益气活血膏方与补阳还五汤颗粒对气虚血瘀证患者血凝影响的比较性研究

目的:通过检测血凝指标,比较益气活血膏方与补阳还五汤颗粒治疗气虚血瘀证临床有效性。方法:采用前瞻性随机对照研究方法,将60名气虚血瘀证患者随机分为益气活血膏方(治疗)、补阳还五汤颗粒(对照)2组。对照组按照补阳还五汤剂量配制颗粒,1袋/次,2次/d;治疗组服用与对照组相等量的膏方,疗程28 d。分别于治疗前后检测血凝指标变化,并统计分析。结果:治疗28 d后,治疗组PT、APTT、TT、FIB均有不同程度的改善,与对照组比较,具有统计学意义(P<0.05);2组治疗后减治疗前差值的平均值比较,具有统计学意义(P<0.05)。结论:益气活血膏方能更好的改善气虚血瘀证患者血凝指标,且具有良好的安全型。     

雌雄激素联合作用对高脂血症小鼠血脂水平及凝血功能的影响

目的 探讨雌雄激素联合作用对高脂血症小鼠血脂水平及凝血功能的影响。方法 对小鼠行去势手术后通过高脂饮食建立高脂血症模型,通过给予不同激素将老鼠分为5组。造模结束后采集小鼠血液,一部分小鼠分离血清检测小鼠血脂水平,一部分小鼠分离血浆检测凝血功能。结果 高脂饮食后,小鼠血清总胆固醇、甘油三酯和低密度脂蛋白水平较对照组相比明显升高,凝血酶原时间、活化部分凝血酶原时间时间明显缩短(P<0.05),给予雌雄激素联合治疗后,与造模组相比,小鼠血清总胆固醇、甘油三酯和低密度脂蛋白水平较对照组相比明显下降,凝血酶原时间、活化部分凝血酶原时间时间明显延长(P<0.05),而与对照组无明显差异。结论 雌雄激素联合治疗可以调节血脂,显著降低低密度脂蛋白的水平,调节凝血功能,提示雌雄激素联合作用可以降低冠心病的发病风险,为冠心病的激素治疗提供新思路。     

Increasing radiofrequency ablation volumes with the use of internally cooled electrodes and injected hydrochloric acid in ex vivo bovine livers

Purpose: We used an impedance-controlled generator with an internally cooled electrode to perform radiofrequency ablation (RFA) in ex vivo bovine livers, with a single injection of either 38.5% sodium chloride (NaCl) or 10% hydrochloric acid (HCl), to determine the relative effects of these two solutions on tissue impedance, temperature and ablation volume.

Materials and methods: We performed 10 ablations each with injections of NaCl (NaCl-RFA), HCl (HCl-RFA) or nothing (RFA-alone), with a power setting of 200 W for 15?minutes. We recorded tissue impedance before and after injection. We logged temperatures obtained from thermocouple probes positioned 5, 10, 15 and 20?mm from the internally cooled RF electrode. After ablation, we measured ablation zone longitudinal and transverse diameters, and we calculated a spherical ratio (SR) for each ablation.

Results: Mean post-injection impedance of 30.3 (standard deviation [SD] 2.5) ohms for HCl was significantly lower than that of 55.4 (SD 3.5) ohms for NaCl (p?<?.001). Mean maximum temperatures recorded at each respective distance from the RFA electrode were all highest for HCl-RFA and lowest for RFA-alone (p?<?.001). Mean longitudinal and transverse diameters after HCl-RFA (5.50 [SD 0.25] cm and 5.28 [SD 0.22] cm, respectively) were significantly larger than those after NaCl-RFA (4.24 [SD 0.35] cm and 3.55 [SD 0.43] cm, respectively) and after RFA-alone (3.60 [SD 0.10] cm and 2.70 [SD 0.13] cm, respectively) (p?<?.001). Mean SR after HCl-RFA (0.93, SD 0.02) was significantly higher than mean SR after NaCl-RFA (0.76, SD 0.06) and RFA-alone (0.72, SD 0.04) (p?<?.001).

Conclusion: Monopolar, impedance-controlled RFA, with an internally cooled electrode and a single 10% HCl injection may allow larger tumors to be treated, potentially resulting in improved patient outcomes.     

