降纤酶和低分子肝素联合治疗糖尿病下肢血管病变疗效观察

我院对已有下肢血流异常的．糖尿病患运用降纤酶和低分子肝素钙治疗，疗效显，现总结如下。     

川芎嗪联合低分子肝素治疗糖尿病周围血管病变临床观察

我科自2007-10至今,应用川芎嗪联合低分子肝素治疗糖尿病周围血管病变[1]102例,获得良好效果。现报道如下。     

奥扎格雷钠、低分子肝素联合使用治疗进展性脑梗死

我院 2 0 0 0年 1月至 2 0 0 1年 7月联合使用奥扎格雷钠(商品名 :丹奥 )、低分子肝素治疗进展性脑梗死 2 5例 ,取得满意效果 ,现报告如下。1　资料与方法1.1　病例资料　随机将 5 1例患者分为治疗组与对照组 ,治疗组 2 5例 ,男 15例 ,女 10例 ,年龄 4 3～ 84岁 ,平均 6 3.5岁 ,病情进展的平均时间为 18小时。对照组 2 6例 ,男 18例 ,女 8例 ,年龄 4 6～ 78岁 ,平均 6 2岁 ,病情进展的平均时间为 16 .5小时 ,两组间的发病时间、年龄、病程及神经功能评分无显著差异 (Ｐ >0 .0 5 )。1.2　入选标准和排除标准　①近 2年来我科住院患者中选取发…     

奥扎格雷钠联合低分子肝素治疗下肢深静脉血栓54例分析

目的：探索奥扎格雷钠与低分子肝素合用对下肢深静脉血栓的治疗效果。方法：下肢深静脉血栓患者54例,应用奥扎格雷钠与低分子肝素治疗深静脉血栓形成,观察疗效。结果：54例下肢深静脉血栓形成的患者治愈36例,有效14例,无效4例。结论：联合应用奥扎格雷钠与低分子肝素是治疗下肢深静脉血栓的有效、安全和简便的方法。     

低分子肝素治疗急性肺栓塞疗效分析

目的 通过分析低分子肝素治疗急性肺栓塞患者的临床效果、并发症发生率等， 探讨低分子肝素在急性肺栓塞抗凝治疗中的地位。方法 分析低分子肝素用于我院50例急性肺栓塞患者的治疗情况，观察临床疗效，包括症状改善，血气分析、D－二聚体、下肢静脉超声、肺通气／灌注扫描或螺旋CT、以及血小板减少、出血并发症等。结果 死亡4例，治愈40例，显效6例。总死亡率8%，再发下肢深静脉血栓形成1例，未发现再发肺栓塞，出血并发症发生率4.34％。结论 低分子肝素用于急性肺栓塞治疗的疗效可靠、副作用低，监测方便，可以作为抗凝治疗的首选。     

低分子肝素钙联用奥扎格雷钠治疗不稳定型心绞痛疗效分析

目的 探讨低分子肝素钙联用奥扎格雷钠治疗不稳定型心绞痛(UAP)的疗效.方法 将160例UAP患者随机分为治疗组和对照组各80例,治疗组采用低分子肝素钙联用奥扎格雷钠治疗,对照组应用常规治疗.结果 治疗组74例心绞痛得到控制,控制率为91.3%;对照组60例得到控制,控制率为75%.两组相比差异有统计学意义.而不良反应发生率差异无统计学意义.结论 低分子肝素钙联用奥扎格雷钠治疗UAP疗效好,不良反应轻微,是安全可靠的治疗方法.     

