降纤酶治疗脑梗死临床观察

目的 探讨降纤酶对脑梗死的治疗作用及其机制。方法 80例脑梗死患者分为治疗组和对照组,治疗组40例用降纤酶治疗,对照组用血栓通治疗,进行两组疗效比较,同时对治疗组患者治疗前后的纤维蛋白原、血液粘度、血浆粘度、血小板及血细胞压积等进行检测。结果 治疗组的总有效率为90％,对照组为65％,两组差异有显著性(P<0.05)。治疗组治疗前后血纤维蛋白原显著下降(P<0.01);血液低切、高切粘度,血细胞压积明显下降(P<0.05),而血小板数量及凝血时间无明显变化(P>0.05)。结论 降纤酶治疗脑梗死疗效显著。其机制与降纤酶能明显降低患者血纤维蛋白原、血液粘度和血细胞压积有关。     

西医联合血塞通片治疗糖尿病合并脑梗效果

目的探讨西医常规治疗联合血塞通治疗2型糖尿病合并脑梗死的临床疗效。方法将100例2型糖尿病合并脑梗死的患者分为观察组和对照组各50例,对照组采用常规西药治疗,观察组在对照组的基础上采用血塞通治疗,比较两组患者的疗效及血液流变学变化。结果两组患者随访期间均无死亡病例,观察组良好35例,中残11例,重残3例,植物生存1例,GOS良好率为70.0%;对照组分别为25例、18例、5例、2例,GOS良好率为50.0%,观察组的GOS良好率显著高于对照组(P<0.05)。且观察组的全血高切黏度、全血低切黏度以及红细胞压积改善显著优于对照组(P<0.05)。结论血塞通能够显著改善2型糖尿病合并脑梗死患者的血液流变学特点,提高疗效。     

脑梗塞的血液稀释疗法(附14例分析)

14例急性脑梗塞患者(病程平均2天)采用血液稀释疗法:静脉放血同时输入低分子右旋糖酐,每日1次至红细胞压积接近35%时停止。治疗1周后高切率全血粘度、低切率全血粘度明显降低(P<0.01)。1个月后平均病情评分增高(P<0.01)。治疗总有效率为92.9%。疗效满意组平均年龄小于疗效不满意组(P<0.05)。     

丹参川芎嗪注射液联合常规治疗对脑卒中患者血液流变的影响

目的:探讨丹参川芎嗪注射液联合常规治疗对脑卒中患者血液流变学的影响。方法:将我院2010年12月至2011年5月收治的100例脑卒中的患者按照治疗方法的不同分为治疗组和对照组,对照组采用脑卒中常规疗法,治疗组在对照组的基础上采用丹参注射液治疗,比较两组患者的治疗效果及血液流变学的变化。结果:两组患者均无恶化和死亡病例出现,治疗组的总有效率为72.0%显著高于对照组的52.0%(P<0.05)。观察组的全血高切粘度、全血低切粘度以及红细胞压积改善显著优于对照组(P<0.05)。结论:丹参川芎嗪注射液联合常规治疗能显著提高脑卒中患者的治疗效果,可能与其减低患者的血液粘度,增加脑部血液供应有关。     

景天汤治疗慢性肺源性心脏病急性发作期患者的疗效观察

目的:探讨景天汤治疗慢性肺源性心脏病急性发作期患者的疗效及其对患者肺动脉压力、血液流变学指标的影响。方法:将80例慢性肺源性心脏病急性发作期患者随机分为治疗组与对照组,每组40例。两组均采用常规治疗,治疗组在常规治疗基础上加用景天汤,疗程为21 d。观察并比较两组患者的临床疗效及治疗前后肺动脉压力、血液流变学指标的变化。结果:治疗组总有效率为97.5%,对照组总有效率为85.0%,治疗组疗效优于对照组(P<0.01)。治疗后,两组患者的临床症状及体征总积分较治疗前均明显下降(P<0.01),且治疗组患者的总积分较对照组亦明显降低(P<0.05)。治疗后,两组患者的肺动脉压力均明显下降(P<0.05或P<0.01),且治疗组患者的肺动脉压力较对照组亦显著降低(P<0.05);治疗组患者的红细胞压积、血浆黏度、全血黏度(高切、低切)均显著降低(P<0.05或P<0.01),而对照组仅血浆黏度、全血黏度(高切)显著降低(P<0.05),且治疗组血浆黏度、全血黏度(高切)的改善明显优于对照组(P<0.05)。结论:景天汤能够降低肺心病急性发作期患者的肺动脉压力,改善其血黏度,可作为中西医结合治疗肺心病急性发作期患者的有效处方在临床推广应用。     

