【摘要】 目的　探讨血浆置换术 (PE)治疗各型重型肝炎的疗效及影响疗效的相关因素。方法　 171例重肝在内科综合治疗同时每隔 1～ 2d进行血浆置换 ,每次置换 2 0 0 0mL。结果　 171例共进行PE 6 72次 ,每例平均 3.93± 2 .0 5次 ,存活 95例 (存活率 5 5 .5 6 % )。PE对亚重肝早期患者疗效最好 (存活率 89.2 9% ) ,慢重肝早期和亚重肝中期次之 (6 4 % ,5 0 % ) ,对急重肝、慢重肝中、晚期的疗效很差 ,对非甲～非庚和药物性重肝的疗效最好 (71 4 % ,88 2 % ) ,对乙型重肝次之 (5 2 .3% ) ,对重叠感染的重肝最差。PE前TBil、TP、ALB、CHol、TG、GGT、BUN、Cr水平对其能否存活有重要的评估价值 ,是否合并肝硬化腹水、消化道出血、肝性脑病、肝肾综合症是影响存活率最重要的因素。结论　PE治疗重型肝炎安全、有效 ,尤其适用于乙型重肝早期、药物和非甲～非庚型重肝。更多还原

【Abstract】 Objective To discuss the efficacy and its influence factors of the treatment with plasma exchange.Method 171 severe hepatitis patients were treated with medicine synthesis therapy, at the same time, fresh frozen plasma 2 000mL per times was used to exchange the patients’ plasma 1 or 2 days at interval.Result The treatment times of these patients amounted to 672 times, and averagely 3.93±2.05 times. 95 patients of these patients survived(survival rate is 55.56%). The efficacy of the treatment with PE did well in the early stage of subacute severe hepatitis (survival rate is 89.29%), but the medium stage patients and the early stage of chronic severe hepatitis is inferior in its efficacy (64%,50%).For acute severe hepatitis and medium or late chronic severe hepatitis, the efficacy is worst. Non A～E and medicament severe hepatitis’efficacy is best, severe hepatitis B virus is inferior, the superinfectional patients are worst. Pre-PE, the serum density of TBil?TP?ALB?CHol?TG?GGT?BUN?Cr are relevant to the survival rate, and significant factors affecting survival rate including ascites of cirrhosis, gastrointestinal hemorrhage, hepatic encephapathy and hepatorenal syndrome.Conclusion Plasma exchange is a safe and effective means to treat severe hepatitis.更多还原