血浆置换治疗难治性免疫性疾病常可取得较好的疗效。本院自1993年7月至1996年7月用血浆置换治疗、预防严重的免疫相关性疾病19例78例次,现总结如下。 临床资料 1.一般资料:本组19例,其中系统性红斑狼疮(SLE)3例,均为经甲基强的松龙、环磷酰胺冲击治疗无效者;肾移植急性排斥反应11例,7例根据临床表现、4例根据肾活检结果诊断,均经足量甲基强的松龙冲击治疗,剂量达2000～5300mg,部分加用抗胸腺球蛋白、CTX冲击治疗,仍无尿,肾功能未恢复;预防肾移植严重排斥反应5例,其中2例为第2次移植,第1次移植时1例为超急性排斥,1例为加速排斥,经治疗无效行移植肾摘除术,本次淋巴毒试验>15％,另3例淋巴毒试验阴性。本组患者年龄19～68岁,其中女5例,男14例。选择的病例按国内诊断标准确诊。治疗后作近期疗效评定,症状、体征明显改善,血、尿、肾功能、免疫学检查恢复正常或接近正常为显效,否则为无效。 2.方法:采用宁波亚太公司生产的膜式血浆分离器、血浆成份分离器。分离器均重复使用。78例次中膜式一次分离63例次,血流量90～100ml/分,每次丢弃血浆1200～4000ml,平均2797ml。置换液:每次先输入代胶体液500ml,然后输血浆、白蛋白林格液,保证进出平衡;膜式二次分离共15例次,血浆废弃液150～900ml/次,平均381ml/次,? Plasma exchange treatment of refractory immune disease can often achieve better results. The hospital from July 1993 to July 1996 with plasma exchange treatment to prevent serious immune-related diseases, 19 cases of 78 cases, are summarized as follows. Clinical data 1. General information: The group of 19 patients, including systemic lupus erythematosus (SLE) in 3 cases, were treated by methylprednisolone, cyclophosphamide impact treatment ineffective; renal transplant acute rejection in 11 cases, 7 According to the clinical manifestations, 4 cases were diagnosed according to the results of renal biopsy and were treated with sufficient doses of methylprednisolone. The dosage was from 2000 to 5300 mg. Some of them were treated with anti-thymosin and CTX, and no urine or renal function 5 cases of serious rejection of renal transplantation were prevented, of which 2 cases were the second transplant, 1 case was hyperacute rejection on the first transplant, 1 case was accelerated rejection, and the treatment was ineffective. Lymph virus test> 15%, the other three cases of lymphatic toxicity test negative. The patients aged 19 to 68 years, of whom 5 were women, 14 males. Selected cases diagnosed by domestic diagnostic criteria. After treatment, the curative effect was evaluated as soon as possible. Symptoms and signs were significantly improved. Blood, urine and renal function were returned to normal or close to normal, but the results were invalid. 2. Methods: The film produced by Ningbo Asia Pacific plasma separator, plasma components separator. Separators are reused. 78 cases of sub-membrane 63 times a time, blood flow of 90 ~ 100ml / min, each discard the plasma 1200 ~ 4000ml, an average of 2797ml. Displacement: each time the first input of colloid solution 500ml, and then lose plasma, albumin Ringer solution, to ensure the balance; membrane secondary separation a total of 15 cases of plasma waste 150 ~ 900ml / times, an average of 381ml / time, ?