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目的探讨血浆置换频率和量对多发性骨髓瘤合并肾衰竭患者M蛋白清除率的作用。方法选择22例多发性骨髓瘤合并肾功能不同程度损伤并在化疗期间进行血浆置换的患者,分为3组:第1组(M蛋白平均值80g/L组)每日置换1次,置换量为1500ml,连续5d;第2组(M蛋白35g/L组)每日置换1次,置换量为1500ml,连续5d;第3组(M蛋白35g/L组)隔日置换1次,置换量为800ml,连续5d。每组分别在置换3d和5d后检测血液中M蛋白的含量。结果第1组M蛋白3d后下降54.3%,5d后下降78.5%;第2组M蛋白3d后下降49.7%,5d后下降79.7%;第3组M蛋白3d后下降37.1%,5d后下降45.7%。结论在使用有效化疗的同时,连续血浆置换且置换量大,可迅速降低患者血中的M蛋白,减少肾衰竭的发生。
Objective To investigate the effect of plasma exchange rate and plasma M clearance on multiple myeloma patients with renal failure. Methods Twenty-two patients with multiple myeloma with different degree of renal injury and plasma exchange during chemotherapy were divided into three groups: Group 1 (M protein average 80g / L group) (M protein 35g / L group) was replaced daily for 1 day with a volume of 1500ml for 5 days. Group 3 (M protein 35g / L group) was replaced every other day with the volume of 800ml, continuous 5d. Each group were detected in the blood M protein content after 3d and 5d replacement. Results In the first group, M protein decreased 54.3% 3d and decreased 78.5% 5 days later. In the second group M protein decreased 49.7% 3d and decreased 79.7% 5 days later. In the third group M protein decreased 37.1% 3d and decreased 45.7 %. Conclusions While using effective chemotherapy, continuous plasma exchange and large replacement volume can rapidly reduce M protein in patients’ blood and reduce the incidence of renal failure.