不同肝血流阻断方法对半肝切除手术预后的影响

目的 探讨3种不同肝血流阻断方法对半肝切除术手术预后的影响.方法 总结分析216例半肝切除术患者的临床资料,按术中所采用的肝血流阻断方法将患者分为3组:Pringle法为A组98例,选择性出入肝血流阻断术为B组71例,肝悬吊法联合选择性出入肝血流阻断术为C组47例.结果 3组间平均手术时间差异无统计学意义(分别t =0.72,0.83,0.67,均P＞0.05);A组平均术中出血量为和平均输血量均明显多于B、C组(分别t=3.72,3.83,4.11,4.07,均P＜0.05),B、C两组间差异无统计学意义(t=1.08,P＞0.05);A组患者术后第1、3天血清白蛋白水平显著低于B、C组(分别t =3.65,3.77,3.90,3.74,均P＜0.05);A组患者术后第3、5天血清总胆红素水平明显高于B、C组(分别t=4.13,5.01,4.09,3.99,均P＜0.05);A组术后第1、3、5天血清丙氨酸转氨酶水平显著高于B、C组(分别t=5.36、6.14,5.70,7.01,4.94,3.98,均P＜0.05);A组患者术后并发症发生率明显高于B、C组(分别x2 =13.71,23.56,均P＜0.05).B、C组患者术后肝功能变化及并发症发生率差异无统计学意义(均P＞0.05).3组恶性肿瘤患者的术后3年生存率差异无统计学意义(t=2.38,P＞0.05).结论 半肝切除术中采用选择性出入肝血流阻断术或与肝悬吊法联合应用,均可显著减少术中出血,减轻术后肝功能损害及降低术后并发症的发生率.选择性出入肝血流阻断术可作为半肝切除术中血流阻断的首选方法.     

Study on chemical constituents of Folium Artemisiae argyi Carbonisatum,toxicity evaluation on zebrafish and intestinal hemostasis

Folium Artemisiae argyi Carbonisatum (FAAC) is a traditional medicine widely used in clinic. It has the effect of hemostasis by warming meridians. In order to further explore the chemical composition and biological activity of FAAC, the methanol extract of FAAC was isolated and purified by open column and high- performance liquid chromatography. and the complete structure was characterized by nuclear magnetic resonance (NMR) and LREI-MS for the first time, namely rutin, quercetin and octacosanol respectively. Initially the toxic effect of methanol extract of FAAC on zebrafish was evaluated by observing the phenotypic characteristics, spontaneous twitch times, heart rate, hatching rate, the distance of SV-BA and cardiomyocyte apoptosis of zebrafish. The results showed that FAAC has embryonic development toxicity and cardiotoxicity when it was higher than 62.5 μg/mL. Meanwhile, the hemostatic effect of methanol extract of FAAC was compared with FAA (Folium Artemisia argyi) by zebrafish intestinal bleeding model originally. The results showed that the hemostatic effect of the medium and high concentration dose groups (3.0 and 30.0 μg/mL) was enhanced for both FAAC and FAA. This study provided an experimental basis for the clinical application of FAAC.     

氨甲环酸片用于人工流产术止血的临床观察

目的探讨氨甲环酸片用于早孕孕妇行人工流产术的止血效果。方法将120例孕妇随机分为氨甲环酸组和对照组各60例,并按妇科检查及B型超声测定判断孕周大小进行配对。氨甲环酸组于人工流产术前2h予以氨甲环酸片500mg口服,对照组不服用任何药物。测量并比较2组术中及术后出血量,同时观察药物不良反应。结果氨甲环酸组术中、术后出血量及总出血量少于对照组,差异均有统计学意义(P<0.05)。氨甲环酸组出现轻度恶心18例(30.0%),轻度头晕8例(13.3%);对照组仅出现轻度恶心1例(1.7%),均未做任何处理自行好转。结论氨甲环酸片用于早孕孕妇人工流产术有较好的止血效果,术中及术后出血量均明显减少,无严重不良反应,有利于患者恢复。     

