低分子肝素雾化吸入治疗小儿肾病综合征高凝状态的研究

目的 :研究低分子肝素雾化吸入治疗小儿肾病综合征高凝状态的疗效及安全性。方法 :对 1 5例肾病综合征合并高凝状态患儿在激素或加用免疫抑制剂治疗的同时 ,加用低分子肝素雾化吸入 ,剂量为 2 0 0～ 30 0抗因子Xa活性单位 / (公斤·次 ) ,观察皮下瘀血、血小板、血D -二聚体、凝血酶原时间、部分凝血活酶时间及尿蛋白定量、血清白蛋白和胆固醇的变化。另设 1 5例患儿作为对照组。结果 :治疗组 1 4例血D -二聚体、凝血酶原时间、部分凝血活酶时间恢复正常 ,对照组 1 3例恢复正常 ,两组间的差异无统计学意义 (P >0 .0 5 ) ;治疗组无皮下瘀血、血小板减少现象 ,对照组 1 3例患儿出现皮下瘀血、2例患儿血小板减少。治疗前 ,治疗组的尿蛋白定量为 (5 .3± 3.2 ) g/2 4h ,血清白蛋白为 (1 3.3± 4 .1 ) g/L ,胆固醇为 (9.9± 2 .8)mmol/L ,治疗 4周后 ,三项指标分别为 (2 .3± 1 .5 ) g/ 2 4h ,(2 5 .3± 6 .3)g/L和 (7.9± 1 .4 )mmol/L ;治疗组血清白蛋白回升快于对照组 ,两组相比 ,差异有统计学意义 (P <0 .0 5 ) ;治疗 8周后 ,三项指标分别为 (0 .9± 0 .7) g/ 2 4h、(32 .6± 3.5 )g/L和 (5 .4± 0 .8)mmol/L ,两组相比差异无统计学意义 (P >0 .0 5 )。结论 :低分子肝素超声雾化吸入可改善小儿肾病综合征     

小儿肾病综合征38例凝血功能分析

目的　观察肾病综合征凝血功能的改变。方法　对 38例肾病综合征患儿在活动期及恢复期进行凝血功能检查 ,并与对照组比较。结果　肾病综合征活动期存在高凝状态 ,表现血小板升高 [平均 (386 .4± 72 .3)× 1 0 9/L] ,血小板粘附与聚集性增高 [平均值分别为 (74.3± 4 .6) %和 (51 .7± 3 .2 ) % ] ,凝血时间缩短 (3 .1± 1 .1 )min ,凝血酶原时间及活化的部分凝血活酶时间延长 [平均值分别为 (1 5 .4± 2 .5)s和 (48.1± 6 .4)s] ,纤维蛋白原及D -二聚体升高 [平均值分别为 (4.8± 1 .6) g和 (2 .61±0 41 )ml/L] ,恢复期均正常 ,经 χ2 检验 ,有显著性差异 (χ2 =7.2 9,P <0 .0 5)。结论　肾病综合征高凝状态参与发病 ,有肾血管内凝血及继发性纤溶过程 ,导致蛋白尿、水电解质紊乱 ,蛋白质和脂肪代谢异常     

小儿凝血酶原时间、纤维蛋白原与部分凝血活酶时间的检测及结果分析

目的　了解正常儿童的凝血酶原时间 (PT)、纤维蛋白原 (Fg)及部分凝血活酶时间 (APTT)的正常值及该值与患儿出血的关系。方法　应用ACL 2 0 0型全自动凝血仪及其配套试剂 ,检测 180例正常儿童凝血三项 ,12 3例出血性疾病患儿的凝血三项及凝血因子活动度。结果　 180例正常儿童的PT :( 12 .1± 0 .5 )s,Fg :( 2 .5 3± 0 .13)g/L ,APTT :( 2 6 .3± 4.6 )s。PT >正常 3s,临床出血 33.3% ;PT >18s,临床出血为 94.1%。Fg在0 .44～ 1.5 g/L ,临床出血为48.0 % ;Fg在1.5～ 4.5 g/L ,临床出血与其他凝血因子减少有关 ;Fg >4.5 g/L与血液高凝状态有关。APTT在 35～ 40s,临床出血为14.2 % ,即为异常 ;APTT在 40～ 5 0s ,临床出血为 6 3.3% ;APTT >6 0s,临床出血为 80 .8%。结论　PT、APTT时间延长与凝血因子活性减低程度、临床出血呈正相关     