奥扎格雷联合低分子肝素治疗进展型脑梗死疗效观察

对奥扎格雷联合低分子肝素治疗进展型脑梗死疗效观察总结如下。     

奥扎格雷钠联合应用低分子肝素钙治疗急性脑梗死疗效观察

2001—06～2006—08我们采用奥扎格雷钠联合低分子肝素钙治疗急性脑梗死50例，效果良好，报告如下。     

皮下注射低分子肝素治疗TIA临床探讨

目的 观察注射用低分子肝素治疗短暂性脑缺血发作(TIA)的疗效及该药对出凝血指标的影响.方法 临床诊断TIA患者应用注射用低分子肝素钙4800 U皮下注射,每12h一次治疗,进行临床观察并与对照组比较,同时观察治疗组在使用低分子肝素前后血小板及INR的变化.结果 治疗组的基本治愈率、总有效率均明显高于对照组(P＜0.01),治疗组用药前后BPT、INR差异无统计学意义(P＞0.05),未发现明显不良反应.结论 低分子肝素是治疗TIA的一种安全、有效的药物.     

低分子肝素皮下注射操作的最佳证据总结

目的 检索、评价和整合低分子肝素皮下注射操作的相关证据。方法 计算机检索国内外数据库、相关专业网站中关于低分子肝素皮下注射操作的临床决策、推荐实践、证据总结、技术报告、指南、专家共识、系统评价,文献检索时限为建库至2021年11月,由2名研究者独立进行文献质量评价后,根据主题对证据进行提取与汇总。结果 根据纳入标准,共筛选出9篇文献,包括2篇证据总结、2篇专家共识、5篇系统评价。通过文献阅读、证据提取和归类,从注射前准备、注射中规范、注射后处置3个方面总结出12条证据。结论 该研究总结了低分子肝素皮下注射操作的最佳证据,可为护理人员开展临床实践提供参考。护理人员应结合临床情境、患者意愿,审慎地选择并应用证据,从而保障注射安全,降低相关并发症的发生率。     

肝素及低分子肝素对脑血管病患者血中妊娠相关血浆蛋白A浓度的影响

目的 探讨临床脑血管疾病治疗中应用的肝素和低分子肝素对血清学标志物PAPP.A浓度的影响,为进一步准确评价PAPP-A的临床意义提供依据.方法 选取山东大学齐鲁医院2009年11月至2010年5月收入院的40例脑血管病患者,分别采集药物注射前后的血标本.按照治疗方法及肝素和低分子肝素的用药情况分成4组:A组,10例皮下注射低分子肝素抗凝患者,注射前、治疗第1天、第2天和第7天注射后3 h以及末次注射后24 h分别抽取静脉血.B组,10例未用低分子肝素抗凝患者,入院时、入院第1天、第2天和第7天抽取静脉血.C组,10名肝素抗凝支架治疗患者,造影前、注射肝素前、注射肝素后第3、5、15、40和100分钟从动脉鞘管抽取动脉血.D组,10例未用肝素抗凝造影患者,造影前和造影完成后分别从动脉鞘管抽取动脉血.用ELISA方法检测各组标本中PAPP-A浓度,分析不同处理组组间差异及组内各时间点间的差异.结果 A组患者PAPP-A 浓度呈时间依赖性,随着给药天数的增加逐渐从注射前的12.36(9.90～14.32)mIU/L升高至第7天21.80(23.50～19.73)mIU/L,差异有统计学意义(M=38.72,P<0.01).C组患者静脉注射肝素后PAPP-A浓度5 min内由12.86(9.67～14.05)mIU/L升高至51.56(44.20～66.00)mIU/L,差异有统计学意义(M=46.06,P<0.01).皮下注射低分子肝素1周后A组PAPP-A的浓度为21.80(23.50～19.73)mIU/L,高于B组的11.81(9.21～12.89)mIU/L,差异有统计学意义(U<0.001,P<0.01).C组静脉注射肝素15 min时PAPP-A的浓度为43.70(37.70～54.30)mIU/L,高于D组造影后的14.18(11.25～15.86)mIU/L,差异有统计学意义(U<0.001,P<0.01).皮下注射低分子肝素后血中PAPP-A的峰值比静脉注射肝素的峰值低,A组与C组分别为21.80(23.50～19.73)、51.56(44.20～66.00)mIU/L,差异有统计学意义(U=0.999,P<0.01).结论 脑血管疾病临床治疗中应用肝素和低分子肝素会导致血中PAPP-A浓度的升高,选用PAPP-A作为评价指标时应考虑药物的影响.

