危急值登记本在CT检查中的应用

CT检查在疾病诊断中的作用显著,我院每日有250多例患者进行CT检查,技术员根据门诊或病区医生开出的cT申请单,对患者进行不同部位的检查,检查完毕发现急诊诊断（如脑出血、肠穿孔、动脉瘤等）时,立即与当班医生联系,     

神经外科血友病患者的处理

神经外科医生在收治住院病人中时常会遇到凝血功能障碍患者,这类病人往往是以自发性脑出血急诊入院,经术前凝血功能检查发现凝血时间异常而发现,并因此在纠正凝血功能前被迫推迟手术,使急诊患者无法得到及时的手术治疗.神经外科医生在处理这类患者时常常感到较为困难,其中对血友病患者又感到尤为棘手.     

急诊病人检验项目的选择

急诊检验项目选择准则急诊病人多数病情危急和重笃,需要主诊医生尽快作出诊断并给予合理治疗。临床实践证明,急诊患者绝大多数患常见病多发病,无需作任何检验即可诊断与治疗。就以小儿科急诊而言,小儿急诊多数是由细菌或病毒引起的上呼吸     

巧记急诊化验结果

在外科急诊住院的病人,往往需要抽血做生化、凝血等化验检查,为了给医生尽快提供诊断、治疗依据,化验室出结果后先通过电话进行汇报,然后再将结果化验单送至病房,在电话汇报过程中我们采用以下方法进行记录。     

巧记急诊化验结果

在外科急诊住院的病人,往往需要抽血做生化、凝血等化验检查,为了给医生尽快提供诊断、治疗依据,化验室出结果后先通过电话进行汇报,然后再将结果化验单送至病房,在电话汇报过程中我们采用以下方法进行记录.     

院前急诊昏迷瞳孔变化对病因分类的诊断价值

昏迷是院前急救经常遇到的危重急症,起病急、症状重、病情变化快、病史不详是其特点。由于昏迷原因十分复杂,诊断上需要依靠详细询问病史及仔细查体、实验室检查和影像学检查综合判断。院前出诊受条件限制,急诊医生只能通过有限的患者信息,经验性地推断昏迷病因。为探讨院前急诊昏迷     

腹痛的急诊诊断思路

在急诊工作中，腹痛是临床常见的症状之一。然而，临床医生，特别是刚上临床的医生，往往在具体接诊腹痛病人时，显得不知道从何思考，从何下手。现仅就腹痛的产生机制、临床诊断顺序和鉴别诊断等问题，结合临床实际情况简要介绍如下。     

急诊腹部CT在诊断急性肠系膜血管栓塞中的价值研究

目的:研究急性肠系膜血管栓塞患者应用急诊腹部CT诊断价值。方法:选择我院接收的80例急性肠系膜血管栓塞患者,接受急诊腹部CT检查,统计CT平扫、CT分期增强扫描的资料,比较两者诊断结果。结果:与CT平扫比较,CT分期增强扫描的血栓最大直径、血栓累及长度较长;诊断准确率高,误诊率、漏诊率低,P<0.05。结论:急诊腹部CT分期增强扫描能提高急性肠系膜血管栓塞患者的诊断准确度,便于赢得抢救先机。     

缺血性肠病急诊误诊16例分析

目的 分析缺血性肠病的临床特点、诊断要点及误诊的原因,减少急诊误诊、漏诊、误治的发生.方法 回顾性分析首诊于郑州市第一人民医院急诊科2000-2010年16例急性缺血性肠病患者的临床资料.结果 16例患者均存在误诊及诊断不清,经确诊治疗后治愈15例,死亡1例.结论 缺血性肠病临床症状与体征无特异性,误诊率高,急诊医生要提高对本病认识,及早行腹部血管超声检查,螺旋CT检查及DSA检查,是避免误诊的关键所在.     