血栓弹力图在评价肾病综合征患者高凝状态中的作用

目的 研究血栓弹力图(TEG)与常规凝血功能检查在肾病综合征高凝状态中的关系,以评价TEG对肾病综合征高凝状态的诊断作用.方法 选择第二军医大学附属长征医院肾内科住院患者60例,其中慢性肾炎患者20例,肾病综合征患者40例,所有患者入院时均行常规凝血功能、血常规及TEG检测.结果 (1)血红蛋白、血小板和凝血功能各指标在慢性肾炎组和肾病综合征组间差异均无统计学意义[国际标准化比率(1.01±0.10)和(1.01±0.11),P ＞0.05;活化部分凝血活酶时间(30.3±2.6)s和(28.8±5.5)s,P ＞0.05;凝血酶原时间(12.8±1.0)s和(12.9±1.3)s,P ＞0.05;血小板 (179.4±21.2)×109/L和(170.5±32.8)×109/L,P ＞0.05;血红蛋白 (126.6±23.7)g/L和(128.8±26.8)g/L,P ＞0.05];(2)TEG显示肾病综合征患者的R时间、K时间均较慢性肾炎者显著降低[R时间(5.43±0.56)s和(6.18±0.61]s,P ＜0.05;K时间(1.42±0.36)s和(2.08±0.32)s,P ＜0.05],Angle及Cl升高[Angle (68.33±4.38)°和(59.30±2.77)°,P ＜0.05;Cl值(1.35±1.03)和(-0.78±0.60),P ＜0.05],血栓最大弹力度、估计的溶解百分数、LY30在两组间差异无统计学意义( P ＞0.05).结论 与其他常规凝血功能检查比较,TEG是反映肾病综合征患者高凝状态的一个更为敏感的指标.肾病综合征高凝状态与纤维蛋白升高有关,而受血小板的影响较小,这对肾病综合征的抗凝治疗有一定指导意义.     

儿童肾病综合征高凝状态治疗方法探讨

高凝状态（血浆AT Ⅲ减少，纤维蛋白原、第Ⅴ、Ⅶ、Ⅷ、Ⅹ因子及血小板增高、凝血活酶生成增多、低白蛋白血症及高胆固醇血症）是肾病综合征患儿常见并发症，易导致病情迁延不愈，甚至形成血栓栓塞并发症。因此，及时抗凝治疗至关重要。为探讨治疗肾病综合征高凝状态的有效方法，我院2004年1月--2005年6月采用联合用药方法治疗了部分肾脏疾病并高凝状态的患儿，取得了较满意疗效，结果报告如下：     

低分子肝素钙治疗小儿原发性肾病综合征疗效观察

目的探讨低分子肝素钙在小儿原发性肾病综合征伴高凝状态中的治疗作用。方法对42例原发性肾病综合征合并高凝状态的患儿进行前瞻性研究,所有患儿随机分为2组：均服用常规剂量激素,其中治疗组24例以低分子肝素钙治疗（每日60～100 U/kg静脉滴注）,对照组18例服用潘生丁抗凝。均4周为1疗程。结果2组治疗后活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）均改善,24 h尿蛋白及总胆固醇均较治疗前下降（P〈0.05）,血清白蛋白上升（P〈0.05）,且治疗组均优于对照组（P〈0.05）,差异有统计学意义（P〈0.05）;血小板均未发现明显变化（P〉0.05）。治疗组治疗中未发现明显出血、肝损害、过敏等不良反应。结论在激素基础治疗上加用低分子肝素钙辅助治疗,可改善高凝状态,有助于降低蛋白尿,有利于原发性肾病综合征早期缓解,且对血小板无明显影响。     

