Serotonergic mechanisms are involved in the hemostatic action of erythropoietin in uremic patients

Summary Recombinant human erythropoietin was administered to 12 patients with end-stage renal failure on long-term hemodialysis. They responded to the therapy with a shortening of the prolonged bleeding time, starting from the 1st week of therapy, before a significant increase in hemoglobin concentration was achieved. We also observed an increase in the activity of tissue plasminogen activator and a decrease in the activity of its inhibitor. There were no changes in platelet count but a significant increase in blood and platelet serotonin concentration was found. The shortening of the prolonged bleeding time before the correction of the anemia correlated with the rise in blood and platelet serotomin concentration during erythropoietin therapy. We suggest the possible involvement of an serotonergic mechanism in the hemostatic action of recombinant human erythropoietin.     

益智灵对“血瘀”大鼠血液流变性的影响

益智灵主要由黄芪、丹参、菖蒲、灵芝等中草药组成。本文观察了它对“血瘀”大鼠血液流变性的影响。大鼠ｉｇ益智灵 ０．３２和 ０．６４ｇ／ｋｇ，连续 ７天。第 ７天用肾上腺素加冷刺激造成血瘀模型，再次给药２小时后测定血液粘度、红细胞压积和体外血栓 结果表明该药能非常显著地降低血瘀大鼠的全血粘度、血浆粘度、红细胞压积、血栓长度及血栓重量。     

Effects of the etonogestrel-releasing contraceptive implant inserted immediately postpartum on maternal hemostasis: A randomized controlled trial

Introduction

The puerperium is the period of highest risk for thrombosis during a woman´s reproductive life and it is an important time for initiating an effective contraceptive method in order to increase intergestational interval. Thus, the objective of the present study was to evaluated the effects of the etonogestrel (ENG)-releasing contraceptive implant inserted immediately postpartum on maternal hemostasis markers during the first six weeks of delivery.

Materials and Methods

Forty healthy women aged 18 to 35 years-old were randomized to receive either the ENG-releasing implant 24-48 h after delivery (implant group; n = 20) or nothing (control group) until the sixth postpartum week. Blood samples were collected at 24-48 h and at 6 weeks after delivery, and hemostatic variables, including fibrinogen, coagulation factors, protein C, free protein S, antithrombin, α2-antiplasmin, plasminogen activator inhibitor 1, thrombin-antithrombin complex (TAT), prothrombin fragment (PF)1 + 2, and D-dimers, as well as normalized activated protein C sensitivity ratio (nAPCsr), thrombin time, activated partial thromboplastin time, and prothrombin time were evaluated.

Results

Insertion of the ENG-releasing contraceptive implant did not change the physiological reduction in overall coagulation (TAT and PF1 + 2) and fibrinolysis (D-dimer) markers, or nAPCsr. Reductions in factors II, VII, X and fibrinogen and increases in factor V were greater in the control than in the implant group. Clotting factors remained within normal limits throughout the study.

Conclusion

The ENG-releasing contraceptive implant inserted immediately postpartum did not have negative effects on physiological variations of the hemostatic system during the first 6 weeks postpartum.     

耻骨上前列腺切除术中应用聚维酮碘纱带填塞前列腺腺窝止血100例效果观察

目的 探讨聚维酮碘纱带填塞前列腺腺窝止血在耻骨上前列腺切除术中的应用效果.方法 对2000年5月-2011年10月行耻骨上前列腺切除术中应用聚维酮碘纱带填塞前列腺腺窝止血100例的临床资料进行回顾性分析.结果 本组平均手术时间42min,术中平均出血量90ml.术后均未进行膀胱冲洗,未发生膀胱痉挛性疼痛.切口Ⅰ期愈合,未发生并发症.结论 聚维酮碘纱带填塞前列腺腺窝上血是简便、有效、安全的开放性前列腺切除术止血方法.     

