目的 评估密闭式回浆在双重血浆分子吸附系统(double plasma molecular absorption system，DPMAS)治疗中的应用效果。 方法 选取2021年5月─2023年2月在四川大学华西医院行DPMAS治疗的患者60例。将患者随机分为不回浆组、密闭式回浆400 ml组和密闭式回浆600 ml组，每组患者20例。比较3组在DPMAS治疗结束回浆后白蛋白的残留量、密闭式回浆组在回浆前后血中胆红素的变化。 结果 DPMAS治疗结束回浆后，3组患者在胆红素吸附器、血液灌流器和体外循环回路管部位的剩余白蛋白比较有统计学差异，平均白蛋白残留量比较有统计学差异(H=52.465， P＜0.001)。密闭式回浆400 ml组，密闭式回浆600 ml组在回浆前和回浆后血中胆红素差异无统计学意义(t=-0.461、-0.513，P=0.647、0.611)。 结论 密闭式回浆不仅可以减少患者的白蛋白丢失，而且不会增加胆红素脱落的风险。
Objective To evaluate the application effect of closed plasma reinfusion in the treatment of patients with double plasma molecular absorption system (DPMAS). Methods A total of 60 patients who underwent DPMAS treatment in our hospital from May 2021 to February 2023 were selected and randomly divided into three groups: non-reinfusion group, closed plasma reinfusion 400 ml group, and closed plasma reinfusion 600 ml group, with 20 patients in each group. The loss of albumin after the completion of DPMAS treatment and the change in bilirubin levels in the blood before and after plasma reinfusion in the closed plasma reinfusion groups were compared. Results After DPMAS treatment and reinfusion, the remaining albumin levels in different locations of the three groups were significantly different (bilirubin adsorber: 11.9(10.4, 13.0)g vs. 1.2 (1.0, 1.5)g vs. 0.8(0.6, 0.9)g, H=49.266, P<0.001). hemoperfusion device: 11.9 (10.4, 13.0) g vs. 4.0 (3.7, 5.2) g vs. 1.3(1.1, 2.0)g, H=52.477, P<0.001). extracorporeal circuit: 11.9(10.4,13.0)g vs. 9.0(7.9,10.0)g vs. 3.2(2.2, 3.8)g, H=46.787, P<0.001). The average albumin loss was also significantly different [11.9(10.4, 13.0)g vs. 4.7(4.3, 5.3)g vs. 1.8(1.4, 2.0)g, H=52.465, P<0.001]. In the closed plasma reinfusion groups (400 ml and 600 ml), no statistically significant difference was observed in bilirubin levels before [(236.21±98.31) vs. (224.07±64.63)mmol/L, t=-0.461, P=0.647] and after reinfusion [(233.83±99.98) vs. (220.04±66.67)mmol/L, t=-0.513, P=0.611]. Conclusion Closed plasma reinfusion can not only reduce the loss of albumin in patients but also does not increase the risk of bilirubin shedding.
