换血治疗Rh溶血病新生儿的护理

新生儿Rh溶血病是指母子Rh血型不合引起的新生儿溶血。换血是治疗Rh溶血病的有效方法。1999-08～2003—10我院为8例Rh溶血病患者实施换血，现将护理体会总结如下。     

Rh血型抗体四例分析

多次输血或妊娠可刺激机体Rh系统或其它血型系统产生抗体,引起输血反应。现将我们遇到的4例Rh血型抗体材料报告如下。一、临床资料:4例中女3例男1例,均为多次输血者。3例女性曾有妊娠史,其中2例为Rh。阴性。由于输血前配血仅用盐水配血法,输血后出现程度不同的输血反应,表现为胸闷、气短、呼吸     

上饶地区无偿献血者Rh血型分布调查与应用分析

目的 研究RhD阳性献血者Rh表型分布频率,建立献血者Rh表型库并应用于患者疑难配血。方法 10034例RhD阳性献血者,采用微量板盐水法检测献血者Rh(D)、Rh(C)、Rh(c)、Rh(E)、Rh(e)血型,分析RhD阳性献血者Rh表型ABO血型分布情况、Rh抗原分布情况以及不同Rh表型输血相容性频率,分析Rh血型不规则抗体阳性受血者情况。结果 10034例RhD阳性献血者检出8种表型,占比由高到低为CCDee(46.98%)、CcDEe(33.84%)、CcDee(8.72%)、ccDEE(5.88%)、ccDEe(3.14%)、CCDEe(0.92%)、CcDEE(0.27%)、ccDee(0.25%),未检出CCDEE表型。RhD阳性献血者Rh抗原阳性率由高到低为e(93.85%)>C(90.73%)>c(52.10%)>E(44.05%)。根据本地区献血者Rh表型分布频率,应用表型相容性原理计算血液相容性频率,不同Rh表型输血相容性频率由高到低分别为CcDEe(100.00%)>CcDee(55.95%)>CCDEe(47.90%)>CC...     

新生儿溶血病的早期诊断治疗

目的探讨新生儿溶血病的早期诊断方法和治疗效果。方法凡查出孕妇血型为O或Rh阴性,并与丈夫血型不合,且抗A(或B)效价>1∶64,或抗Rh效价>1∶8,分娩时常规留取脐静脉血3ml,送验血型和溶血三项试验,确诊为母婴血型不合溶血病的不等黄疸出现,立即开始治疗,作为早治组。孕妇未作血型检查,其新生儿出现病理性黄疸后才确诊为新生儿溶血病而开始治疗的为对照组。比较两组新生儿黄疸持续时间、高峰期胆红素值、出生体重、胎龄以及换血例数、胆红素脑病发生例数等。结果十年间共诊断新生儿溶血病46例,其中早治组28例(ABO溶血病26例,Rh溶血病2例),对照组18例(ABO溶血病16例,Rh溶血病2例)。黄疸持续时间,早治组显著短于对照组(P<001)。高峰期胆红素值,两组比较差异无显著意义(P>005)。出生体重、胎龄,两组比较差异无显著意义(P>005)。对照组2例Rh溶血病均经换血治疗,1例发生胆红素脑病。早治组全部治愈,未经换血,无胆红素脑病发生。结论利用脐血检验能早期诊断新生儿溶血病;在黄疸出现前确诊并开始治疗,能显著缩短黄疸持续时间,减少换血治疗,防止胆红素脑病。     

实验诊断学(10)

9.3Rh血型系统及其鉴定Rh血型的发现是继ABO之后临床意义最大的一个血型系统,也是最为复杂的一个系统。其重要性与临床意义就在于:一旦输入Rh血型不合的血液或母—胎Rh血型不合的妊娠因同种免疫作用,而产生Rh抗体。当其产生Rh抗体后输入Rh血型不合的血液时,将导致溶血性输血反应,甚至危及生命;分娩后婴儿将出现Rh血型不合的新生儿溶血病(HDN,hemolyticdiseaseofthenewborn),一旦确诊应尽早实施换血疗法。在Rh血型的常规鉴定中,通常只测抗D,我国市售的抗D血清多属IgG,不能凝集盐水介质中的红细胞。鉴定Rh血型的方法须视所用标准血清…     