Abstract：

Objecfive To investigate the effects of treatment for cerebrovascular disorder patients with heparin and low molecular weight heparin(LMWH) on serum PAPP-A concentrations and provide the basis for evaluating the clinical significance of PAPP-A in the following study.Methods Forty cases with cerebrovascular disease from Qilu Hospital from November 2009 to May 2010 were collected in this study.Blood samples were taken before and after drug administration.All cases were divided into four groups according to situation of medication.Group A consisted of 10 patients who received subcutaneous LMWH anticoagulation therapy, and blood samples were collected before LMWH injection, three hours after subcutaneous LMWH anticoagulation therapy in the first day, the second day and the seventh day and 24 hours after the last injection. Group B consisted of 10 patients who did not receive LMWH therapy, and blood samples were collected immediately after admission, the first day, the second day and the seventh day after admission. Group C consisted of 10 patients with percutaneous carotid intervention who received intravenous heparin at the beginning of stenting, and blood samples were collected from the arterial sheath just before angiography and heparin administration, and at 3, 5, 15, 40 and 100 min after heparin administration. Group D consisted of 10 patients who received carotid angiography but LMWH-free therapy,and blood samples were collected from the arterial sheath just before and after angiography. Serum PAPP-A concentrations were analyzed by ELISA to evaluate the differences of intra-groups and differences at different time points of inter-groups. Results In group A, PAPP-A concentrations were time dependent and elevated gradually from 12. 36 (9. 90-14. 32) mIU/L before LMWH injection to 21.80 (23.50-19.73) mIU/L at the seventh day after injection (M=38. 72, P < 0.01 ). In group C, there was a rapid increase of PAPP-A concentration from 12. 86 ( 9. 67-14. 05 ) mIU/L to 51.56 ( 44. 20-66. 00 ) mIU/L within 5 min after intravenous heparin injection (M=46. 06, P <0. 01 ). The PAPP-A concentration of one week after LMWH administration in group A was 21.80 (23.50-19.73) mIU/L, significantly higher than that in group B [11.81 (9. 21-12. 89) mIU/L] (U<0. O01, P<0.01). The PAPP-A concentration at 15 min after heparin administration in group C was 43.70 (37.70-54. 30) mIU/L, significantly higher than that after angiography in group D [14. 18 (11.25-15. 86) mIU/L] ( U<0. 001, P <0. 01 ). The peak level of blood PAPP-A after subcutaneous LMWH injection was significantly lower than that after intravenous heparin injection. The concentrations in group A and C were 21.80 ( 23.50-19. 73 ) and 51.56 (44. 20-66. 00) mIU/L respectively, and had a significant difference ( U=0. 999, P < 0. 01 ) . Conclusions Both intravenous heparin and subcutaneous LMWH administration induce an increase in serum PAPP-A concentration. The effect of drug should be considered when PAPP-A is selected as an evaluation indicator.     

低分子量肝素治疗糖尿病肾病的临床研究

目的观察低分子量肝素治疗糖尿病肾病的临床疗效和安全性。方法将 6 4例糖尿病肾病患者根据 2 4h尿白蛋白或蛋白定量分为早期糖尿病肾病 (30例 )和临床期糖尿病肾病 (34例 ) ,再随机分为治疗组和对照组。所有患者均给予降糖降压治疗 ;治疗组再予以低分子量肝素治疗 ,疗程 8周 ,观察血脂、血小板、纤维蛋白原、凝血酶原标准化比率、肝肾功能、内生肌酐清除率、2 4h尿白蛋白或蛋白定量变化及副作用。结果两期治疗组疗程后 ,血脂、胆固醇、纤维蛋白原、2 4h尿白蛋白或蛋白定量下降 ;临床糖尿病肾病治疗组血尿素氮、肌酐降低 ,内生肌酐清除率升高与治疗前及对照组治疗后比较均有显著性差异 (P <0 .0 1或 0 .0 5 )。结论低分子量肝素可安全有效的用于糖尿病肾病的临床治疗。     