The action of Lonomin V (Lonomia achelous) on fibronectin functional properties

Lonomia achelous caterpillar, Lepidoptera distributed along some South American countries, induces a hemorrhagic syndrome in people who come into contact with its bristles. A clinical characteristic in these patients is that fresh healed wounds are re-opened and bleed. In order to explain this symptomatology, we evaluated the effect of Lonomin V (a protein isolated from L. achelous hemolymph), on some functional properties of fibronectin, which in turn plays an important role in the hemostasis. The effect of Lonomin V on fibronectin was studied by SDS-PAGE in reduced condition, binding to gelatin and heparin, crosslinking to fibrin and platelet adhesion. Formation of degradation products of 120, 66, 50, 40 and 29 kDa, some of which retain affinity to heparin and gelatin were observed; however, the fibronectin degradation fragments presented a significant decrease of crosslinking capacity to fibrin and platelet adhesion, suggesting that the proteolysis of fibronectin by Lonomin V induces changes in its crosslinking sites and on platelet receptors. These findings might partially explain the wound dehiscence observed in the patients. Due to its effect on adhesive proteins with concomitant impairment of some functional properties, Lonomin V might be useful for cellular adhesion studies involved in hemostasis such as platelet adhesion.     

鼻内镜下成人严重鼻出血处理

目的：探寻成人严重鼻出血位置分布规律及有效微创处理方法。方法：通过鼻内镜观察成人严重鼻出血位置,并以微创手段进行止血。结果：129例成人严重鼻出血患者出血部位：鼻中隔嗅裂区及鼻顶前端68例(52.7%);下鼻道后端穹隆部37例(28.7%);蝶筛隐窝下方10例(7.8%);利特尔氏区8例(6.2%);中隔后上端5例(3.9%);部位不明1例(0.8%)。查明出血部位的128例患者为动脉出血,均予电凝止血。结论：绝大多数患者出血部位在鼻中隔嗅裂区、鼻顶前端和下鼻道后端穹隆部;鼻内镜下绝大多数出血部位均可发现;鼻内镜下电凝止血创伤微小,效果确切。     

可降解止血粉在慢性鼻窦炎内镜手术中的应用:前瞻性、随机、对照、单盲临床试验

目的评估可降解止血粉应用于鼻内镜手术的有效性及舒适度。方法前瞻性纳入2015年10月至2019年7月期间就诊于首都医科大学附属北京同仁医院的慢性鼻窦炎患者21例,患者均为双侧病变,其中男17例,女4例,年龄18~65岁,平均42岁。所有患者均接受鼻内镜手术治疗,采用同一患者左右侧鼻腔随机对照试验,若试验侧鼻腔应用可降解止血粉,则对照侧鼻腔应用可降解止血绵。患者术前CT平均评分为6.25分。术后第1、7、14、30天完成左右侧鼻腔鼻出血以及鼻塞、流涕、疼痛视觉模拟量表(VAS)评分。评估患者术后鼻内镜评分。应用SPSS 22和Graphpad prism 8.0 软件进行统计学分析。患者试验侧和对照侧之间采用配对t检验或非参数检验。P<0.05为差异有统计学意义。结果患者在术后第1、7、14、30天,止血粉侧和对照侧鼻腔的出血评分、鼻部症状总评分差异无统计学意义(t值分别为1.341、0.552、0.631、0.158,P值均>0.05;t值分别为0.944、1.471、1.612、2.251,P值均>0.05);各鼻部症状评分差异无统计学意义(P值均>0.05)。术后第1、7、14天,止血粉侧的材料降解评分分别为(1.33±0.21)、(0.38±0.18)、0分;低于对照侧的(2.00±0.00)、(1.95±0.22)、(1.80±0.13)分,差异有统计学意义(P值均<0.01)。术后第1、7、14和30天,患者止血粉侧鼻腔的鼻内镜评分(水肿、结痂、分泌物、瘢痕、息肉)均低于对照侧(t=3.07、7.00、6.41、2.69,P值均<0.05)。结论慢性鼻窦炎患者行内镜鼻窦手术后,止血粉与可降解止血绵的止血效果相当。术后14 d止血粉降解和清除程度优于可降解止血绵,对黏膜伤口愈合没有影响。     

