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目的观察治疗性血浆置换(TPE)治疗血栓性血小板减少性紫癜(TTP)的疗效和不良反应。方法采用Baxter公司生产的CS-3000 P lus血细胞分离机对16例确诊为TTP的患者进行96例次TPE,观察其临床症状,血红蛋白(HGB)、血小板(PLT)、尿蛋白、肾功能、血清间接胆红素(IB IL)等检测指标及TPE中的不良反应。结果14例(87.5%)患者临床症状缓解,HGB、PLT、尿蛋白、肾功能和IB IL恢复正常。96例次TPE出现枸橼酸盐中毒38例次,占39.5%;低血容量反应3例次,占3.1%;过敏反应4例次,占4.2%。结论TPE是治疗TTP的有效方法,TPE过程中出现的不良反应主要有枸橼酸盐中毒、低血容量反应、过敏反应等。TPE过程中密切观察和对症处理,能减少不良反应,确保TPE的顺利进行。
Objective To observe the efficacy and adverse reactions of therapeutic plasmapheresis (TPE) in the treatment of thrombotic thrombocytopenic purpura (TTP). Methods Totally 96 cases of TPE were detected in 16 patients diagnosed with TTP using CS-3000 P lus blood cell separator manufactured by Baxter Company. The clinical symptoms, hemoglobin (HGB), platelet (PLT), urinary protein, renal function, serum Indirect bilirubin (IBIL) and other indicators of detection and TPE adverse reactions. Results The clinical symptoms of 14 patients (87.5%) were relieved, and HGB, PLT, urinary protein, renal function and IB IL returned to normal. 96 cases of TPE citrate poisoning occurred in 38 cases, accounting for 39.5%; hypovolemia in 3 cases, accounting for 3.1%; allergic reaction in 4 cases, accounting for 4.2%. Conclusion TPE is an effective method for the treatment of TTP. The adverse reactions in TPE process include citrate poisoning, hypovolemia, anaphylaxis and so on. TPE process closely observed and symptomatic treatment, can reduce adverse reactions, to ensure the smooth progress of TPE.