肾病综合征高凝状态下纤维蛋白原的检测及临床意义

目的 探讨纤维蛋白原对肾病综合征高凝状态诊断的临床意义。方法 用双缩脲法测定纤维蛋白原,同时检测血浆胆固醇和自蛋白浓度。结果 肾病综合征活动期纤维蛋白原均值与正常比较增高(p相似文献   

血友病A伴发脑内假瘤一例

患者男,12岁.因间断性头痛、癫痫大发作9个月入院,既往史、个人史、家族史未见明显异常,神经系统查体发现右侧顶骨顶结节形状略向外突出,直径约4 cm.实验室检查发现血红蛋白计数4.53×1012/L(正常值范围3.512/L～5.512/L),血红蛋白96 g/L(正常值110 g/L～160 g/L);红细胞压积28.7%(正常值37%～49%);血小板计数281×109/L(正常值范围1009/L～3009/L);凝血酶原时间12.5 s;部分凝血活酶时间55.9 s;凝血酶原时间14.3 s;纤维蛋白原时间3.6 s(正常值2～4.5 s).颅骨正侧位平片发现顶骨不规则侵蚀.CT发现在左顶高密度圆形占位,密度不均一,有钙化(图1).     

中西结合治疗小儿肾病综合征伴高凝状态的疗效观察与护理

目的 观察中西结合治疗小儿肾病综合征伴高凝状态的临床效果.方法 选取2013年2月至2016年6月期间我院收治的96例肾病综合征伴高凝状态患儿,按随机数表法分为观察组和对照组,每组48例.对照组予常规西药治疗与预见性护理,观察组在对照组基础上加用中药益气活血汤辨证加减治疗.治疗1个疗程后(14 d)观察相关实验室指标[(24 h尿蛋白定量(U-TP)、血清总蛋白(TP)、血清白蛋白(ALB)、血总胆固醇(TC)]和凝血指标水平[血浆凝血酶原时间(PT)、凝血酶时间(TT)、部分活化凝血活酶时间(aPTT)、血浆纤维蛋白原(Fbg)、D二聚体(D-D)],并观察和记录治疗期间及治疗后药物不良反应和出血、血栓、血小板减少等相关并发症发生情况.结果 治疗后两组患儿24h U-TP、TP、ALB、TC以及凝血各指标PT、TT、aPTT、Fbg、D-D均与本组治疗前比较差异有统计学意义(P＜0.05);而观察组各指标改善更为明显(P＜0.05).两组不良反应发生率均低于9％,,观察组并发症发生率10.42％低于对照组27.08％ (P ＜0.05).结论 益气活血中药和预见性护理干预可明显改善24 h尿蛋白、血清白蛋白、血胆固醇、凝血指标等,降低出血、血栓、血小板减少等并发症发生风险.     

中西医结合治疗肾病综合征的72例临床报告

肾病综合征(NS)以原发性肾病常见于儿童,临床表现是大量蛋白尿，或有高度水肿，血液高凝,高粘；合并感染.血管堵塞,急性肾衰而危及生命。单用中药或西药,病情经治得以缓解后易于反复和产生副作用,严重影响儿童身心健康。为提高肾病的治疗效果,近年来,我门诊部对72例肾病患儿,采用中西医结合进行治疗，疗效较明显,临床报告如下：
　　1.临床资料
　　1.1西医诊断标准参照《儿科学》[4]中单纯型肾病、肾炎型肾病诊断标准。高凝状态按参考文献[1]制定以下标准：凝血酶原时间(PT)比正常参考值(11～14s)缩短>3s，白陶土部分凝血活酶时间(APTT)比正常参考值(35～45s)缩短>10s，血浆纤维蛋白原(FIB)>4.0g/L，血浆D二聚体(DD)>0.5mg/L。符合两项及以上者。     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.