硝苯地平治疗缺氧性肺动脉高压临床观察

目的探讨硝苯地平治疗缺氧性肺动脉高压的临床效果。方法选择2011年1～12月本院56例缺氧性肺动脉高压患者进行回顾性分析,根据治疗方法将患者分为治疗组(30例)和对照组(26例),测量治疗前、后患者的肺动脉平均压,体循环平均压,监测血液流变学指标并行血气分析,评价两种方法的治疗效果。结果治疗组总有效率明显优于对照组(P<0.05);两组患者的平均肺动脉压治疗前、后比较差异有统计学意义(P<0.05);与对照组相比,治疗组患者的肺动脉平均压有更显著的降低(P<0.05);两组患者动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)治疗前、后比较差异有统计学意义(P<0.05);与对照组相比,治疗组患者的PaO2、PaCO2有更显著的改善(P<0.05)。结论硝苯地平治疗缺氧性肺动脉高压有很好的疗效,值得在临床上广泛应用。     

小剂量尿激酶连续静滴治疗不稳定型心绞痛

将78例不稳定型心绞痛患者随机分组,采用常规治疗和小剂量尿激酶连续静滴+常规治疗两种方法进行疗效对比。结果:常规治疗组(简称对照组)5例(14.3％)转为AMI,2例(5.7％)死亡,尿激酶组无1例发生AMI或死亡。对照组心绞痛显效率为48.6％,尿激酶组为95.3％,差异非常显著(P<0.01)。对照组心绞痛平均好转时间及平均显效时间分别为7.79±5.05d和9.46±3.75d,尿激酶组分别为2.14±1.35d和3.28±1.86d,两组差异均极为显著(P<0.001)。提示对不稳定型心绞痛应用小剂量尿激酶连续静滴可防止AMI及死亡发生,并能加速缓解或消除心绞痛。     

“血液稀释疗法”配合中药治疗急性加重期肺心病疗效观察

报告30例急性加重期肺心病患者采用血液稀释疗法配合“益气活血、清肺化痰”中药治疗,可使全血粘度、红细胞压积明显降低、红细胞电泳时间缩短(P<0.01),氧分压上升41.4％、二氧化碳分压下降32.2％(P<0.01)。临床显效率63.3％,与同期单纯西药组比较有显著性差异(P<0.05)。认为血液稀释疗法可迅速改善肺心病患者血液流变性及心肺功能,配合中药可进一步巩固疗效。     

落液林治疗慢性肺源性心脏病的疗效观察及机制探讨

目的　观察落液林对慢性肺源性心脏病的临床疗效并探讨其机制。方法　选择 10 8例慢性肺源性心脏病患者 ,随机分成两组 ,试验前评价心功能及监测动脉血气、右房压 (RAP)、右室压 (RVP)、平均肺动脉压 (m PAP)、全血高切黏度、全血低切黏度、血浆黏度、红细胞压积、纤维蛋白原、血红蛋白定量和红细胞计数等指标。对照组只给予常规治疗 ,落液林组在给予常规治疗的同时合并给予落液林 30 0 m g/ d,稀释后静脉滴注 ,疗程 3周 ;3周后 ,复查上述指标 ,比较各组前后的变化。结果　落液林组心力衰竭纠正有效率为 79.6 3% ,显著高于对照组 (P<0 .0 5 ) ;试验前后比较落液林组血氧分压 (pO2 )显著上升 ,血二氧化碳分压 (pCO2 )显著下降 ;而对照组均无显著性变化 ;落液林组 RAP、RVP、m PAP均明显下降 ;而对照组无显著性变化 ;落液林组全血高切黏度、全血低切黏度、血浆黏度、红细胞压积、纤维蛋白原、血红蛋白定量和红细胞计数等指标均明显下降 ;而对照组则无显著变化。结论　落液林对慢性肺源性心脏病具有纠正心力衰竭、降低肺动脉及右心房和右心室压力、改善血液流变和动脉血气的作用。     

组合型血液净化治疗急性联苯菊酯中毒疗效观察

目的探讨血液灌流联合血液透析治疗急性联苯菊酯中毒的临床疗效。方法将88例急性联苯菊酯中毒患者随机分治疗组(46例)和对照组(42例),两组患者性别、年龄、病情之间无明显差别,具有可比性。治疗组在内科常规治疗的同时给予血液灌流联合血液透析治疗,对照组仅予内科常规治疗。观察两组治疗前后临床症状缓解程度及预后。结果治疗组症状改善的时间显著短于对照组(P<0.01),差异具有统计学意义;治疗组死亡2例,对照组死亡10例。结论血液灌流联合血液透析治疗急性联苯菊酯中毒的临床疗效肯定,可短期减轻临床症状,明显改善患者预后。     