Rh（D）血型筛查实验方法对比分析

Rh（D）阴性血又叫熊猫血,是非常稀有的血型.当一个人的红细胞上存在一种D血型物质（抗原）时,则称为Rh（D）阳性血;当缺乏D抗原时即为Rh（D）阴性血.Rh（D）阴性血的分布因种族不同而差异很大,在白种人中的比例较高,约为15%.我国汉族和大多数少数民族中,99.7%都是Rh（D）阳性血的人,只有0.3%是Rh（D）阴性血[1].     

Rh(D)阴性患者肝移植术前治疗体会

目的：探讨Rh（D）阴性血型患者接受Rh（D）阳性供肝在肝移植术前备血、免疫诱导的方案。方法：总结我院实施的3例Rh（D）阴性患者的肝移植术前治疗经验。结果：3例患者肝移植手术均获成功,在围手术期未出现严重的并发症,3例患者均治愈出院,目前仍在随访中。结论：Rh（D）阴性血型患者不再因为输血或供体原因而失去肝移植的机会,充分的术前治疗是Rh（D）阴性血型终末期肝病患者肝移植的关键。     

输血患者Rh血型鉴定及临床意义

Rh血型不合输血可产生危及生命的溶血性输血反应,Rh阴性未婚妇女如输入Rh阳性血而产生同种抗体,婚后怀孕可发生新生儿溶血病,为了确保患者输血安全,避免Rh阴性妇女产生同种抗体,我们对本院48 760例患者进行常规盐水抗-D鉴定患者Rh血型,收到良好效果,现报告如下:     

Rh阴性患者输血致溶血反应死亡一例

输血是临床常用于治疗和抢救的重要方法之一。Rh血型系统阴性者在我国汉族人群中较少见 ,所以在输血时由于Rh血型不和而造成的溶血反应报道较少 ,现将我们遇见的 1例报告如下。1　病例资料女 ,6 2岁。汉族 ,血型AB。主因双下肢淤斑两年、伴间断性鼻出血两个月于 2 0 0 0年 4月 5日入院。 1 991年在外院行右股骨头置换术曾输血 ,量不详。查体 :贫血貌 ,全身皮肤无黄染 ,双下肢可见大片状的淤斑 ,压之不退色。血白细胞 5 2× 1 0 9/L ,红细胞 2 82× 1 0 12 /L ,血红蛋白 82g/L ,出、凝血时间各 2分钟。尿常规隐血阳性。血糖 7 5mmol/L…     

Rh血型表型检测在输血中的应用意义研究

目的探讨Rh血型表型检测在输血中的应用意义。方法选择我院43900份需要血型检测患者。上述患者Rh血型进行初筛和确认,采用微量板盐水法用抗D试剂对上述血样本进行Rh阴性初步筛选,用抗人球蛋白实用对不同来源是IgG抗D标本进行确认,排除弱D或者不完全D。而后对Rh（D）阴性和血样标本采用抗C、抗c、抗E及抗e试剂进行血清型分型。结果本组患者血样标本中,检出Rh阴性个体共129例,检出率为0.293%（129/43900）。表型为ccdee共69例,其出现频率为53.4%;表型为Ccdee共38例,出现频率为29.4%;表型为ccdEe共9例,出现频率为6.9%;表型为CcdEe共7例,出现频率为5.4%;表型为CcdEe共5例,出现频率为3.8%;表型为ccdEE共38例,出现频率为0.7%。结论 Rh血型表型检测有助于发现Rh阴性患者,为患者输血安全提高有力保障,具有重要的检测意义。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.