洛美沙星注射液与四种止血药配伍稳定性考察

目的:考察洛美沙星葡萄糖注射液与4种止血药配伍的稳定性。方法:在25℃、37℃下模拟临床常用浓度,洛美沙星葡萄糖注射液与氨甲环酸、氨基己酸、氨甲苯酸、酚磺乙胺在5%葡萄糖注射液中配伍6h内观察配伍液的外观、扫描紫外光谱、测定pH值、测定洛美沙星的含量变化。结果:洛美沙星葡萄糖注射液与氨甲环酸、酚磺乙胺注射液混合6h内较稳定;但与氨甲苯酸配伍时含量均在90%以下,与氨基己酸注射液配伍时含量均在90%以下,且pH值上升。结论:洛美沙星葡萄糖注射液与氨甲环酸、酚磺乙胺注射液可以配伍使用,但与氨甲苯酸、氨基己酸注射液不宜配伍使用。     

术益纱作为肝创伤止血修复材料的可行性研究

目的 探讨术益纱作为肝组织创面止血修复材料的可行性. 方法 在鼠肝脏左叶制造敞开型创面(5 mm×3 mm ×2 mm),形成出血模型.实验组使用术益纱贴敷创面,对照组贴敷速即纱.记录各组止血时间和总出血量,定期对创面进行肉眼观察和行组织学检查,研究术益纱的溶血率、急性毒性和细胞毒性. 结果 术益纱溶血率为2.30%,最大耐受量>0.48 g/kg,细胞毒性为0级;术益纱止血时间为(5.00±0.00)s,总出血量为(0.88±0.18)g/kg,优于速即纱(P<0.05);术益纱在14 d降解完全,创面在21 d完全愈合,效果明显优于速即纱. 结论 术益纱的溶血率、急性毒性和细胞毒性指标符合生物医用材料的要求,止血愈创效果显著,作用可能与其分子结构和黏附力有关.     

Active gastrointestinal bleeding:Use of hemostatic forceps beyond endoscopic submucosal dissection

To the best of our knowledge,this is the f irst report of the application of hemostatic forceps in active gastrointestinal(GI) bleeding that is not related to endoscopic submucosal dissection.An 86-year-old woman with chronic intake of low-dose aspirin had a Dieulafoy‘s lesion of the third duodenal portion.Bleeding control with epinephrine injection was unsuccessful.A 60-year-old man presented with a bleeding ulcer in the duodenal bulb.Ten days after combined endotherapy,he had recurrent bleeding from two m...     

开放与腔内腹主动脉暂时阻断在凶险性前置胎盘合并胎盘植入剖宫产手术中的应用比较

目的：比较腹主动脉暂时阻断（TAL）与腹主动脉球囊阻断（LABO）在凶险性前置胎盘合并胎盘植入剖宫产手术中的预防出血的优劣。 方法：回顾2016年1月—2018年7月在湖南省妇幼保健院住院分娩的84例凶险性前置胎盘合并胎盘植入患者资料,其中48例采用开放TAL止血,36例采用LABO止血。比较两组患者术前情况、手术相关指标、手术后及新生儿情况等各项参数。 结果：两组患者的年龄、孕产次、分娩间隔时间、分娩孕周、术前胎盘超声评分差异均无统计学意义（均P>0.05）;两组患者剖宫产手术时间、术中出血量、输浓缩红细胞量、子宫切除率差异均无统计学意义（均P>0.05）;两组患者在新生儿Apgar评分、新生儿体质量、术后住院时间差异均无统计学意义（均P>0.05）,TAL组剖宫产术后血管并发症发生率明显低于LABO组、住院费用明显少于LABO组（19.4% vs. 0;40 278 元 vs. 29 100元,均P<0.05）。 结论：在凶险性前置胎盘合并胎盘植入剖宫产手术中,TAL与LABO止血效果及子宫切除率相似,但前者更安全、经济,并发症少,值得推广。     