控制性低血压联合高容量血液稀释的临床研究

目的:探索控制性低血压联合高容量血液稀释的血液保护效果.方法:33例ASAⅠ～Ⅱ级行择期神经外科手术的患者随机进入对照组(单纯控制性低血压组,n=17)与实验组(控制性低血压高容量血液稀释联合组,n=16).对照组手术中平均动脉压维持于55 mmHg～60 mmHg;实验组采用同样的低血压水平,且在此基础上大量输入6%羟乙基淀粉与乳酸林格液的混合液体,使手术中血球压积降低至接近25%.比较两组患者手术失血量、库血输入量、尿量等指标.结果:两组患者的手术失血量、库血输入量无显著差别.实验组手术中尿量明显多于对照组.结论:控制性低血压联合高容量血液稀释技术血液保护的效果与单纯的控制性低血压技术相当,但联合技术对改善低血压下的内脏灌注有益.     

急性等容血液稀释联合控制性降压用于脊柱矫形手术

目的 :了解急性等容血液稀释联合控制性降压法在脊柱矫形手术中对出血量和术后血红蛋白 (Hgb) ,红细胞压积 (Hct)的影响。方法 :选择脊柱矫形手术患者 2 0例 ,ASAⅠ～Ⅱ级 ,随机分成对照组 (组Ⅰ ,n =10 )和稀释组 (组Ⅱ ,n =10 )。行全麻气管插管 ,控制呼吸。组Ⅱ于麻醉后手术前进行急性等容血液稀释 (ANHD) ,术中结合控制性降压。组Ⅰ仅术中进行控制性降压。比较两组病人的出血量 ,输血量和术后Hgb、Hct变化。结果 :组Ⅱ病人术中平均出血 (45 0± 96 )ml,比组Ⅰ (980± 15 4 )ml明显减少。组Ⅰ病人平均输血 (6 10± 14 5 )ml,而组Ⅱ病人没有输血。术后两组病人均有轻度贫血。结论 :急性等容血液稀释联合控制性降压用于脊柱矫形手术可明显减少术中出血量 ,可避免输异体血。     

羟乙基淀粉血液稀释对慢性肝病患者血液流变学的影响

目的 体外实验探讨羟乙基淀粉(hydroxyethyl-starch,HES)对慢性肝病患者血液流变学的影响。方法 21例健康人作为对照组,21例慢性肝病患者作为实验组,两组均随机分为HES组(11例)及林格氏液R-L组(10例)。每个实验对象采集贵要静脉血12ml,等分为4个亚组,每组3ml;亚组1为全血基础值,亚组2、3、4分别以6%HES和R-L稀释,使红细胞压积分别降到30%、25%、20%。测定各样本红细胞压积、全血高切粘度、全血中切粘度、全血低切粘度、血浆粘度、红细胞聚集指数、红细胞刚性指数等血液流变学指标。结果 实验组全血红细胞压积显著低于对照组,血浆粘度、红细胞聚集指数显著高于对照组(P<0.05)。HES稀释后,实验组与对照组全血粘度均显著下降(P<0.05),两组间无显著差异(P>0.05);与HES组相比,R-L组全血粘度下降趋势更为显著。HES稀释后,实验组红细胞聚集指数显著下降(P<0.05),亚组3、4与对照组无显著差异(P>0.05);R-L稀释后,实验组与对照组的红细胞聚集指数均显著上升(P<0.05)。HES稀释后,对照组红细胞刚性指数无显著改变,实验组呈升高趋势,但只有亚组4显著高于对照组(P<0.05);R-L稀释后,两组红细胞刚性指数均显著上升(P<0.05)。结论 肝病患者红细胞聚集指数显著增高,用6%HES给肝病患者作适度的血液稀释可降低其全血粘度和红细胞聚集率。     