尖吻蝮蛇血凝酶用于鼻内镜手术患者止血的效果

目的评价尖吻蝮蛇血凝酶（HCA）用于鼻内镜手术患者的止血效果。方法将择期行鼻内镜下手术患者60例随机分为观察组（R组）和对照组（F组）,每组各30例。R组于术前15min给予尖吻蝮蛇血凝酶2U,F组未用任何止血药物。记录两组术中出血量,评价HCA的止血效果。结果 R组总有效28例,占93.3%;F组总有效21例,占70.0%。R组止血效果优于F组（P〈0.05）。结论尖吻蝮蛇血凝酶在鼻内镜下手术应用中有较好的止血效果。     

胶原蛋白海绵在腰椎间盘突出手术中的止血作用

目的探讨胶原蛋白海绵在腰椎间盘突出症手术中的止血作用。方法选择在本院脊柱外科收治的椎间盘突出症单纯行半椎板减压髓核摘除的患者,随机分为两组,一组用胶原蛋白海绵覆盖在硬脊膜外后缝合切口,另一组不用胶原蛋白海绵,直接缝合切口,记录患者术后24、48h内引流血量,根据手术前、后血红蛋白检测结果计算患者血红蛋白的丢失量,并对两组数据进行比较。结果应用胶原蛋白海绵组引流量较不用组引流量少,二者间具有显著性差异。结论在腰椎半椎板减压髓核摘除术后应用胶原蛋白海绵可以明显减少椎管内出血,临床值得推荐。     

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。     

鼻内镜下半导体激光治疗难治性鼻出血效果分析

目的探讨鼻内镜下半导体激光治疗难治性鼻出血的临床效果。方法难治性鼻出血患者80例随机分为观察组和对照组各40例,鼻内镜下探查鼻腔,明确出血点后观察组采用半导体激光止血,对照组采用微波止血,观察比较2组治疗效果。结果观察组治愈率、总有效率分别为80.0%、97.5%,高于对照组的60.0%、85.0%,差异有统计学意义(P<0.05)。经积极对症处理,所有患者预后良好。结论鼻内镜下半导体激光治疗难治性鼻出血,效果可靠,方法简便,患者痛苦小,值得临床推广。     

超声引导放置Foley导尿管在治疗剖宫产切口妊娠出血中的应用

目的 探讨超声引导下放置Foley水囊在剖宫产切口妊娠清宫术中及术后出血治疗中的应用价值.方法 对76例剖宫产切口妊娠清宫术术中或术后出血患者,于超声引导下放置Foley导尿管,充盈球囊,使之完全压迫出血部位.超声实时观察出血部位,如发现出血量渐增多,则继续压迫止血;如无继续出血,可安全取出球囊.记录术中出血量、注液量及水囊留置时间.结果 76例患者中,35例为孕囊型,41例为混合性包块型;孕囊型术中出血量为(30.16±5.20)ml,注液量(20.11±5.62)ml,水囊留置时间(13.37±4.19)h;混合性包块型术中出血量为(85.88±6.81)ml,注液量(30.12±9.06)ml,水囊留置时间(31.32±8.28)h.对所有患者均成功放置Foley水囊压迫止血,效果良好.结论 超声实时监视下放置Foley导尿管对治疗剖宫产切口妊娠具有较高应用价值.     

两种拔针顺序对透析后动静脉内瘘出血的影响

目的探讨恰当的拔针顺序,减少内瘘并发症,为延长动静脉内瘘使用时间提供依据。方法采用方便取样的方法对80例内瘘穿刺后应用不同拔针顺序进行维持性血液透析的患者进行观察。密闭式回血下机后,一种方法是根据过去传统经验先拔动脉穿刺针,另一种方法是根据实际情况先拔静脉穿刺针。对两组动静脉内瘘的止血按压时间及内瘘并发症的发生率进行比较。结果（1）先拔静脉穿刺针组在止血按压时间（9．47min）、穿刺点出血量（0．23m1）方面优于先拔动脉穿刺针组（19．87min、4．82ml）,比较差异有统计学意义（Z值分别为3．801,1．901;P均〈0．01）。（2）先拔静脉穿刺针组皮下血肿、渗血的发生率（0．oo％,10．50％）低于先拔动脉穿刺针组（3．00％,31．00％）,比较差异均有统计学意义（x^2值分别为136．98,84．25;P均〈0．01）。结论先拔静脉针更能达到有效止血目的,从而避免内瘘因压迫不当而出血及渗血,减少了并发症的发生,能够更好地保护动静脉内瘘,延长其使用寿命。