中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2015年
7期
458-461
,共4页
张桂菊%刘小荣%孟繁英%马军梅
張桂菊%劉小榮%孟繁英%馬軍梅
장계국%류소영%맹번영%마군매
血浆置换%溶血尿毒综合征%神经系统疾病%儿童
血漿置換%溶血尿毒綜閤徵%神經繫統疾病%兒童
혈장치환%용혈뇨독종합정%신경계통질병%인동
Plasma exchange%Hemolytic uremic syndrome%Nervous system disease%Children
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。
目的：探討血漿置換(plasma exchange,PE )在兒科應用的指徵、治療效果及不良反應。方法迴顧性分析93例應用 PE 治療患兒,總結前後病情轉歸。結果93例患兒 PE 治療2~11次,平均5.5次,53例患兒採用聯閤血液淨化治療。溶血尿毒綜閤徵36例,22例(61.1%)痊愈,14例(38.9%)遺留不同程度血尿、蛋白尿,其中5例(13.9%)腎功能未恢複正常。神經繫統疾病患兒中吉蘭-巴雷綜閤徵9例,治療後好轉8例；抗 NMDA 腦炎8例,治療後好轉6例；重癥肌無力3例,PE 後均有不同程度好轉；急性播散性腦脊髓炎4例,好轉3例；慢性炎癥性脫髓鞘多神經病4例,好轉3例。毒蕈中毒9例,好轉4例。其他18例。93例中齣現不良反應12例(12.9%),其中過敏反應9例,低血壓3例,未見嚴重不良反應。結論 PE 是一種安全的血液淨化方法,不良反應少,對于很多疾病如非典型性溶血尿毒綜閤徵及某些危重型神經繫統疾病等療效肯定。
목적：탐토혈장치환(plasma exchange,PE )재인과응용적지정、치료효과급불량반응。방법회고성분석93례응용 PE 치료환인,총결전후병정전귀。결과93례환인 PE 치료2~11차,평균5.5차,53례환인채용연합혈액정화치료。용혈뇨독종합정36례,22례(61.1%)전유,14례(38.9%)유류불동정도혈뇨、단백뇨,기중5례(13.9%)신공능미회복정상。신경계통질병환인중길란-파뢰종합정9례,치료후호전8례；항 NMDA 뇌염8례,치료후호전6례；중증기무력3례,PE 후균유불동정도호전；급성파산성뇌척수염4례,호전3례；만성염증성탈수초다신경병4례,호전3례。독심중독9례,호전4례。기타18례。93례중출현불량반응12례(12.9%),기중과민반응9례,저혈압3례,미견엄중불량반응。결론 PE 시일충안전적혈액정화방법,불량반응소,대우흔다질병여비전형성용혈뇨독종합정급모사위중형신경계통질병등료효긍정。
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 mani-festations before and after treatment were analyzed retrospectively.Results Ninety-three cases of children received PE treatment 2 to 1 1 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 ob-served 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.
