背景:治疗性血浆置换(TPE)用于治疗各种危及生命的疾病。它由肾脏病学家广泛执行,密集主义者,病理学家,或全球输血医学专家。然而,TPE会议的成本非常高,它们对患者的经济负担有巨大的影响。在这里,我们调查了多次在TPE中重复使用血浆过滤器的结果。
方法:这是一项对2020年1月1日至2023年4月30日在肾内科接受TPE的患者的回顾性分析。使用具有RO水稀释的4.5%过乙酸和24%过氧化氢酸的制剂进行再处理。临床结果,风险,在血浆过滤器重复使用组(GP-1)和不重复使用组(GP-2)之间评估和比较成本效益。
结果:本研究共纳入70例患者。在GP-1和GP-2中分别进行200和112个TPE会话。两组中TPE最常见的适应症是神经系统。两组TPE的临床疗效相似。血浆过滤器的凝血没有差异,任何过敏反应,感染,或者是群里的出血.然而,两组术前和术后的纤维蛋白原水平有显著差异(p=0.03).发现GP-1的低血压发生率(26%)高于GP-2(15.6%),p=0.05。GP-1的总体治疗费用降低了38%。
结论:再次使用血浆过滤器是一种安全有效的方法,可以使需要TPE的患者的成本最小化。这种方法可以在资源贫乏的环境中有效利用,而不会增加不利影响的风险。
BACKGROUND: Therapeutic plasma exchange (TPE) is used to manage various life-threatening illnesses. It is widely performed by nephrologists, intensivists, pathologists, or experts in transfusion medicine worldwide. However, the costs of TPE sessions are exceedingly high, and they have a huge impact on patients\' financial burden. Herein, we investigated the outcomes of the reuse of plasma filters in TPE on several occasions.
METHODS: This is a retrospective analysis of patients receiving TPE from January 1, 2020, to April 30, 2023, in the Department of Nephrology. A formulation of 4.5% peracetic acid and 24% hydrogen peroxide acid with RO water dilution was used for reprocessing. Clinical outcomes, risks, and cost-benefit were evaluated and compared between the plasma filter reuse group (GP-1) and the no-reuse group (GP-2).
RESULTS: A total of 70 patients were included in this study. 200 and 112 TPE sessions were performed in GP-1 and GP-2, respectively. The most common indication for TPE in both groups was neurological. The clinical efficacy of TPE was similar in both groups. There was no difference in the clotting of the plasma filter, any allergic reaction, infection, or bleeding in the group. However, there was a significant difference in levels of fibrinogen (p=0.03) pre and post-procedure in both groups. The incidence of hypotension was found to be higher in GP-1 (26%) compared to GP-2 (15.6%), p = 0.05. The cost of overall treatment was 38% less in GP-1.
CONCLUSIONS: The reuse of plasma filters is a safe and effective method for cost minimization in patients requiring TPE. This method can be effectively utilized in resource-poor settings without any increased risk of adverse effects.