术前应用rhuEPO复合急性等容血液稀释对氧平衡的影响

目的通过术前应用人工促红细胞生成素 (rhuEPO)对犬急性等容血液稀释时氧供需平衡的影响 ,探讨有效和安全的血液保护措施。方法 16条健康土种犬随机分配为单纯急性等容血液稀释 (ANH)组 (对照组 )和EPO ANH组 (实验组 )。实验组在术前第 15、11、8、4d及手术当天 ,皮下注射rhuEPO 5 0 0IU/kg并口服铁剂。两组均实施三个步骤的等容血液稀释 ,每次放血 15mL/kg ,总计 4 5mL/kg ,予 6 %低分子右旋糖酐加以替代。结果稀释当天 ,实验组Hct升至 0 .6 3,明显高于对照组 (P <0 .0 5 )。 3次稀释后 ,实验组的Hct和动脉氧含量高于对照组 ,而氧摄取和心排量上升幅度较对照组低。结论EPO能增加机体的氧储备 ,用药后再进行血液稀释对机体氧平衡无明显影响 ,可稀释幅度亦较大     

羟乙基淀粉血液稀释对慢性肝病患者血液流变学的影响

OBJECTIVE: To investigate the effects of hemodilution with hydroxyethyl-starch (HES) on hemorheology in patients with chronic liver diseases in vitro. METHODS: Twenty-one healthy volunteers were selected as the control group and 21 patients with chronic liver disease as the study group. Both of the two groups were divided into HSE (n=11) and Ringer's solution (n=10) groups. Venous blood of 12 ml were collected from each subject and aliquoted into 4 samples, one of the 4 samples served as control (sample 1), and the other 3 (samples 2, 3, 4 respectively) were diluted with 6%; HES or Ringer's solution to cause the hematocrit (Hct) decrease to 30%;, 25%; or 20%;. The rheological parameters including Hct, blood viscosity, plasma viscosity, index of red blood cell aggregation (ARBC) and index of red blood cell rigidity (RRBC) were examined. RESULTS: The Hct of the study group was significantly lower than that of the control group (P<0.05), but plasma viscosity and ARBC were significantly higher. After being diluted by HES, the blood viscosity and ARBC decreased significantly in the study group (P<0.05), and were not significantly different from those of the control group (P>0.05) when Hct=25%; and 20%;. The RRBC of the study group was increased, but the increment was significantly higher than that of control group (P>0.05) only when Hct=20%;. CONCLUSION: The ARBC of patients with chronic liver diseases was significantly higher. Hemodilution with 6%; HES could significantly reduce the blood viscosity and ARBC.     

Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis

Background Hemoconcentration may be an important factor that determines the progression of severe acute pancreatitis (SAP). In addition, it has been proposed that biomarkers may be useful in predicting subsequent necrosis in SAP. However, it is still uncertain whether hemodilution in a short term can improve outcome. We aimed to investigate the effect of rapid hemodilution on the outcome of patients with SAP.Methods One hundred and fifteen patients were admitted prospectively according to the criteria within 24 hours of SAP onset. Patients were randomly assigned to either rapid hemodilution (hematocrit (HCT) <35%, n=56) or slow hemodilution (HCT 235%, n=59) within 48 hours of onset. Balthazar CT scores were calculated on admission, day 7, and day 14, after onset of the disease. Time interval for sepsis presented, incidence of sepsis within 28 days and in-hospital survival rate were determined.Results The amount of fluid used in rapid hemodilution was significantly more than that used in slow hemodilution (P <0.05) on the admission day, the first day, and the second day. There were significant differences between the rapid and slow hemodilution group in terms of hematocrit, oxygenation index, pH values, APACHE II scores and organ dysfunction at different time during the first week. There were significant differences in the time interval to sepsis in rapid hemodilution ((7.4 1.9) days) compared with the slow hemodilution group ((10.2 2.3) days), and the incidence of sepsis (78.6%) was higher in the rapid group compared to the slow (57.6%) in the first 28 days. The survival rate of the slow hemodilution group (84.7%) was better than the rapid hemodilution (66.1%. P<0.05).Conclusions Rapid hemodilution can increase the incidence of sepsis within 28 days and in-hospital mortality. Hematocrit should be maintained between 30%-40% in the acute response stage.     

