血浆D-二聚体与纤维蛋白原在下肢深静脉血栓中的诊断价值

目的：探讨D-二聚体（DD）和纤维蛋白原（FIB）在下肢深静脉血栓形成（DVT）诊断中的临床意义。方法对52例疑似DVT患者进行血浆DD和FIB检测,并计算D-二聚体/纤维蛋白原比值（D/F值）,根据彩色多普勒超声检查结果明确诊断,同时选取健康体检者50例作为对照组。结果 DVT组血浆DD、FIB及D/F值均明显高于健康对照组,差异有统计学意义（P＜0.01）;DVT组与非DVT组比较,DVT组DD、FIB和D/F值明显高于非DVT组具有显著性差异（P＜0.01）,D/F值、DD、FIB对诊断DVT的敏感度分别为98%、94%、85%,D/F值在诊断DVT中较单独应用DD或FIB有较高的敏感度。结论检测血浆DD、FIB及D/F比值可提高DVT临床诊断的特异性,对下肢深静脉血栓的早期诊断具有重要的临床意义。     

急性下肢深静脉血栓形成患者IL-6、IL-8、IL-10及TNF-α的水平及意义探讨

目的探讨炎性细胞因子IL-6、II，8、IL-10及TNF-α在急性下肢深静脉血栓形成（DVT）疾病中的水平及意义。方法选择未经治疗的急性下肢DVT患者40例为DVT组，年龄、性别比无统计学差异的健康志愿者30例作为正常对照组。运用放射免疫分析检测血浆IL-6、IL-8及TNF-α水平，用ELISA法检测血浆IL-10水平。并对DVT组内细胞因子水平分别进行相关性分析，探讨各细胞因子之间的关系。结果相对于正常对照组，DVT组细胞因子水平均明显升高（P均〈0．001）。DVT组内相关性分析，IL-6与IL-8及IL-10之间无相关性，IL-8与IL-10及TNF-α之间无相关性；IL-6与TNF-α之间呈正相关（r=0．383，P〈0．05），IL-10与TNF-α之间呈正相关（r=0．390，P〈0．05）。结论在DVT患者外周血中，均检测到血浆细胞因子的升高，炎性细胞因子可能在静脉血栓形成疾病中起重要的作用。     

重症急性胰腺炎患者下肢深静脉血栓的早期预防

目的探讨重症急性胰腺炎（SAP）患者早期预防下肢深静脉血栓（DVT）的护理要点。方法将100例SAP患者（APACHEⅡ评分≥8分）随机分为观察组和对照组各50例。对照组采用常规措施预防DVT。观察组在此基础上对患者进行下肢深静脉血栓危险因素评分，根据评分采用相应预防措施。结果观察组出现DVT阳性体征2例，对照组9例，两组比较，差异有显著性意义（P〈0．05）。结论SAP患者早期进行DVT风险因素评估，并针对风险因素分级采用预防护理措施，是降低DVT发生的有效措施。     

D-二聚体测定在下肢深静脉血栓诊断中的临床价值

目的:探讨D-二聚体（DD）测定在下肢深静脉血栓形成(DVT)诊断中的临床价值。方法:回顾分析106例DVT患者DD值在不同的发病时间和临床分型的变化，并与99例下肢深静脉瓣膜功能不全（PDVI）患者DD值进行比较。结果:DVT患者DD值在急性期内含量较高，陈旧性血栓随时间而逐步降低，而无血栓者呈阴性；周围型DVT阳性率高达85.7%。结论:DD可作为急性DVT诊断、预测及预后判断方法之一,尤其对周围型DVT诊断更适合。     

白介素、C-反应蛋白和纤维蛋白原在下肢深静脉血栓炎症反应中的作用

目的探讨炎症因子血清白介素-6（IL-6）、白介素-10（IL-10）、C-反应蛋白（CRP）和纤维蛋白原（FIB）在下肢深静脉血栓形成（deep vein thrombosis,DVT）中的作用。方法 30例DVT患者为DVT组,30例健康自愿者为正常对照组,检测DVT组患者治疗前、后及正常对照组血清IL-6、IL-10、CRP及FIB浓度。结果 DVT组患者治疗前血清IL-6、IL-10、CRP和FIB浓度均明显高于正常对照组（P〈0.001）;治疗后DVT组患者血清IL-6、CRP和FIB浓度显著低于治疗前（P〈0.001）,而血清IL-10浓度则高于治疗前（P〈0.001）;治疗后DVT组患者血清FIB浓度与正常对照组比较差异无统计学意义（P〉0.05）,血清IL-6、IL-10及CRP浓度仍高于正常对照组（P〈0.05）。结论炎症因子参与下肢DVT的发生、发展,其中IL-6、CRP及FIB可能在血栓急性期起重要作用,而IL-10则可能起抗炎作用。     