医生对急诊血糖超过6.1mmol/L患者的诊治现状调查

目的调查急诊和病房医生对急诊随机毛细血管血糖或静脉血浆血糖大于或等于6.1mmol/L患者的检查、诊断和治疗情况。方法 2009年1月重庆市第四人民医院急诊科入院检查随机毛细血管血糖或静脉血浆血糖,血糖值大于或等于6.1mmol/L并住院的患者,查阅出院病历记录中是否复查血糖,以及诊断和治疗的情况。结果急诊血糖大于或等于6.1mmol/L且住院的患者共104例,11例在急诊室被诊断为糖尿病或高血糖;患者住院后复查血糖的69例,占所有患者的66.3%,做口服葡萄糖耐量试验(OGTT)的仅1例,占患者总数的0.98%,检查糖化血红蛋白(HbA1c)的15例,均值为7.86%;入院后被诊断为糖尿病的19例,诊断为葡萄糖耐量异常(IGT)的1例;24例使用胰岛素治疗,其中1例使用胰岛素加口服降糖药。结论急诊和病房医生可能低估了急诊血糖大于或等于6.1mmol/L人群的糖尿病流行情况。     

Causes of venous thrombosis

Venous thrombosis which mainly manifests as deep vein thrombosis of the leg or pulmonary embolism occurs in 1 per 1000 per year. It occurs due to interacting genetic, environmental and behavioral risk factors. The strongest risk factors are certain types of surgery and malignancies. Over the last decade many new risk factors for venous thrombosis have been identified. Venous thrombosis has a high recurrence rate, of around 5 % per year. Whereas clinically it would be most important to identify patients at risk of recurrence, only male sex and a previous unprovoked thrombosis are established determinants of recurrent thrombosis.     

Central vein thrombosis: a complication of internal jugular vein cannulation.

Clinical signs of central vein thrombosis as a complication of internal jugular vein cannulation are rarely seen. Two infants who developed thrombosis of the superior vena cava and one adult who developed thrombosis of the left brachiocephalic vein are presented.     

Genetic determinants of von Willebrand factor levels and activity in relation to the risk of cardiovascular disease: a review

Summary. It is well established that high plasma von Willebrand factor (VWF) levels are associated with an increased risk of arterial thrombosis, including myocardial infarction and ischemic stroke. As plasma VWF levels are, to a large extent, genetically determined, numerous association studies have been performed to assess the effect of genetic variability in the VWF gene (VWF) on VWF antigen and activity levels, and on the risk of arterial thrombosis. Genetic variations in other regulators of VWF, including the ABO blood group, ADAMTS‐13, thrombospondin‐1 and the recently identified SNARE protein genes, have also been investigated. In this article, we review the current literature as exploring the associations between genetic variations and the risk of arterial thrombosis may help elucidate the role of VWF in the pathogenesis of arterial thrombosis. However, as studies frequently differ in design, population and endpoint, and are often underpowered, it remains unclear whether VWF is causally related to the occurrence of arterial thrombosis or primarily mirrors endothelial dysfunction, which predisposes to atherosclerosis and subsequent arterial thrombosis. Nevertheless, current studies provide interesting results that do not exclude the possibility of VWF as causal mediator and justify further research into the relationship between VWF and arterial thrombosis. Large prospective studies are required to further establish the role of VWF in the occurrence of arterial thrombosis.     

Are B vitamins a risk factor for VTE? Perhaps

Venous thrombosis is considered as a multicausal disease. Hyperhomocysteinemia is considered as one of the risk factors for venous thrombosis. Because homocysteine levels are strongly influenced by the intake and concentrations of B vitamins, it is worthwhile to assess the role of these vitamins as a risk factor for venous thrombosis.     

深静脉血栓形成临床诊治误区

深静脉血栓形成是一种临床常见病,其导致的肺动脉栓塞是常见的急性致死性原因。本文就深静脉血栓形成目前临床常见诊治误区进行梳理分析后指出:D-二聚体只能用于排除深静脉血栓形成,诊断首选彩色多普勒超声;深静脉血栓形成的治疗以抗凝为基础,而非溶栓治疗;应用华法林抗凝时,国际标准化比值(INR)应控制在2.0~3.0;肿瘤患者合并深静脉血栓形成应同步治疗,抗凝首选低分子肝素;对于下肢深静脉血栓形成患者,有抗凝禁忌证或并发症时推荐使用下腔静脉滤器来预防肺栓塞。     

Guidelines for the diagnostics of deep pelvic/lower limb vein thrombosis

As a result of availability and failing invasiveness the technique of compression sonography led to a change in the indication of thrombosis examination - from the proof of thrombosis shown by phlebography to exclusion of thrombosis by ultrasound. Compression sonography showed the same sensitivity and specificity as phlebography for proximal limb thrombosis and reaches high safety due to actual treatment studies in the diagnosis of deep vein thrombosis. For the distal limb the compression sonography has provided > 90 % specificity, with an examinator dependent sensitivity of 50 to 95 %, and hence examination of the distal limb must be recommended. These guidelines for the diagnosis of deep vein thrombosis are recommendations by the Section of Vascular Ultrasound of DEGUM for examination technique and documentation. It also contains an algorithm of diagnosis for thrombosis as a result of the actual treatment studies.     

