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目的：探讨综合治疗和加用非连续、非密闭式血浆置换（ＰＥ）治疗重症肝炎的疗效。方法：对２５例重症肝炎患者在内科综合治疗的基础上加用非连续、非密闭式ＰＥ，每次置换血浆量４００～１２００ｍｌ，其中置换１、２、３和４次者分别为５、１５、３和２例，每次间隔时间为１～３天。并与仅用内科综合治疗的１９例重症肝炎患者比较。结果：治疗组及对照组的治愈好转率分别为８０％和５３％（Ｐ＜０．０５），病死率分别为１２％和４２％（Ｐ＜０．０５）。治疗组加用ＰＥ后血清总胆红素及谷丙转氨酶明显降低（Ｐ＜０．０１），消化道症状迅速改善。５例腹水者中３例腹水完全消失，４例肝昏迷者中３例意识转清。结论：在内科综合治疗的基础上加用ＰＥ可明显提高重症肝炎的治愈好转率，降低病死率；ＰＥ副作用轻且可逆。
Objective: To investigate the curative effect of combined treatment and non-continuous and non-closed plasma exchange (PE) on severe hepatitis. Methods: Twenty-five patients with severe hepatitis were treated with non-continuous and non-closed PE on the basis of comprehensive medical treatment. The volume of plasma replacement was 400 ~ 1200ml per one time, of which 5, 15 , 3 and 2 cases, each interval of 1 to 3 days. And compared with 19 patients with severe hepatitis treated only with internal medicine. Results: The healing improvement rates of the treatment group and the control group were 80% and 53%, respectively (P <0.05), and the mortality rates were 12% and 42% respectively (P <0.05). After treatment with PE, serum total bilirubin and alanine aminotransferase were significantly decreased (P <0.01), gastrointestinal symptoms improved rapidly. Ascites in 5 cases of ascites in 3 cases completely disappeared, 4 cases of hepatic coma in 3 cases of consciousness clear. Conclusion: Addition of PE on the basis of comprehensive medical treatment can significantly improve the cure rate of severe hepatitis and reduce the mortality; PE has mild and reversible side effects.