低分子量肝素对纤维蛋白凝结速率影响的体外研究

目的 应用SONOCLOT血凝分析仪测定不同剂量及不同种类LMWH对纤维蛋白CR的影响,探讨应用CR检测LMWH抗凝活性的可行性.方法 选择20名健康志愿者,抽取所有受试者外周血标本依次加入不同剂量的LMWH(达肝素),最终血标本浓度范围为0～1.8 IU/ml;应用3种不同促凝剂玻璃珠、硅藻土、高岭土分别依次测定CR值,对不同浓度达肝素与相应的CR值进行相关性分析.向外周血标本分别加入相同剂量(最终血标本浓度为0.8 IU/ml)的不同种类LMWH(达肝素、依诺肝素、那曲肝素),应用玻璃珠促凝剂依次测定CR值并进行相关性分析.结果 随达肝素剂量的增加,用3种促凝剂分别测得的CR值均逐渐降低.达肝素浓度为0～1.8 IU/ml时,应用玻璃珠促凝剂测定的CR值为20.0～4.5 IU/min,应用硅藻土促凝剂测定的CR值为26.1～6.6 IU/min,应用高岭土促凝剂测定的CR值为27.2～7.5 IU/min,均与达肝素浓度呈指数相关关系(R2分别为-0.796、-0.884、-0.921,P＜0.01).不同种类LMWH在相同浓度下(0.8 IU/ml)测定的CR值也不同,达肝素作用下测定的CR值为7.4 IU/min,依诺肝素作用下测定的CR值为8.5 IU/min,那曲肝素作用下测定的CR值为8.5 IU/min,与基线值17.6 IU/min比较差异均有统计学意义(t值分别为18.45、12.33、14.93,P＜0.01),达肝素作用下测定的CR值低于依诺肝素和那曲肝素作用下测定的CR值(t值分别为2.552、2.924,P＜0.05).结论 3种促凝剂所测得的CR值与达肝素浓度均呈指数相关关系,不同种类LMWH均可显著降低CR值.CR值有可能成为LMWH抗凝活性的床旁检测指标.

Abstract：

Objective To study the in vitro effects of different doses and different kinds of LMWH on CR, and to determine whether the CR test could be used to monitor LMWH. Methods The CR value was measured with different reagents ( glass beads, celite and kaolin ) in blood samples from twenty volunteer donors, which were spiked with increasing concentration of LMWH ( dalteparin, 0-1.8 IU/ml ). Then the CR test was performed again on the same blood samples spiked with the same concentration ( 0. 8 IU/ml ) but different LMWH ( dalteparin, enoxaparin and nadroparin ). Regression analysis was performed to establish a regression equation from corresponding LMWH levels. Results With the increasing of dalteparin dose, CR values were reduced gradually for all three reagents. When the concentration of dalteparin was 0-1.8 IU/ml,the value of CR was 20. 0-4. 5 IU/min for glass beads, 26. 1-6.6 IU/min for celite and 27. 2-7. 5 IU/min for kaolin. An exponential relationship was observed between the CR value and dalteparin concentration for three reagents( R2 = -0.796, -0.884, -0.921 ,P ＜0.01 ). All three kinds of LMWH with the same concentration (0.8 IU/ml ) induced a different change in CR. The value of CR was 7.4 IU/min with dalteparin,8. 5 IU/min with enoxaparin and 8.5 IU/min with nadroparin. Compared with the control group ( CR was 17.6 IU/min ), three kinds of LMWH had statistical significance ( t = 18.45, 12. 33, 14. 93, P ＜ 0.01 ).Compared with the enoxaparin and nadroparin, dalteparin induced a higher CR value ( t = 2. 552,2. 924,P＜0. 05 ). Conclusions There is an exponential relationship between CR value and dalteparin concentration for three reagents. Three kinds of LMWH can significantly reduce the value of CR. CR test can be used to monitor the anticoagulant effect of LMWH.     