急性非等容量血液稀释对直肠癌患者循环及凝血功能的影响

目的 观察急性非等容量血液稀释(ANIH)对直肠癌患者围术期循环及凝血功能的影响.方法 择期直肠癌根治术(Mile's)患者30例,年龄40～65岁,体重50～75 kg,随机均分为C 组(n＝15):对照组,术中常规输液,术毕输异体少白细胞红细胞2 U;A组:ANIH组,于麻醉诱导前采血400～600 mL(循环血量的10%～15%),然后快速输入羟乙基淀粉(HES130/0.4)1 000～1 200 mL,并于手术结束前将自体血回输.术中监测平均动脉压(MAP)、心率(HR)、中心静脉压(CVP),分别于麻醉前1 h(T1)、稀释后(T2)、术毕即刻(T3)术后第1天(T4)抽取静脉血,测定Hct和凝血功能(PT、APTT、FIB).结果 稀释后A组CVP明显升高,与基础值和C组比差异均有统计学意义(P＜0.05),诱导时2组患者均有一过性低血压,但C组较A组降低明显(P＜0.05),术中A组尿量较C组明显增多(P＜0.05).稀释后A组Hct、FIB 明显降低,APTT明显延长,与基础值和C组比差异均有统计学意义(P＜0.05);术毕及术后1 d A组Hct、PT、APTT 与C组比差异无统计学意义(P＞0.05),术毕A组FIB明显低于C组(P＜0.05).结论 ANIH能增加循环功能的稳定性,可有效减少术中异体血输入,对凝血功能无明显影响.     

Rapid hemodilution is associated with increased sepsis and mortality among patients with severe acute pancreatitis

Background Hemoconcentration may be an important factor that determines the progression of severe acute pancreatitis (SAP). In addition, it has been proposed that biomarkers may be useful in predicting subsequent necrosis in SAP. However, it is still uncertain whether hemodilution in a short term can improve outcome. We aimed to investigate the effect of rapid hemodilution on the outcome of patients with SAP.Methods One hundred and fifteen patients were admitted prospectively according to the criteria within 24 hours of SAP onset. Patients were randomly assigned to either rapid hemodilution (hematocrit (HCT) <35%, n=56) or slow hemodilution (HCT 235%, n=59) within 48 hours of onset. Balthazar CT scores were calculated on admission, day 7, and day 14, after onset of the disease. Time interval for sepsis presented, incidence of sepsis within 28 days and in-hospital survival rate were determined.Results The amount of fluid used in rapid hemodilution was significantly more than that used in slow hemodilution (P <0.05) on the admission day, the first day, and the second day. There were significant differences between the rapid and slow hemodilution group in terms of hematocrit, oxygenation index, pH values, APACHE II scores and organ dysfunction at different time during the first week. There were significant differences in the time interval to sepsis in rapid hemodilution ((7.4 1.9) days) compared with the slow hemodilution group ((10.2 2.3) days), and the incidence of sepsis (78.6%) was higher in the rapid group compared to the slow (57.6%) in the first 28 days. The survival rate of the slow hemodilution group (84.7%) was better than the rapid hemodilution (66.1%. P<0.05).Conclusions Rapid hemodilution can increase the incidence of sepsis within 28 days and in-hospital mortality. Hematocrit should be maintained between 30%-40% in the acute response stage.     

AHH程度对老年髋关节置换术中凝血功能、内脏灌注的影响

目的 探讨急性高容量血液稀释（acute hypervolemic hemodilution,AHH）程度对老年髋关节置换术患者术中凝血功能、内脏灌注的影响。方法 选取2021年1月至2023年6月于金华市中心医院行髋关节置换术的老年患者102例进行回顾性研究,患者均采用AHH、自体血回输与控制性降压,根据AHH程度将其分成A组（n=55）与B组（n=47）。A组设定目标稀释值为红细胞压积（hematocrit,HCT）30%,B组设定为HCT 25%。比较两组患者的一般资料、尿量、输液总量、出血量及麻醉诱导后（T0）、血液稀释后（T1）、术毕（T2）的心率、体温、凝血酶原时间（prothrombin time,PT）、纤维蛋白原（fibrinogen,FIB）、活化部分凝血活酶时间（activated partial thromboplastin time,APTT）、血小板（platelet,PLT）及胃黏膜二氧化碳分压（gastric intramucosal carbon dioxide tension,PgCO2）、胃黏膜pH值（gastric intramucosal pH,pHi）。结果 B组患者的扩容液体总量、输液总量显著多于A组（P<0.05）。两组患者T1的心率、体温显著低于T0与T2,B组患者T1的心率显著低于A组（P<0.05）。两组患者T1、T2的PT显著长于T0,FIB、PLT显著低于T0（P<0.05）;B组患者T1、T2的PLT显著低于A组（P<0.05）。两组患者T1、T2的PgCO2显著高于T0,pHi显著低于T0（P<0.05）,且B组患者T1、T2的pHi显著低于A组（P<0.05）。结论 AHH目标值设定为HCT 25%~30%的总体安全性高,其中目标值为HCT 25%时PLT水平更低,但亦在正常范围内,而PgCO2增高,pHi有所降低。