Intra-abdominal packing with laparotomy pads and QuikClot™ during damage control laparotomy: A safety analysis

BackgroundIntra-abdominal packing with laparotomy pads (LP) is a common and rapid method for hemorrhage control in critically injured patients. Combat Gauze™ and Trauma Pads™ ([QC] Z-Medica QuikClot^®) are kaolin impregnated hemostatic agents, that in addition to LP, may improve hemorrhage control. While QC packing has been effective in a swine liver injury model, QC remains unstudied for human intra-abdominal use. We hypothesized QC packing during damage control laparotomy (DCL) better controls hemorrhage than standard packing and is safe for intracorporeal use.MethodsA retrospective review (2011–2014) at a Level-I Trauma Center reviewed all patients who underwent DCL with intentionally retained packing. Clinical characteristics, intraoperative and postoperative parameters, and outcomes were compared with respect to packing (LP vs. LP + QC). All complications occurring within the patients’ hospital stays were reviewed. A p ≤ 0.05 was considered significant.Results68 patients underwent DCL with packing; (LP n = 40; LP + QC n = 28). No difference in age, BMI, injury mechanism, ISS, or GCS was detected (Table 1, all p > 0.05). LP + QC patients had a lower systolic blood pressure upon ED presentation and greater blood loss during index laparotomy than LP patients. LP + QC patients received more packed red blood cell and fresh frozen plasma resuscitation during index laparotomy (both p < 0.05). Despite greater physiologic derangement in the LP + QC group, there was no difference in total blood products required after index laparotomy until abdominal closure (LP vs LP + QC; p > 0.05). After a median of 2 days until abdominal closure in both groups, no difference in complications rates attributable to intra-abdominal packing (LP vs LP + QC) was detected.ConclusionWhile the addition of QC to LP packing did not confer additional benefit to standard packing, there was no additional morbidity identified with its use. The surgeons at our institution now select augmented packing with QC for sicker patients, as we believe this may have additional advantage over standard LP packing. A randomized controlled trial is warranted to further evaluate the intra-abdominal use of advanced hemostatic agents, like QC, for both hemostasis and associated morbidity.     

垂体后叶素在腹腔镜全子宫切除术止血中的应用与疗效观察

目的：观察垂体后叶素在腹腔镜全子宫切除术(TLH)止血过程中的临床疗效。方法：将入选的70例行TLH患者随机分为观察组与对照组,观察组术中宫底注射稀释后的垂体后叶素10U,对照组注射缩宫素10U,监测两组术中血压等生命体征变化,对比两组术中出血量、手术时间、术后血红蛋白的变化情况。结果：①TLH中,观察组在手术时间、术中出血量、手术前后血红蛋白的变化方面均少于或低于对照组(P<0.01)；②对照组2例患者术中转为开腹手术；③观察组注射垂体后叶素后20分钟内血压水平明显升高,30分钟后升压效果消失。结论：①腔镜下大子宫切除术中使用垂体后叶素较之缩宫素具备更好的临床止血效果；②应严格掌握垂体后叶素的用药指征和适应证。     

水囊压迫法在子宫疤痕妊娠7例止血观察及护理配合

目的 分析宫腔放置水囊压迫法在子宫疤痕妊娠的止血效果及护理配合.方法 将7例确诊为子宫疤痕妊娠妇女作为研究对象,均进行刮宫术联合宫腔放置水囊压迫法止血治疗.结果 7例患者平均住院时间（5.6±2.0）d,术中出血量平均为（268.9±71.6） ml,放置水囊压迫法后平均出血量为（65.4±11.9） ml,血清β-HCG下水平降至正常水平时间（11.9±3.8）d,术后无一例患者出现感染.结论 宫腔放置水囊压迫法止血效果可靠、安全,且水囊制作简单、应用广泛、费用低廉,尤其适合基层医院妇产科手术宫腔大出血的止血处理.