- 期刊
治療性血漿交換術在小兒領域之應用
Therapeutic Plasma Exchange in Children
摘要
由於建立適當血管路徑的困難與施術時體外血量佔全身血量比例較高等種種技術上的問題，使得血漿交換術甚少應用於小兒科病人，高雄醫學院小兒科自民國73年2月至74年12月間，共有10位住院患兒利用Haemonetics 30-S與V-50之間歇性血液分離機與小兒離心碗，做了24次的血漿交換術。男孩3位，女孩7位，年齡分佈由4歲至14歲。其中系統性紅斑狼瘡3例：Stevens-Johnson氏症候羣2例，溶血性尿毒症候羣1例，Wilms氏腫瘤病人合併嚴重進行性水痘1例。亞急性肝壞死1例，Guillain-Barré氏症候羣1例與胡蜂叮螫1例。系統性紅斑狼瘡、Stevens-Johnson氏症候羣、溶血性尿毒症候羣與嚴重進行性水痘的7位患兒都獲致顯著改善或痊癒；亞急性肝壞死、Guillain-Barré氏症候羣與胡蜂叮螫的3位患兒在治療當中都獲致改善，但終因治療中斷或合併症而死亡。雖然孩童接受血漿交換術之危險性較成人高，體內外血量與血液內成分之變化多予小心注意：小兒病人還是可以很安全地接受血槳交換術。我們在這24次之施術中，並無發生體液不平衡或休克等併發症，也沒有患兒因施術而死亡。本法對於小兒疾患以傳統療法無效時，不失爲一可行之治療方法。
關鍵字
無資料並列摘要
Therapeutic plasma exchange is less frequently applied in children than in adults because of the many technical problems encountered. Children are so different from adults in size, surface area, cognitive development, and communication ability that modifications of procedures are required. From February 1984 to December 1985, 24 plasma exchanges were performed on 10 children aged from 4 to 14 years at the Department of Pediatrics, Kaohsiung Medical College Hospital. These cases included three patients with systemic lupus erythematosus with CNS involvement, two of Stevens-Johnson syndrome, one of severe chickenpox in an immunocompromised patient, one with hemolytic-uremic syndrome, one with Guillain-Barré syndrome, one of subacute hepatic necrosis, and one who had suffered wasp stings. Plasma exchanges were carried out by intermittent-flow centrifugation separators (Haemonetics(superscript ®) Model 30S or V-50 cell separators). The procedure appeared to play a significant role in reversing the clinical course of disease in or curing in all but three of the patients (patients of Guillain-Barré syndrome, subacute hepatic necrosis, or wasp stings) all of whom died because of discontinuation of procedure or of complications. Morbidity resulting from the procedure itself was virtually nonexistent. Plasma exchange has a great potential for treatment of various refractory diseases if pathogens can be reduced by plasma removal before irreversible change occurs.
延伸閱讀
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- 錢光新（1963）。兒童之胎兒性紅血球及血紅素量及換血治療之影響。Acta Paediatrica Sinica，4(3)，169-175。https://www.airitilibrary.com/Article/Detail?DocID=00016578-196309-4-3-169-175-a
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- 黃繩龍、田望赐、溫明達、許美芸、黃文雄（2008）。Medical Therapy of Immune Deficiency。臺灣兒童過敏氣喘及免疫學會學會通訊，9(3)，4-7。https://doi.org/10.7025/HEJ.200809.0004