【摘 要】 目的 观察血浆置换(PE)治疗三氯乙烯药疹样皮炎(DMLT)合并重度肝损害的疗效。方法 21例患者在内科综合治疗的基础上给予血浆置换治疗，观察临床疗效和并发症发生情况，监测治疗前后肝功能生化指标、凝血功能及肿瘤坏死因子-α(TNF-α)的变化情。 结果 所有患者经血浆置换治疗后临床症状有不同程度缓解，有效率为100%；治疗后肝功能好转，TNF-α低于治疗前，凝血酶原时间(PT)缩短，差异均有统计学意义，活化部分凝血酶原时问(APTT)、凝血酶时间(TT)、纤维蛋白原 (FBG)水平前后相比较无明显差异；1例因并发肺部诺卡菌感染死亡；21例患者共进行血浆置换治疗81次，出现不良反应2次。结论 血浆置换治疗三氯乙烯药疹样皮炎合并重度肝功能衰竭疗效明显

【Abstract】 Objective　To explore the therapeutic effect of plasma exchange in the treatment of patients with dermatitis medicamentosa like of trichloroethylene(DMLT) accompanied with severe hepatitis．Methods 21 patients were treated with plasma exchange on the basis of conventional therapy．The hepatic function makers，coagulation tests and improvements of clinical symptoms were compared．Results After treatment，the patients total bilirubin，alanine aminotransferase，aspartate amino transferase，Tumor necrosis factor-α，prothrombin time decreased(P<0.05)，albumin increased(P<0.05)，and clinical symptoms improved. There were no significant difference in activeated partial thromboplastin time、thrombin time and Human Fibrinogen．The effective rates were 100%. 1 patient died of pulmonary infection because of Nocadia. 20cases(95.2%) out of the 21 patients survived. 81 times of plasma exchange treatments were done in all 21 cases，and that with adverse reaction was 2 times．Conclusions　Plasma exchange is safe and effective in treatment of patients with DMLT．