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目的:探讨血液置换疗法对自身免疫性溶血性贫血(AIHA)患者的治疗效果。方法:回顾性分析2014年1月-2015年1月中山市人民医院收治的AIHA患者78例,根据输血方法的不同,分为对照组36例和观察组42例。对照组给予洗涤红细胞输注治疗,观察组在对照组的基础上联合血液置换治疗,检测并观察两组患者输血前后红细胞计数、网织红细胞、血红蛋白和胆红素的变化,并比较两组患者的临床疗效及不良反应发生情况。结果:两组患者输血后的红细胞计数和血红蛋白水平显著升高,而网织红细胞和胆红素水平显著降低,与输血前比较,差异具有统计学意义(P<0.05);观察组患者输血后的红细胞计数和血红蛋白水平分别为(4.76±0.42)×10~(12)/L和(92.54±6.68)g/L,显著高于对照组的(3.14±0.26)×10~(12)/L和(72.58±6.03)g/L,差异具有统计学意义(P<0.05);观察组患者输血后的网织红细胞和胆红素水平分别为(18.06±5.56)%和(26.78±7.14)μmol/L,显著高于对照组的(24.25±4.98)%和(40.35±6.89)μmol/L,差异具有统计学意义(P<0.05)。观察组的治疗总有效率为92.86%,显著高于对照组的72.22%,差异具有统计学意义(P<0.05)。观察组的不良反应发生率为9.52%高于对照组的8.33%,但差异无统计学意义(P>0.05)。结论:洗涤红细胞联合血液置换治疗AIHA,可显著改善患者的血液指标。
Objective: To investigate the therapeutic effect of blood exchange therapy on patients with autoimmune hemolytic anemia (AIHA). Methods: A retrospective analysis of 78 patients with AIHA admitted to Zhongshan People’s Hospital from January 2014 to January 2015 was divided into control group (n = 36) and observation group (n = 42) according to the method of transfusion. The control group was treated with RBC infusion. The observation group was treated with blood replacement therapy on the basis of the control group. The changes of red blood cell count, reticulocyte, hemoglobin and bilirubin before and after blood transfusion in both groups were detected and observed. The clinical efficacy and adverse reactions occurred. Results: The red blood cell count and hemoglobin level after transfusion were significantly increased in both groups, while the levels of reticulocyte and bilirubin were significantly lower than those before transfusion (P <0.05). After transfusion (4.76 ± 0.42) × 10 ~ (12) / L and (92.54 ± 6.68) g / L, respectively, which were significantly higher than those in the control group (3.14 ± 0.26) × 10 ~ (12) / L And (72.58 ± 6.03) g / L, respectively (P <0.05). The levels of reticulocyte and bilirubin in the observation group were (18.06 ± 5.56)% and (26.78 ± 7.14) μmol / L, which was significantly higher than that of the control group (24.25 ± 4.98)% and (40.35 ± 6.89) μmol / L, respectively, with statistical significance (P <0.05). The total effective rate of the observation group was 92.86%, which was significantly higher than that of the control group (72.22%), the difference was statistically significant (P <0.05). The incidence of adverse reactions in the observation group was 9.52% higher than that in the control group (8.33%), but the difference was not statistically significant (P> 0.05). Conclusion: The combination of washing erythrocyte and blood replacement for AIHA can significantly improve the blood parameters of patients.