子宫背带式缝合术治疗剖宫产术中产后出血的临床效果及对手术时间的影响

目的 观察子宫背带式缝合术治疗剖宫产术中产后出血的临床效果及对手术时间的影响。方法 回顾性分析2018年1月～2019年12月我院剖宫产产后出血患者，共计60 例，将常规止血处理的28 例患者作为对照组，子宫背带式缝合术治疗的32 例患者作为观察组，对比两组治疗相关指标、治疗前后凝血功能变化情况及术后并发症发生率。结果 观察组患者手术时间、住院时间均短于对照组，术后24 h 阴道出血量及总出血量少于对照组，差异有统计学意义（P＜0.05）；两组患者各项凝血功能指标在治疗前差异不显著，治疗后，观察组各项指标均改善，与对照组比较差异有统计学意义（P＜0.05）；在术后并发症发生率方面观察组明显少于对照组（6.25% vs 28.57%），差异有统计学意义（P＜0.05）。结论 子宫背带式缝合术治疗剖宫产术中产后出血，对患者凝血功能具有改善作用，能够减少产后出血量，降低术后并发症发生率，疗效确切，值得临床借鉴。     

冠状动脉旁路移植术后早期发生大量引流原因分析

目的:探讨冠状动脉旁路移植术(CABG)后早期发生大量引流的相关危险因素。方法:回顾性分析我院心脏大血管外科在2015年1月至2019年5月行CABG术治疗的患者375例,收集患者一般资料年龄、性别,贫血、心房颤动、血小板数量、凝血酶原时间、部分凝血活酶时间、国际标准化比值、术前口服抗凝药(华法林、达比加群、利伐沙班等)、是否合并急性心肌梗死、是否合并高血压、高脂血症、糖尿病、术前停用抗血小板药物时间<5 d等;手术情况,如手术时间、是否体外循环>5 h、旁路移植数量、是否同期置换瓣膜、出血量、输血量、自体血输血量、ACT值,对各项观察指标进行单因素和Logistic多因素分析。结果:术后12 h内出现大量引流患者39例,术后平均引流量为:(630.0±210.0)mL,术后12 h内引流量>2000 mL的患者17例,行二次开胸探查加止血患者20例。Logistic单因素分析显示:术前停用抗血小板药物<5 d、体外循环时间>5 h、出血量均与术后早期大量引流发生有关,Logistic多因素分析显示:术前停用抗血小板药物<5 d(OR=1.438,95%CI:0.017~3.154,P=0.003)是影响患者术后早期大量引流的危险因素。结论:术前停用抗血小板药物<5 d、体外循环时间>5 h、出血量均与术后早期大量引流发生有关,术前停用抗血小板药物<5 d是影响患者术后早期大量引流的危险因素。     

BILT肝病治疗仪对肝硬化患者血小板参数与凝血的影响

目的探讨肝硬化患者采用BILT肝病治疗仪治疗对血小板参数与凝血的影响。方法本次共选择80例肝硬化患者,分组就常规对症支持(对照组)与加用BILT肝病治疗仪(观察组)治疗。对凝血机制和预后的影响进行比较。结果观察组临床情况优于对照组(P<0.05)。结论肝硬化患者采用BILT肝病治疗仪治疗,可显著减轻临床症状,具较高安全性,值得广泛推广应用。     

D-二聚体检测在产前高凝中的应用

目的 探讨D-二聚体检测在产前高凝状态判断中的意义.方法 通过对420例孕末期妇女进行D-二聚体检测并追踪观测产后临床情况,进行比较分析.结果 >0.5 mg/L时,要尤其注意DIC的危险,特别是>5.0 mg/L,一定要采取治疗措施.结论 对于孕末期妇女检测D-二聚体高于正常值的妇女临床应严加注意.     

Alternations of Maternal and Cord Plasma Hemostasis in Preeclampsia Before and After Delivery

Objective: The aim of this study was to investigate the role of hemostatic factors in the pathogenesis of preeclampsia. Materials and Methods: Maternal and cord plasma concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), von willebrand factor (vWF), soluble P-selectin (sP-selectin), fibrinopeptide A (FPA), D-dimer, and antithrombin III (AT-III) were measured by enzyme-linked immunosorbent assay (ELISA) in 46 women with preeclampsia and 40 normotensive pregnant women before and after delivery. Results: The maternal plasma concentrations of TF, vWF, and sP‐selectin were higher, but lower concentrations of TFPI, AT-III, and D-dimer were observed in women with preeclampsia compared to normotensive pregnant women before and after delivery. Compared with maternal plasma, fetal plasma concentrations of TF concentrations were increased significantly in both groups, whereas vWF, FPA, TFPI, AT-III, and D-dimer were decreased. Compared with normotensive pregnancy, fetal plasma concentrations of TF were markedly increased in preeclampsia, accompanied with a higher vWF and a lower sP-selectin and D-dimer levels. Furthermore, fetal plasma TF concentrations were more significantly increased in women with high blood pressure and severe proteinuria. Conclusions: Imbalance in the coagulation/fibrinolysis equilibrium, especially alterations in the extrinsic pathway of coagulation and anticoagulation, may play an important role in the pathogenesis of preeclampsia. In addition, fetal alteration of TF may be involved in the pathogenesis of fetal complications of preeclampsia.