Efficacy of three plasma exchange methods in improving renal insufficiency after kidney transplantation and the induction of plasma exchange related adverse reactions: a comparative study / 中国输血杂志

【Objective】 To compare the efficacy of double filtration plasmapheresis(DFPP), centrifugal therapeutic plasma exchange(cTPE) and centrifugation-filtration plasmapheresis(CFPP) in improving renal insufficiency after kidney transplantation, as well as the differences in inducing plasma exchange-related adverse reactions. 【Methods】 Clinical data from 46 patients who underwent plasma exchange after renal transplantation in our hospital were retrospectively collected, and patiens were divided into DFPP group(n=33), cTPE group(n=7) and CFPP group(n=6). Changes in peripheral blood creatinine, albumin, hemoglobin, platelets, fibrinogen levels and urine volume before and after TPE were compared and analyzed among the three groups. 【Results】 Among the DFPP group, cTPE group and CFPP group, the creatinine after TPE decreased by (31.40±25.38)%, (58.91±19.75)% and (39.44±28.64)%, respectively, with cTPE group significantly higher than the DFPP group(P0.05); the urine volume after TPE increased by (49.33±30.03)%, (54.62±39.32)% and (68.89±23.00)%, showing no significant differences(P>0.05); the hemoglobin after TPE decreased by (11.97±5.94)%, (20.17±5.75)% and (9.65±8.75)%, respectively, with the cTPE group significantly higher than the DFPP group and CFPP group(P0.05). The platelet count after TPE decreased by (37.88±18.39)%, (24.56±12.36)% and (21.40±12.51)%, respectively, with no significant differences between the three groups(P>0.05); the fibrinogen after TPE decreased by (0.57±0.20)%, (0.14±0.06)% and (0.26±0.22)%, respectively, with the DFPP group significantly higher than the cTPE group(P0.05); the albumin after TPE decreased by (11.41±5.97)%, (14.67±6.52)% and (25.18±5.10)%, respectively, with cTPE group and DFPP group significantly lower than the CFPP group(P0.05). 【Conclusion】 The effect of three plasma exchange methods varies on renal function, anemia and coagulation function of patients after kidney transplantation. It is necessary to consider the the patient’s disease characteristics and treatment needs, as well as the laboratory′s technical conditions and plasma supply when selecting TPE methods.

Application of emergency transcatheter arterial embolization on liver and spleen rupture / 中国基层医药

Objective To investigate the value of emergency transcatheter arterial embolization in the treat-ment of liver and spleen rupture,in order to provide the reference for clinical therapeutic strategies.Methods In our hospital,58 patients with liver and spleen rupture were selected.Operation time,catheter angiography,embolization of success rate,postoperative survival rates and the postoperative complications were recorded.Then follow-up,patients with sequela of occurrence was recorded.Results Embolizations of 55 cases were successful,3 cases accounted for 94.8%,2 were successful, no embolization failed, the success rate of catheter angiography in the diagnosis was 100.0%.31 cases of arterial embolization for splenic artery,10 cases of hepatic artery,8 cases of right hepatic artery, 2 cases of left hepatic artery.The average operation time was (57.8 ±15.6) min.All the patients were successfully hemostatic,postoperative survival rate was 100.0%for patients.2 cases of postoperative biliary leakage,1 cases with splenic abscess,the incidence of postoperative complications was 5.2%.Recovery of all patients was good,without the occurrence of sequelae.Conclusion Rupture has good clinical efficacy of emergency transcatheter arterial emboliza-tion in treatment of liver and spleen,liver,spleen can be retained in the circumstances,the effective control of hemor-rhage,improve the clinical success rate.