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目的:采用二级血浆分离器对高胆红素患者行白蛋白置换治疗,观察其对血液胆红素及血液中其他溶质的清除作用。方法:7例伴高胆红素血症的住院患者,共接受12次以二级血浆分离器EC20W/30W为滤器的白蛋白置换治疗(ART),其中5次采用EC20W,7次采用EC30W。ART方法与后稀释连续性静脉-静脉血液滤过(CVVH)相似,置换液速度2000ml/h,净超滤150~200ml/h。在原有CVVH置换液配方中加入25%人体白蛋白100ml(浓度0.6%)。测定治疗10h对总胆红素(TB)、直接胆红素(DB)、间接胆红素(IDB)、血浆蛋白及凝血指标的影响。结果:采用EC20W行ART治疗10hTB、DB、IDB下降率分别为(29.1±3.0)%、(31.3±4.5)%、(18.7±10.2)%,采用EC30W治疗10hTB、DB、IDB下降率分别为(52.4±7.5)%、(54.9±9.4)%、(45.7±10.9)%。治疗开始时EC20W及EC30W组TB的清除率分别为(11.1±1.3)ml/min,(14.5±1.6)ml/min(P<0.01),治疗中两组清除率逐步下降,结束时两组清除率分别为(4.4±0.5)ml/min,(8.6±1.2)ml/min(P<0.01)。采用EC20W治疗前后血总蛋白、白蛋白、IgA、IgM水平无明显变化,而球蛋白及IgG水平轻度下降。采用EC30W治疗10h患者血总蛋白、白蛋白、球蛋白、IgG、IgA水平显著下降,而血IgM水平反有明显上升。EC20W组单次治疗分离白蛋白(95.0±27.2)g,分离球蛋白(22.4±9.3)g,而EC30W组分离白蛋白(164.6±18.3)g,分离球蛋白(29.5±8.3)g,两组治疗中补充白蛋白量为125g。EC20W及EC30W治疗对血纤维蛋白原水平无明显影响,EC20W可纠正患者延长的凝血酶原时间,EC30W则无明显影响。结论:采用二级分离器EC20W行白蛋白置换可选择性分离血液中白蛋白及其结合胆红素,对分子量更大的免疫球蛋白影响不明显。
OBJECTIVE: To study the clearance of blood bilirubin and other solutes in the blood of patients with hyperbilirubinemia by secondary plasma separator. Methods: Seven hospitalized patients with hyperbilirubinemia received 12 times of albumin replacement therapy (ART) with secondary plasma separator EC20W / 30W as filter, of which EC20W was used 5 times and EC30W was used 7 times. The ART method is similar to post-dilution continuous venovenous hemofiltration (CVVH) with a displacement of 2000 ml / h and a net ultrafiltration of 150-200 ml / h. In the original CVVH replacement fluid formulations added 25% human albumin 100ml (concentration 0.6%). The effects of 10 hours of treatment on total bilirubin (TB), direct bilirubin (DB), indirect bilirubin (IDB), plasma protein and coagulation index were determined. Results: The descending rates of DB and IDB were (29.1 ± 3.0)% and (31.3 ± 4.5)%, (18.7 ± 10.2)% respectively in EC20W line treated with ECT for 10h, and the decreasing rates of DB and IDB were 52.4 ± 7.5%, (54.9 ± 9.4)%, (45.7 ± 10.9)%. At the beginning of treatment, the clearance rates of TB in EC20W and EC30W groups were (11.1 ± 1.3) ml / min and (14.5 ± 1.6) ml / min respectively (P <0.01) Rates were (4.4 ± 0.5) ml / min and (8.6 ± 1.2) ml / min, respectively (P <0.01). Before and after treatment with EC20W blood total protein, albumin, IgA, IgM levels did not change, while globulin and IgG levels decreased slightly. The level of serum total protein, albumin, globulin, IgG and IgA in patients treated with EC30W for 10 hours decreased significantly, while the level of blood IgM increased significantly. In the EC20W group, albumin (95.0 ± 27.2) g was isolated and globulin was isolated (22.4 ± 9.3) g, while albumin was separated from the EC30W group (164.6 ± 18.3 g) and globulin (29.5 ± 8.3 g) The amount of albumin added during treatment was 125 g. EC20W and EC30W treatment had no significant effect on fibrinogen level, EC20W can correct patients prolonged prothrombin time, EC30W no significant effect. CONCLUSION: The albumin and its conjugated bilirubin can be selectively separated from the blood by EC20W secondary albumin exchange. The effect on the immunoglobulin with larger molecular weight is not obvious.