摘要
目的探讨血浆置换（plasma exchange，PE）在儿科应用的指征、治疗效果及不良反应。方法回顾性分析93例应用PE治疗患儿，总结前后病情转归。结果93例患儿PE治疗2—11次，平均5．5次，53例患儿采用联合血液净化治疗。溶血尿毒综合征36例，22例（61．1％）痊愈，14例（38．9％）遗留不同程度血尿、蛋白尿，其中5例（13．9％）’肾功能未恢复正常。神经系统疾病患儿中吉兰-巴雷综合征9例，治疗后好转8例；抗NMDA脑炎8例，治疗后好转6例；重症肌无力3例，PE后均有不同程度好转；急性播散性脑脊髓炎4例，好转3例；慢性炎症性脱髓鞘多神经病4例，好转3例。毒蕈中毒9例，好转4例。其他18例。93例中出现不良反应12例（12．9％），其中过敏反应9例，低血压3例，未见严重不良反应。结论PE是一种安全的血液净化方法，不良反应少，对于很多疾病如非典型性溶血尿毒综合征及某些危重型神经系统疾病等疗效肯定。
Objective To assess the indications, effect and complications of plasma exchange （PE） application in children. Methods A total of 93 patients treated with PE were enrolled, and the clinical manifestations before and after treatment were analyzed retrospectively. Results Ninety-three cases of children received PE treatment 2 to 11 times, an average of 5.5 times, 53 cases with combination blood purification treatment. In 93 patients, there were 36 cases with hemolytic uremic syndrome, among them, 22 cases （ 61.1% ） were healed, 14 cases （ 38.9 % ） remained hematuria, and proteinuria and 5 of them （ 13.9 % ） with injured renal function. There were 9 cases with Guillain-Barre＇ syndrome and 8 of them got improved. Six in 8 cases with anti-N-methyl-D-aspartate receptorencephalitis got better after treatment. All of the 3 cases with myasthenia gravis got recovery. There were 4 cases with acute disseminated encephalomyelitis and 4 cases with chronic inflammatory demyelinating polyneuropathy respectively. The treatment effect rate was all 3/4. Four in 9 patients with poisonous mushroom poisoning also got improved. The adverse reactions were observed in 12 cases（ 12. 9% ） ,including allergic in 9 cases and hypotension in 3 patients. No serious adverse reactions were found during treatment. Conclusion PE is an safe and effective blood purification method, with less adverse reaction, for treatment of the atypical hemolytic uremic syndrome and some serious nervous system diseases, such as myasthenia gravis, Guillain-Barre syndrome, etc.
出处
《中国小儿急救医学》
CAS
2015年第7期458-461,共4页
Chinese Pediatric Emergency Medicine
关键词
血浆置换
溶血尿毒综合征
神经系统疾病
儿童
Plasma exchange
Hemolytic uremic syndrome
Nervous system disease
Children
