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[治疗性血浆置换中蛋白质替代的定量评估]

[Quantitative assessment of protein replacement in therapeutic plasmapheresis].

作者信息

Kalinin N N, Movshev B E, Khester D, Petrova V I

出版信息

Ter Arkh. 2003;75(2):65-8.

Abstract

AIM

To calculate parameters of replacement in which the amount of total protein (TP) in the circulating blood remains above critical level after removal of 17-75% of circulating plasm volume (CPL).

MATERIAL AND METHODS

Therapeutic plasmapheresis (TPA) was made in 96 patients with rheumatoid arthritis, bronchial asthma, systemic lupus erythematosus and other diseases. The plasm was replaced by 0.9% sodium chloride solution, rheopolyglucine and albumin solutions in isovolemic regime. Albumin was given in quantities equivalent to 50-65% of the removed protein.

RESULTS

Close correlation was observed between the expected and actual concentrations of total protein in 96 patients who have undergone 206 TPA procedures. In removal of up to 35% CPL protein deficiency is compensated by its mobilization from the deposits and due to protein-synthetizing function of the liver. In removal of 75% and more and in initial hypoproteinemia 50% of the protein should be replaced.

CONCLUSION

It is confirmed that rheopolyglucin can be used for plasm replacement in TPA in patients with hyperproteinemia having no contraindications.

摘要

目的

计算在去除17 - 75%循环血浆量(CPL)后,循环血液中总蛋白(TP)量仍保持在临界水平以上的置换参数。

材料与方法

对96例类风湿关节炎、支气管哮喘、系统性红斑狼疮及其他疾病患者进行治疗性血浆置换(TPA)。在等容状态下,用0.9%氯化钠溶液、低分子右旋糖酐和白蛋白溶液置换血浆。给予的白蛋白量相当于去除蛋白质的50 - 65%。

结果

在接受206次TPA治疗的96例患者中,观察到总蛋白的预期浓度与实际浓度之间密切相关。去除高达35%的CPL时,蛋白质缺乏可通过从储存库中动员以及肝脏的蛋白质合成功能得到补偿。去除75%及更多以及初始低蛋白血症时,应置换50%的蛋白质。

结论

证实无禁忌证的高蛋白血症患者在TPA中可用低分子右旋糖酐进行血浆置换。

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