目的：探讨血浆置换不同补充时机对药物性肝损伤疗效的影响。方法：96 例药物性肝损伤患者，按照随机数字表法分为

A、B、C组，各32 例。所有患者在常规治疗基础上进行血浆置换治疗。其中，A组患者与血浆置换同步进行的替补液为100％新鲜

血浆；B组患者与血浆置换同步进行的替补液为：先补充40％生理盐水，再补充60％新鲜血浆；C组患者在血浆置换至离体血液达

1 个体循环量的12％时，再开始补充替补液，补充顺序为先补充40％生理盐水，再补充60％新鲜血浆。观察各组患者治疗前后的

临床症状及体征、肝脏功能和凝血酶原活动度。结果：采用血浆置换治疗药物性肝损伤均可获得较好的疗效，但C组患者临床症

状及体征消失的时间显著短于A组和B组，B组又显著短于A组，组间比较差异均具有统计学意义（P＜0.05）。3 组患者治疗后的

总胆红素、凝血酶原活动度、白蛋白水平均显著优于治疗前，差异具有统计学意义（P＜0.05），且C组优于A、B两组，B组优于A

组，组间比较差异均具有统计学意义（P＜0.05）。3 组患者治疗后的丙氨酸转氨酶和天冬氨酸转氨酶水平显著下降，与治疗前比较

差异具有统计学意义（P＜0.05），且B、C组显著优于A组，差异具有统计学意义（P＜0.05），而B、C两组相似，差异无统计学意义

（P＞0.05）。结论：在不同时机进行血浆置换对药物性肝损伤有着不同的疗效，在血浆置换至离体血液达1 个体循环量的12％时，

先补充40％生理盐水，再补充60％新鲜血浆的效果较为显著。

OBJECTIVE：To explore the effect of different plasmapheresis supplement timing on therapeutic efficacy of toxic

liver injury. METHODS：96 patients with toxic liver injury and divided into group A，B ，C and D with 32 cases in each group according

to different plasmapheresis supplement timing. All patients received plasmapheresis supplement based on routine treatment.

In group A，synchronized fluid replacement was 100％ fresh plasma；in group B，synchronized fluid replacement was 40％ normal

saline firstly，and then 60％ fresh plasma；in group C，substitute liquid was given till the in vitro blood reached 12％ of circulation

amount，supplement order as 40％ normal saline for the first supplement，and then add 60％ fresh plasma. The clinical symptoms

and signs，liver function，prothrombin activity and blood biochemical indicators were observed in each group before and after treatment.

RESULTS：Plasmapheresis supplement had good therapeutic efficacy on toxic liver injury；but the time of clinical symptoms

and signs disappearance in group C was significantly shorter than that in group A and B，and the group B was significantly shorter

the group A，with statistical significance（P＜0.05）. The plasma bilirubin，prothrombin activity，albumin levels of 3 groups after

treatment were significantly better than before，with statistical significance（P＜0.05）；the group C was better than the group A and

B，and the group B was better than the group A，with statistical significance（P＜0.05）. Compared with before treatment，the levels

of AST and ALT in 3 groups decreased significantly after treatment，with statistical significance（P＜0.05）；the group B and C

were better than the group A，with statistical significance（P＜0.05）；the group B and C was similar to each other，without statistical

significance（P＞0.05）. CONCLUSIONS：Different plasmapheresis supplement timing have different effect on toxic liver injury.

The supplement method that giving 40％ normal saline for the first supplement，and then add 60％ fresh plasma when in vitro

blood reach 12％ of circulation amount has more significant effect.