临产孕妇凝血功能检测的探讨

目的:掌握临产孕妇分娩前的凝血功能状况,探讨临产孕妇分娩前的凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)、血浆纤维蛋白原含量(Fib)等凝血指标变化的检测。方法:选取180例正常妊娠临产孕妇及83例非怀孕育龄妇女进行PT、TT、APTT、Fib检测。结果:临产孕妇组的PT、TT值明显低于非怀孕妇女组,而Fib值有明显的升高,两组PT、TT、Fib值差异(P0.01)有统计学意义,APTT值虽有降低但与对照组相比差异不显著,而且APTT值差异(P0.05)无统计学意义。结论:做好临床孕妇分娩前凝血功能检测,加强分娩过程中产妇各项凝血指标的密切监测在防止生产异常出血和预防诱发DIC及血栓性疾病等方面具有重大意义。     

肝硬化患者PT、APTT、FIB、TT及D-D参数变化的初步探讨

目的 研究肝硬化患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)、血浆凝血酶时间(TT)及D-二聚体(D-D)的变化及临床意义.方法 应用全自动血凝仪和全自动生化仪检测各组血浆中PT、APTT、FIB、TT及D-D值.结果 肝硬化患者与对照组比较PT、APTT、TT及D-D均明显延长而FIB则明显下降,两者比较差异有显著性(P＜0.01).结论 肝硬化患者血浆凝血及纤溶实验(PT、APTT、FIB、TT及D-D)各参数均有变化,可从多方面客观准确地评价肝硬化患者凝血功能状况及其病情预后.     

体外循环常用预充液离体血液稀释对凝血功能的影响

目的探讨体外循环常用预充液离体条件下进行不同程度血液稀释后对凝血功能的影响。方法采取10名成年男性健康志愿者静脉血,分别用乳酸林格氏液(L组),4%琥珀酰明胶(G组)及和6%羟乙基淀粉130/0.4(W组),进行10%、30%、50%的稀释,以未稀释血作为基础值。用血栓弹力图(TEG)行动态凝血功能检测,包括反应时间(R)、血凝块时间(K)、凝固角(α角)、血凝块强度值最大振幅(MA);同时用常规实验室方法检测血细胞比容(Hct)、血小板计数(Plt)、凝血酶原时间(PT)、凝血酶原时间活动度(PTA)、国际标准比值(INR)、部分凝血活酶时间测定(APTT)、凝血酶时间(TT)及纤维蛋白原(FIB)含量。结果常规实验室检查表明Hct、Plt、FIB随稀释程度增加而降低,与基础值比较,10%稀释时,L组TT值显著缩短(P<0.05),稀释30%和50%时,各组PT、APTT、INR均显著延长(P<0.01)。TEG结果显示值比较,10%稀释后L组的K值显著缩短(P<0.05),MA增大(P<0.05);30%稀释时,G组和W组多项参数有显著变化(P<0.05),但大多仍处于正常范围;50%稀释时,各组所有凝血参数均有显著变化(P<0.05),且大多超出正常范围。结论不同预充液体血液稀释后对凝血功能的影响程度不一,L组10%稀释时凝血功能略有增强;30%稀释时对凝血指标没有影响,G组和W组在30%稀释时对部分凝血参数有影响,但整体凝血功能仍处于正常范围,50%稀释时各组凝血功能均显著下降。     

中国眼镜蛇毒蛋白酶（natrahagin）的抗凝作用

目的 观察具有纤维蛋白原水解活性的中国眼镜蛇毒蛋白酶（natrahagin)在动物体内的抗凝作用。方法 将不同浓度的natrahagin分别静脉注射入大鼠体内,观察其在动物体内的抗凝作用并与生理盐水对照。凝血仪上直接测定血浆凝血酶原时间（PT）、凝血酶时间（TT）和活化部分凝血活酶时间（APTT）,双缩脲法测定血浆纤维蛋白质水平。结果 与对照组比较,不同剂量natrahagin静脉注射给药后,大鼠PT、TT和APTT显著延长,效应呈浓度依赖性。剂量为0.1mg/kg.b.w.时,PT、TT和APTT分别为对照组的1.5、1.5和1.9倍;兔血浆纤维蛋白质水平也显著降低,血浆纤维蛋白原水平降至对照组的33.3%。结论 Natrahagin在体内具有抗凝活性。     

注射用复方荭草冻干粉针对大鼠凝血系统影响的实验研究

目的 探讨注射用复方荭草冻干粉针(WHG)对大鼠凝血系统的影响,探讨其发挥活血化瘀作用的机理.方法 以Wistar大鼠为研究对象,通过测定其凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原(FIB),观察WHG对大鼠凝血系统的影响.结果 WHG 对大鼠凝血系统有显著影响,显著延长PT,APTT,TT(P＜0.05); 显著降低FIB的含量(P＜0.05).结论 注射用复方荭草冻干粉针通过影响大鼠凝血系统的多个环节发挥抗凝血作用.     