肝素钠抗凝剂对手工凝聚胺配血的影响分析

目的了解肝素钠抗凝剂对手工凝聚胺配血结果产生的影响。方法分别采用不同类型的抗凝剂、不同的肝素钠浓度，用两家生产商的凝聚胺试剂，对20例临床患、97名体检人员的血标本进行交叉配血。结果不同生产商的凝聚胺试剂结果相同，而不同的抗凝剂、不同的肝素钠浓度对交叉配血的影响不同。结论肝素钠具有干扰手工凝聚胺配血结果的作用。其作用的大小可能与抗凝剂的浓度有一定关系。     

低分子肝素治疗不稳定型心绞痛的疗效观察

目的　观察低分子肝素治疗不稳定型心绞痛 (UAP)的疗效。方法　低分子肝素 0 4ml,每天 2次 ,皮下注射 ,连用 7～ 10d。结果　 30例UAP患者总有效率为 90 0 0 % ,心电图改善 6 6 6 7%。可明显减少心绞痛发作次数和时间、减少硝酸甘油用量、减少心电图上心肌缺血的范围和程度。结论　低分子肝素治疗不稳定型心绞痛方法简单 ,安全可靠 ,疗效满意。     

Inhibition of HIV-1 infectivity by low molecular weight heparin

Several sulfated polysaccharides have been shown to have anti-HIV activity in vitro. However, many of these compounds are not suited for use in vivo because they present an increased risk of bleeding or cannot be administered chronically. We tested the anti-HIV effects of low molecular weight heparin (LMW-heparin) (Enoxaparin) in vitro using a model system of HIV infectivity because LMW-heparin can be given to patients on a longterm basis with little risk. In vitro, LMW-heparin was shown to inhibit HIV-1 production from a T cell lymphoma line (H9) and phytohemagglutinin-stimulated lymphoblasts. Inhibition of infectivity was dose dependent at concentrations achievable in vivo. We then performed a pilot clinical trial in 13 patients with advanced AIDS of 6 months of chronic, self-administered Enoxaparin given in standard prophylactic doses. CD4 counts appeared to stabilize or increase in most patients during the first 3 months of treatment, then remained stable or declined after 6 months. There was no appreciable change in serum p24 levels. There was no evidence of drug toxicity and no bleeding episodes. These findings demonstrate that a commercially available, relatively non-toxic form of LMW-heparin is a potent inhibitor of HIV-1 production in cultured cells and that it is feasible to treat patients with AIDS with LMW-heparin on a long-term basis. Definitive clinical trials of LMW-heparins and related compounds as experimental anti-viral agents in patients with HIV infection are indicated.     

论糖尿病下肢血管病变治疗策略的选择

糖尿病下肢血管病变（lower extremity arterial disease, LEAD）是糖尿病常见的慢性并发症之一,是糖尿病患者致残、致死的主要原因,目前关于LEAD的治疗各地、各医院方案各异,本文将对目前治疗LEAD的策略进行总结比较,为临床治疗提供依据。     

低分子量肝素钙治疗不稳定心绞痛的疗效观察

目的观察低分子量肝素钙对不稳定心绞痛的治疗效果。方法选择住院不稳定心绞痛患者78例,随机分为常规治疗组(对照组)和在常规治疗基础上加用低分子量肝素钙(治疗组)进行疗效比较。结果治疗组对不稳定心绞痛疗效达91.3%,与对照组疗效62.5%比较,差异有高度显著性(P＜0.01);治疗组心电图改善83.5%,优于对照组56.3%(P＜0.05)。结论低分子量肝素钙治疗不稳定心绞痛方法简便,安全可靠,疗效满意。