小講課-血漿置換教學(xué)課件

LOGO美國(guó)血液分離協(xié)會(huì)2019年(第五版)血液分離循證應(yīng)用指南血漿置換章節(jié)節(jié)選By優(yōu)雅的貓2019.5.29病史JournalofClinicalApheresis25:83-177(2019)uidelinesontheUseofTherapeuticApheresis急性肝衰竭--1ACUTELIVERFAILURe:Exactincidenceunknown,LivertrarplantationratProcedureis5,0006,00yearintheUSofreportedpatients*:>30Typeofevidence◆發(fā)病率不詳,美國(guó)肝移植5000-6000每年令美國(guó)最大原因:病毒性肝炎,英國(guó):對(duì)乙酰氨基酚其他原因:藥物,肝毒性物質(zhì),自身免疫性肝炎,肝豆?fàn)詈俗冃浴舨∷缆?50-90%:代謝紊亂,肝性腦病,凝血異常心使用肝移植后,存活率大于60%基于細(xì)胞的人工肝:FDA未批準(zhǔn),屬于實(shí)驗(yàn)性令非細(xì)胞人工肝:血漿清除,白蛋白透析,MARSSPAD。

綜合管理:血壓,抗生素,血糖,防潰瘍,昏迷治療,凝血功能,cvVH院。急性肝衰竭-2心血漿置換:清除白蛋白,以及大分子毒素改善:腦血流、平均動(dòng)脈壓、腦灌注壓、腦代謝率、肝血流冷改善凝血功能某些病人:肝臟再生心等待肝移植移除膽汁酸:治療難治性瘙癢◆替代物:血漿,白蛋白心治療容量:1-15倍血漿頻率:每天◆持續(xù):肝移植或者肝再生ANcA相關(guān)性快速進(jìn)展腎炎(魏格納肉芽腫)ANCA-ASSOCIATEDRAPIDLYPROGRESSIVEGLOMERULONEPHRITIS(WEGENER"SGRANULOMATOSISProcedureRecommendationGrseGrade1(I[diffusealveolarhemorrhage(DAH)Grade2cofreportedpatients*:>300TypeofesidenceInpalientswithpulmonaryIeimomhage,rtplaccanctwithplasmaisttcummmcdcdloawuiddilutionalcugalopthyresultingfrumnon-plasmItplaccnciL.olumetreated:ItolsTPYFrequency:dailyareveryotrday抗腎小球基底膜病(GOODPASTURES綜合征)ANTI-GLOMERULARBASEMENTMEMBRANEDISEASE(GOODPASTURE'SSYNDROMEIncidence:IperLODD00/year[4(dialysisindependentI"[diffusealveolarhemorrhage(DAH)Iv(dialysisdependent;noDAH)ofreportedRCTTypeofevidence目前治療:血漿置換+環(huán)磷酰胺+激素自身免疫性溶血性貧血AUTOIMMUNEHEMOLYTICANEMIA:WARMIDIOPATHICHEMOLYTICANEMIA:COLDAGGLUTTINDISEASEIncidence:Iper100,000/yearProeedureIIIWAIHAⅡCADMifethreatening)fofreportedpaTypeofevidenceWAIHACAD19(22)TypeⅢ燒傷復(fù)蘇BURNSHOCKRESUSCITATIONncidence:unknwnProcedureRecommendationffofreportedpatients":<1TypeofevidenceImetrFrequency:once,seebelowid:plasma心目前:補(bǔ)液◆血漿置換:清除炎癥因子有限的觀察:有助于改善:血壓,補(bǔ)液反應(yīng),尿量,心功能◆燒傷后一天內(nèi),做一次心臟移植排斥RAFTREJECTIONAntibodymedatedrejection(AMR)II(treatmentofcellularrejection)Hofreportedpatients"100-300(ECP):100-300(TPE)RCTECPProphylaxis1(16)4(57)TypeIl-3Type心目前:抗排異藥物令血漿置換:清除供體特異性抗體和/或炎癥因子回顧性研究支持Volumetreated:ECP:AnMNCproductof200-270Frequency:ECP:ItsMNCsobtainedfrom2-timesTBYprocessing.days(oneseries)weeklyarewery2to8weeksforseveralmonthsregimensReplacementfluid;ECP:NATPE:albuminsplasmaTPE:dailyforaminimumof3days災(zāi)難性抗磷脂抗體綜合征CATASTROPHICANTIPHOSPHOLIPIDSYNDROMEIncidence:veryrare(282casesinCAPSRegistry)ProcedureRecommendationIofreportedpatients*:100-300RUI