南山人民医院2007-2011年临床输血回顾分析

目的:通过临床输血资料统计分析,了解临床输血现状与趋势,探讨提高临床输血质量的措施和对策。方法:对我院2007-2011年临床输血总量、全血和成分用血等指标进行统计分析。结果:成分输血比例较高;临床用血量逐年增加;血小板、冷沉淀、洗涤红细胞等用量逐步增加;人均用血量逐年增加;血浆用量比例有下降趋势,但与红细胞悬液的比例仍明显高于国外。结论:临床用血日趋规范,但仍有一些不合理现象,需要采取有效措施,进一步提高临床输血质量。     

以输血治疗预期为目标的临床输血路径管理

按照临床路径管理模式建立以输血治疗预期目标为导向的临床输血路径管理体系,采用输血信息管理系统对输血前评估、输血预期目标、输血剂量、输血后效果评价进行全程控制。以输血预期为目标的输血管理系统确保了输血治疗目标明确、输血剂量合理并实现输血全过程密闭管理。提高了临床输血的合理性以及输血治疗过程信息的完整性与规范性。     

Genetical Study of Mutation in Maternal-fetal ABO Incompatibility

This study looked into a family involving a rare mother-child ABO blood type inconsistency and explored its genetic and molecular basis. In the family, the mother had type AB blood and the father was blood type B and they gave birth to a baby of blood type O. Their blood types were phenotypically identified by using different techniques, including micro-column gel test, immune inhibition test, absorption and elution tests. The sequences of all 7 exons of ABO allele from the core family members were determined by using PCR and clone-based sequencing. The loci of mutated gene were compared against normal human genes. The result showed that the mother’s erythrocytes were agglutinable with monoclonal anti-A antibody(2+) and had agglutination reaction with anti-B antibody(4+). The mother’s serum registered agglutination action with standard blood type A cells. The findings showed an ABO inconsistency. When domestic antibodies were used, the mother’s erythrocytes yielded agglutination reaction with humanized anti-B serum(4+) and anti-B monoclonal antibody but were non-agglutinable with humanized anti-A serum and anti-A monoclonal antibody. Upon absorption and elution, the titer of anit-A antibody was 128 both before and after the absorption test, with no significant difference found between pre- and post-absorption values. Our results confirmed that the mother’s allelic gene was type B and contained type A. The father’s blood type was type B, and son’s blood type was type O. Clone-based sequencing revealed that the mother carried a heterozygous gene of B101.01(nt A640→G)/O01, which contained an M214→V mutation that could express a weak expression of antigen A, resulting in blood type AB. However, their son did not have the M214→V mutation, which yielded a false ABO-inconsistency between him and his mother. We were led to conclude that type B gene with a M214→V mutation can encode both antigen B and weak antigen B that can lead to false ABO-inconsistencies.     

ICU患者铜绿假单胞菌获得性金属β-内酰胺酶基因的研究及其耐药性分析

目的:了解我院ICU患者铜绿假单胞菌的耐药性,为临床合理使用抗生素提供依据和探讨该耐药菌的防治方法。方法:临床分离的106株铜绿假单胞菌用法国梅里埃公司的VITEK-2全自动微生物分析系统鉴定,纸片扩散法进行抗生素敏感试验,采用纸片协同法检测金属酶表型,PCR法扩增金属酶基因。结果:2007～2009年共分离出106株铜绿假单胞菌,对头孢他啶、亚胺培南、哌拉西林、氨曲南、头孢哌酮、头孢吡肟、左氧氟沙星的耐药率分别为50.9%、39.6%、79.2%、56.6%、57.5%、41.5%、25.5%。结论:携带AmpC金属酶基因是本院ICU患者铜绿假单胞菌耐碳青霉烯类等多种药物的主要原因。     