Current perspective of venous thrombosis in the upper extremity

Summary.  Venous thrombosis of the upper extremity is a rare disease. Therefore, not as much is known about risk factors, treatment and the risk of recurrence as for venous thrombosis of the leg. Only central venous catheters and strenuous exercise are commonly known risk factors for an upper extremity venous thrombosis. In this review an overview of the different risk factors, possible treatments and the complications for patients with a venous thrombosis of the upper extremity is given.     

抗磷脂血栓综合征与获得性抗活化的影响C现象

了解抗磷脂抗体（ＡＰＡ）,抗活性化的蛋白Ｃ（ＡＰＣＲ）与抗磷脂血栓综合征（ＡＰＬ－Ｔ）的关系,进一步探讨ＡＰＬ－Ｔ血栓发生机制。方法以ＥＬＩＳＡ检测ＡＣＡ（ＩｇＭ,ＩｇＡ）;ＡＰＴＴ检测ＬＡ;ＡＰＴＴ＋／－ＡＰＣ检测ＡＰＣＲ。结果２０例患者符合ＡＰＬ－Ｔ诊断。根据病因分类,１００例ＳＬＥ患者中１４例为继发性ＡＰＬ－６：１６例“原因不明”血栓与习惯性流产患者中６例为原发性ＡＰＬ－Ｔ。根据抗体分类,２     

Venous thrombosis in the elderly: incidence,risk factors and risk groups

Summary. The incidence of venous thrombosis (VT) increases sharply with age: it is very rare in young individuals (< 1 per 10 000 per year) but increases to ～ 1% per year in the elderly, which indicates that aging is one of the strongest and most prevalent risk factor for venous thrombosis. The cause of this steep age gradient is as yet, unexplained. The aim of this review was to provide an overview of studies on the effect of conventional risk factors as well as age‐specific risk factors for thrombosis in the elderly. Limited data are available on risk factors for thrombosis in the elderly, i.e. all results are based on small study groups. Results indicate that, of the conventional risk factors, malignant disease, the presence of co‐morbidities and the genetic risk factors factor (F)V Leiden and the prothrombin mutation seem to be associated with an increased risk of venous thrombosis. In the elderly, the population attributable risk (PAR) of malignancy is approximately 35%, for co‐morbidities a PAR up to 25% is found, and the contribution of genetic risk factors to the thrombosis incidence is estimated to be 7–22%. Age‐specific risk factors of thrombosis, i.e. endothelial dysfunction and frailty may be important in the explanation of the increased incidence of VT in the elderly. In conclusion, as aging is a major risk factor for thrombosis, further identification of the risk factors for thrombosis in the elderly is needed to elucidate the age gradient of the incidence of VT and to target preventive measures.     

Clinical manifestations of the prothrombin G20210A mutation in children: a pediatric coagulation consortium study

Summary.  The prothrombin G20210A mutation is a common risk factor for thrombosis which increases the risk of deep vein thrombosis, stroke, and fetal loss. There are few publications of its clinical manifestations in children. Our objective was to determine the clinical manifestations of the prothrombin mutation in children. Via survey of pediatric hematologists, we collected data on children with thrombosis and the prothrombin mutation. Thirty-eight patients with a thrombotic event were identified as having the prothrombin mutation. Children with arterial thrombosis were younger, less than half had additional risk factors present at the time of the event, and had a high frequency of central nervous system thrombosis. Children with venous thrombosis were older, almost always had additional risk factors present, and had thrombosis occur most often in the extremities, although there were also a significant number of events in the central venous and cerebral circulation. There was a striking predilection for central nervous system events as 30% of all the events and 67% of the arterial events occurred there. In all, 14/38 children (37%) had central nervous system thrombosis. Unlike factor V Leiden and deficiencies of proteins C and S which cause venous thromboembolism, the prothrombin mutation in children is often associated with arterial thrombosis and with central nervous system events. In children with the prothrombin mutation and venous thrombosis, other risk factors are usually present. Therefore, children with arterial or venous thrombosis of any location should be evaluated for the presence of the prothrombin mutation.