巨块型宫颈癌肿瘤中心前程同步加量调强放疗止血效果的观察

目的 探讨肿瘤中心前程同步加量调强放疗治疗巨块型宫颈癌大出血的有效性和安全性。方法 21例伴有阴道大出血的巨块型宫颈癌患者,前程(前3次)给予肿瘤中心(宫颈大肿块边界内收2 cm的范围)同步加量放疗15 Gy分3次后给予常规分割剂量(2 Gy/次),肿瘤周边和盆腔全程采用常规分割照射剂量46 Gy分23次。同步化疗采用顺铂25 mg/m²每周方案。外照射结束后给予腔内放疗20 Gy/4次。结果 首程大剂量放疗后24 h内阴道出血量较前减少50%,1周内阴道出血渐止,止血率100%。结论 采用肿瘤中心同步加量调强放疗是巨块型宫颈癌阴道大出血的有效治疗措施。     

Long-term uterine balloon tamponade for treatment and obliteration of ruptured uterine pseudoaneurysm

Objective

Rupture of uterine artery pseudoaneurysm (UAP) is a life-threatening event after childbirth. Hysterectomy or uterine arterial embolization was often needed for hemostasis. However, such procedures may cause severe morbidities for these women. To estimate the efficacy of uterine balloon tamponade (UBT) for controlling ruptured UAP bleeding, a retrospective analysis in a single teaching hospital was performed.

凶险性前置胎盘伴宫颈植入的诊断与治疗

目的探讨凶险性前置胎盘伴宫颈植入的诊治方法。 方法回顾性分析2017年1月至2019年1月江西省妇幼保健院收治的凶险性前置胎盘伴胎盘植入96例患者的临床资料,其中32例伴宫颈植入(宫颈植入组),64例伴子宫下段植入(子宫下段植入组),比较2组病例术中出血量、输血量、术后血红蛋白水平、手术止血方法、术后并发症等。 结果(1)宫颈植入组术中出血量2000～2975 ml,平均2500 ml,显著高于子宫下段植入组(1000～1500 ml,平均1200 ml), (Z＝－6.634,P＝0.001);输红细胞悬液、血浆、血小板及冷沉淀的量亦显著多于子宫下段植入组,P均<0.05;(2)子宫下段植入组中57例(89.06%)采取子宫血管结扎进行止血,高于宫颈植入组20例(62.5%), χ²＝9.48,P<0.05;宫颈植入组宫颈环形缝合术28.13%(9/32)和子宫切除率达34.38%(11/32),高于子宫下段植入组的9.38%(6/64)和1.56%(1/64), χ²＝5.69和18.11,P<0.05;(3)宫颈植入组失血性休克及膀胱损伤的发生率分别为56.25%(18/32)、15.63%(5/32),高于子宫下段植入组的14.06%(9/64)、1.56%(1/64),P<0.05。 结论凶险性前置胎盘伴宫颈植入患者病情更凶险;对宫颈植入患者术前应准确评估病情程度,术中选择合适的止血措施,控制其出血量,在保障孕产妇安全的前提下,降低子宫切除率。     

内镜下止血联合不同剂量艾司奥美拉唑钠治疗急性消化性溃疡出血效果分析研究

目的　比较内镜下止血联合不同剂量注射用艾司奥美拉唑钠治疗急性消化性溃疡出血的临床效果。方法　选取2016年1月—2018年1月武警总医院消化内科收治的160例急性消化性溃疡出血患者,采用随机数字表法将其分为标准剂量组（研究组）和大剂量组（对照组）,各80例。所有患者接受内镜下止血治疗。研究组给予注射用艾司奥美拉唑钠80 mg静脉注射+40 mg静脉滴注,每12 h 1次,维持治疗72 h。对照组给予注射用艾司奥美拉唑钠80 mg静脉注射+8 mg/h静脉持续泵入,维持治疗72 h。对比两组患者的平均止血时间、平均输血量、再出血率、平均住院时间、不良反应发生率及手术干预情况。结果　两组平均止血时间、平均输血量、再出血率、平均住院时间、不良反应发生率以及转外科手术率比较,差异均无统计学意义（P>0.05）。结论　对于急性消化性溃疡出血患者,内镜下止血联合标准剂量注射用艾司奥美拉唑钠间歇静脉滴注与大剂量持续泵入的止血效果相当,但前者更有利于减少医疗资源,值得临床应用与推广。     

