical Pediatrics
关键词
溶血尿毒综合征
血浆置换
儿童
hemolytic uremic syndrome
plasma exchange
child