Frenkel训练法对脑卒中后本体感觉障碍作用的观察

目的探讨Frenkel训练法对脑卒中本体感觉障碍患者功能恢复的影响。方法共选取有本体感觉功能障碍的脑卒中患者60例,将其随机分为治疗组和观察组,两组患者均采用常规康复措施进行训练,治疗组同时接受Frenkel训练法。康复评定采用Fugl-Meyer运动功能和四肢本体感觉功能评分法,患者日常生活活动能力（ADL）评定采用改良Barthel指数（MBI）。结果两组患者分别经训练后,其Fugl-Meyer运动功能评分和MBI评分均较治疗前明显改善（P〈0．01）,但治疗组的效果优于对照组（P〈0．01）。结论本体感觉障碍能明显影响脑卒中患者康复疗效,脑卒中感觉障碍患者应用Frenkel训练法,不仅有利于其感觉功能进一步康复,而且对提高患者运动功能和ADL也有显著促进作用。     

临床输血路径管理体系的构建

按临床路径管理的要求制定标准化输血和质量监控流程,以计算机网络技术为基础构建临床输血闭环管理体系。初步建成了输血前评估、输血申请和审批、标本采集和运输、血液库存管理、血型复检和输血相容性试验、发血和取血、输血前准备和核查、输血过程巡查、输血后效果评价、输血不良反应处理、血袋回收等全程各节点的闭环式管理和监控体系。经多家医疗机构试运行,可为临床输血提供高效、安全、可溯源的临床输血管理模式。     

粪便中灵芝孢子与肺吸虫卵形态学鉴别

口服灵芝保健品患者粪便用0.9%NaC l溶液涂片,在显微镜下观察灵芝孢子形态与肺吸虫卵形态,并对两者进行比较。结果粪便中灵芝孢子与肺吸虫卵形态上有很多相近之处,但两者还是各有特征。在实际工作中,粪便检查查到大量肺吸虫卵样物质时,应询问病史,结合临床,通过显微镜下形态学特征鉴别粪便中灵芝孢子与肺吸虫卵。     

IL-32在PR3-ANCA相关性血管炎中的表达水平的变化

目的:分析蛋白酶3-抗中性粒细胞抗体(proteimase 3-antineutrocyte antibody,PR3-ANCA)相关性血管炎患者外周血IL-32的表达,初步探讨IL-32在PR3-ANCA相关性血管炎的发病中的作用.方法:运用酶联免疫吸附试验(ELISA)检测PR3-ANCA相关性血管炎患者血清和外周...     

标本放置时间和温度对血清乳酸脱氢酶活性的影响

目的:分析血标本在不同放置时间和温度对血清乳酸脱氢酶(LD)的影响。方法:采用34例健康成人血标本分别放置于4℃～6℃、23℃～25℃和37℃,在即时、8 h、24 h、48 h、72 h和96 h测定其血清LD活性并进行分析比较。结果:在4℃～6℃条件下,分别于即时和放置8 h、24 h、48 h、72 h及96 h测定血清LD活性结果为(127.2±8.7)U/L、(125.5±12.6)U/L、(130.2±14.2)U/L、(145.8±18.4)U/L、(161.3±24.7)U/L和(191.2±28.0)U/L.经统计学分析,标本放置8 h和24 h与即时测定结果无明显差异(P>0.05),当标本放置48 h、72 h和96 h血清LD活性比即时测定结果明显升高(P<0.05、P<0.001);当标本放置24 h,冷藏组(4℃～6℃)、室温组(23℃～25℃)和温育组(37℃)血标本LD活性分别为(130.2±14.2)U/L、(141.9±15.1)U/L和(168.8±17.1)U/L,与即时测定结果比较,冷藏组(P>0.05)无明显差异,而室温组(P<0.05)和温育组(P<0.01)血清LD活性明显升高。结论:随着血标本放置时间的延长和放置温度的增加血清LD活性会逐渐升高。     

临床输血电子病历及首页管理模式的建立

在临床输血路径引导下的输血闭环式管理中,将输血前评估、输血过程管理、输血后效果评价、输血不良反应处理等相关记录自动生成可编辑的输血病历电子文档,汇总成临床输血病历。借鉴病历首页的管理模式设计输血病历首页,通过输血病历首页监控输血病历书写的及时性和病历的完整性,通过输血病历的上传和汇总分析获得区域性临床输血大数据。这种新的管理模式不仅可使输血病历更趋规范化、减少项目遗漏和书写不及时现象,还可避免医务人员重复记录的问题。