合成α-氰基丙烯酸正丁酯医用胶用于肝脏止血

BACKGROUND: There are chemosynthetic and biological medical adhesives, and the former mainly composed by cyanoacrylate, holds poor hydrophilicity and is easy to break off, thereby achieving unsatisfactory hemostatic effect. OBJECTIVE: To evaluate the hemostatic and adhesion effect of the modified α-N butyl cyanoacrylate (NBCA) by the hemostatic test in white rabbit livers. METHODS: Material imprvement: cyanoacrylate monomer was prepared and its components and contents were analyzed by infrared spectrum and gas chromatograph. Sodium lauroyl sarcosinate was used as surfactant to improve the cohesive force between NBCA and tissues and increase the hydrophility. Hemostatic test in the liver incision: the liver incision of rabbits in three groups were sewn with absorbable suture and then covered with gelatin sponge (control group), cyanoacrylate and NBCA medical adhesives, respectively. Blood loss and bleeding time were recorded within 20 minutes. Hemostatic test in the liver section: the liver sections in two groups were smeared with surfactant plus NBCA and cyanoacrylate, respectively. The gross appearance of wound and its adherence to the omentum majus, as well as the histological changes by hematoxylin-eosin staining were observed at 1, 10 and 20 days postoperatively. RSULTS AND CONCLUSIPON: The adhesiveness of NBCA medical adhesive was excellent. Infrared spectrum and gas chromatograph found that the main component was NBCA up to 84.56%, with 8.2% reactants and 3.3% byproducts. The modified NBCA medical adhesive significantly decreased the blood loss and bleeding time compared with the control group (P < 0.01), and did not significantly differ from the cyanoacrylate (P > 0.05). In addition, the modified NBCA adhered more firmly to the wound, and was absorbed completely at 20 days postoperatively, showing no adverse reaction. These results suggest that NBCA is better and more stable than gelatin sponge, and exerts overt hemostatic effect causing no adverse reaction.     

烷基化壳聚糖的制备及止血效果

BACKGROUND: 18-Alkylated-chitosan has been proved to exhibit a good coagulation capacity through hydrophobic modification. OBJECTIVE: To improve the adhesion between the material and the wound through the introduction of alkylated-chitosan molecules. METHODS: The alkyl group was introduced in the chitosan by potentiodynamic method to prepare the alkylated-chitosan with different substitution degrees (7%,16%, 26% and 40%), and then their structure, viscosity, porosity, water absorption, contact angle and in vitro coagulation capacity were detected. Thirty New Zealand rabbits were enrolled, modeled into the left femoral artery hemorrhage, and randomized into six groups, including four experimental groups, positive control and control groups, followed by treated with alkylated-chitosan sponges with different degrees of substitution, absorbable hemostatic gauze and chitosan sponge, respectively. Afterwards, the blood loss and clotting time were observed. RESULTS AND CONCLUISON: With the degree of substitution increased, the viscosity of alkylated-chitosan increased firstly and then decreased, the porosity and water absorption decreased gradually, and the contact angle on a rise. Compared with chitosan, different alkylated-chitosans showed a better henostatic effect in vitro, especially the alkylated-chitosan with 16% substitution degree. The blood loss and clotting time in the experimental groups except that the alkylated-chitosan with 7% substitution degree were significantly lower than those in the control group (P < 0.05); the bold loss in the alkylated-chitosan with 40% substitution degree group was significantly lower than that in the positive control group (P < 0.05). These findings suggest that the alkylated-chitosan with 40% substitution degree exhibits the best hemostatic effect in vivo.