预防脊柱外伤及术后患者深静脉血栓的护理干预

目的探讨预防脊柱外伤及脊柱手术后患者并发深静脉血栓（DVT）的护理干预方法和效果。方法将脊柱外伤及脊柱手术后患者1012例按入院时间顺序分成对照组（470例）和干预组（542例），对照组按照常规护理，干预组在此基础上采取预防性护理干预措施，比较两组DVT发生率。结果对照组发生DVT27例（5．74％），干预组4例（0．74％），两组发生率比较，差异有显著性意义（P〈0．01）。结论预防性护理干预措施能显著降低脊柱外伤及脊柱手术后患者DVT发生率，促进患者康复。     

膝关节镜手术患者血浆纤维蛋白原和D-二聚体检测结果分析

[目的]探讨血浆中纤维蛋白原及D-二聚体的检测对膝关节镜手术患者并发深静脉血栓(DVT)的早期诊断价值.[方法]对796例膝关节镜手术患者术前及术后第3～5 d进行血浆中纤维蛋白原、D-二聚体的水平检测,并与正常对照组(30例)比较.[结果]30例并发DVT组术后与术前及正常对照组血浆中纤维蛋白原、D-二聚体的检测结果差异有统计学意义(P＜0.05);未并发DVT组术前、术后与正常对照组血浆中纤维蛋白原、D-二聚体的检测结果均无统计学意义(P＞0.05).[结论]血浆中纤维蛋白原及D-二聚体的动态检测对膝关节镜手术患者并发深静脉血栓具有早期的诊断价值.     

功能锻炼对髋部骨折术后患者深静脉血栓形成的影响

目的 探讨单独采用功能锻炼预防髋部骨折术后深静脉血栓形成（DVT）的效果。方法 将98例髋部骨折患者随机分为观察组与对照组各19例。对照组按常规护理，观察组术后行早期功能锻炼。结果 术后DVT发生率观察组为8．2％，对照组为24．5％．观察组显著低于对照组（P〈0．05）；观察组术后患肢肿胀程度显著轻于对照组（P〈0．05）。结论 早期功能锻炼能明显减少髋部骨折术后患者DVT的发生率。     

压力梯度长袜和间歇充气装置预防恶性肿瘤患者术后下肢深静脉血栓形成的效果

目的 观察单纯应用压力梯度长袜（CS）或与间歇充气装置（IPC）联合使用预防恶性肿瘤患者术后下肢深静脉血栓（DVT）形成的效果及可能的机制。方法 胸科、泌尿外科、肝胆外科恶性肿瘤根治手术患者240例，随机分为4组：对照组、单纯CS组、CS＋IPC全程组、CS＋IPC术后组，每组60例。术后3～8d内行双下肢深静脉超声检查，记录DVT例数及血栓发生部位（大腿或小腿）。随机选择对照组和CS＋IPC全程组各15例患者，分别于术前、切皮后2h及术后24h各采集外周静脉血2ml，测定D-二聚体（D-D）、纤溶酶原激活物抗原（tPA-Ag）、纤溶酶原激活物抑制物（PAI）、血管性血友病因子（vWF）、凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）。结果 术后3-8d对照组、CS＋IPC全程组、CS＋IPC术后组和单纯CS组DVT发生率分别为49．3％、15．0％、23．3％和30．0％（P〈0．05）。所有发生DVT患者中，除CS组发现1例近端DVT外，其余均为远端DVT。发生DVT患者年龄、卧床时间、危险因素个数等与未发生血栓患者相比差异有统计学意义（P〈0．05）。凝血，纤溶指标：与对照组比较，切皮后2h，CS＋IPC全程组vWF升高，D-D、tPA-Ag降低（P〈0．05），术后24h对照组和cs＋IPC全程组间D—D、vWF、tPA-Ag及PAI差异无统计学意义。结论 CS＋IPC全程或术后使用均能降低高危患者术后DVT的发生，其中CS＋IPC全程使用预防效果最好，可能与IPC增加纤溶活性有关。     

活血复元汤配合低分子肝素钠预防人工髋关节置换术后下肢深静脉血栓形成

目的：探讨人工髋关节置换术后下肢深静脉血栓（DVT）形成的中西医结合的预防方法。方法：本组112例随机分为2组：预防组52例和对照组60例。预防组联合应用活血复元汤及低分子肝素钠，对照组单纯采用低分子肝素钠进行预防。比较治疗前后两组患者DVT发生率、血液流变学、血浆活化的部分凝血活酶时间（APTT）及血浆凝血酶原时间（PT）等指标变化的差异。结果：①DVT的发生率预防组为3.85％，对照组为8．33％，两者比较无统计学差异（P〉0．05）。②预防组用药后血液流变学各项指标与术后2d比较差异有显著性意义（P〈0．01或P〈0．05），与对照组比较差异亦有显著性意义（P〈0．01或P〈0．05）。③预防组用药后APTT、和PT明显延长，与术后2d比较差异有显著性意义（P〈0．01），与对照组比较差异亦有显著性意义（P〈0．01或P〈0．05）。结论：活血复元汤配合低分子肝素钠可有效预防人工髋关节詈换术后下肢深静脉血栓形成。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.