手术前4项凝血功能检测的临床意义

目的　探讨术前检查凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、纤维蛋白原 (FIB)、及凝血酶时间 (TT)的临床意义。方法　利用全自动血凝分析仪检测 2 6 0 8例术前PT、APTT、FIB、TT 4项凝血功能并与Duke法和玻片法测定 180 8例术前出血时间 (BT)与凝血时间 (CT)对比。结果　 2 6 0 8例中 ,PT、APTT、FIB和TT延长分别为 1.7%、2 .9%、15 .4%和 15 % ;180 8例中 ,BT和CT延长分别为 0 .38%和 0 .49%。结论　PT、APTT的敏感性较强 ,TT、FIB可作为筛检试验 ,此 4项均较BT和CT法敏感。     

2型糖尿病患者凝血四项指标变化及其分析

目的 探讨2型糖尿病患者凝血四项指标的变化及其临床意义.方法 用COATRONMI型单通道血凝仪检测65例2型糖尿病患者和29例正常人血浆中凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)水平.结果 2型糖尿病患者体内存在高凝倾向,有微血管病变者更为明显,其血浆PT、APTT、TT结果均明显低于正常对照组和无微血管病变者(P＜0.05),FIB值明显大于正常对照组和无微血管病变者(P＜0.05);2型糖尿病血管病变组较无血管病变组PT、APTT、TT三项指标亦缩短,FIB增高,二者差异亦有统计学意义(P＜0.05).结论 检测糖尿病患者凝血功能的变化,可了解糖尿病微血管病变与凝血状态,为糖尿病的疗效和预后评估提供依据.     

左旋门冬酰胺酶对儿童急性淋巴细胞 白血病凝血功能的影响

目的:探讨左旋门冬酰胺酶影响儿童急性淋巴细胞白血病凝血功能的机制.方法:对18例急性淋巴细胞白血病患儿在用L-Asp治疗前后检测了血浆凝血酶原时间(PT),活化的部分凝血活酶时间(APTT),凝血酶时间(TT),血浆纤维蛋白原定量(FIB)和外周血小板计数(Plt).结果:与用药前比较,用药结束后一天的PT、APTT、TT均显著延长,PT仍在正常范围;FIB显著降低;Plt显著增高,但仍在正常范围.用药结束后一周后的PT、APTT、TT已恢复正常,但FIB仍低于正常.结论:L-Asp主要影响蛋白质的合成而引起蛋白质成分的凝血因子减少,从而引起凝血功能障碍,且对纤维蛋白原的合成影响更为显著.     

月经周期凝血功能的临床观察

目的:探讨月经周期不同阶段手术患者凝血功能变化.方法:对月经周期进行不同分期(分别分为卵泡期和黄体期及围排卵期和围月经期),并分别测定PT(S)血浆凝血酶原时间、FIB(g/L)纤维蛋白原、APTT(S)活化部分凝血酶原时间、TT(S)凝血酶时间.结果:卵泡期和黄体期及围排卵期和围月经期所测定的PT(S)、FIB(g/L)、APTT(S)、TT(S)有显著差别(P＜0.05).结论:凝血功能随着经后时间的推移有下降的趋势.     

乙肝肝硬化患者凝血功能与Child-Pugh肝功能分级的关系

目的分析乙肝后肝硬化患者的凝血功能与Child-Pugh肝功能分级之间的关系。方法使用法国进口STAGO全自动凝血功能分析仪检测110例乙型肝炎后肝硬化患者(观察组)和110例健康体检者(对照组)的凝血功能,主要包括凝血酶时间(PT)、凝血酶时间(TT)、部分活化凝血活酶时间(APTT)、血浆D-二聚体(DD)以及纤维蛋白原定量(FIB)。比较不同Child-Pugh分级肝硬化患者凝血酶时间、APTT、PT、TT、DD及FIB的变化情况。结果同对照组相比,观察组APTT、PT、TT显著延长,DD值显著升高,FIB显著下降(P<0.01);肝功能Child-Pugh分级从A→B→C级,PT、TT、APTT及DD明显延长或升高,FIB逐渐下降(P<0.05)。结论乙型肝炎后肝硬化患者存在凝血功能障碍,其严重程度和肝功能损害程度密切相关,肝功能损害程度越重,凝血功能障碍越明显。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.