服用致畸中药后献血者延期献血的期限设定

目的探讨献血者服用有致畸作用的中药后延期献血期限的设定。方法采用药动学方法,推迟时间从最后一次服药算起为tmax 20×t1/2。结果根据药学研究现状,提出了半夏、人参的暂行延期献血期限。结论服用过有致畸作用中药的献血者必须延期献血。在不能准确设定延期期限之前,需要确定暂行安全间隔时间。     

钙剂在机采血小板中预防献血不良反应的应用

目的 探讨钙剂在防治机采血小板中献血不良发应发生中的应用.方法 将320例机采血小板献血者随机分服用钙剂组即预防组和不服用钙剂组即对照组,使用NGLXCF-3000血液成分分离机进行血小板采集,将其两组进行对比,做好监护工作,仔细询问观察有无献血不良反应症状.结果 口服葡萄糖酸钙预防组发生献血反应的机率比对照组明显降低.结论 在采集血小板前常规口服一支或两支葡萄糖酸钙,如循环血量多及女性献血者在采集过程中根据情况酌情加服,这样能明显预防和减少献血不良反应的发生.     

护理心理学在机采血小板献血前的作用探讨

目的 分析护理心理学在机采血小板献血前的作用.方法 通过对机采血小板献血者献血前的仔细观察,运用护理心理学知识,对献血者进行必要的心理护理.结果 心理护理直接影响献血的情绪及减少或避免献血反应的发生.结论 针对机采血小板献血者运用正确科学的护理心理学知识可以减少或避免献血反应的发生,保护献血者身心健康,保证血液质量,保留住血源,促进无偿机采血小板队伍的壮大.     

通心络和西洛他唑对脑梗死患者阿司匹林抵抗现象的影响

目的探讨通心络和西洛他唑对脑梗死阿司匹林抵抗(AR)患者血小板聚集率、血栓素B2(TXB2)的影响。方法选择60例脑梗死阿司匹林抵抗(AR)患者,随机分为3组,A组常规治疗组,B组通心络组,C组西洛他唑组;分别在治疗前和治疗后1个月测定血小板聚集率、TXB2;比较3组治疗前后及治疗后不同组别上述指标的差异。结果①通心络和西洛他唑均可使脑梗死阿司匹林抵抗患者血小板聚集率下降,西洛他唑对ADP诱导的血小板聚集率的下降更明显。②通心络和西洛他唑治疗后均可使脑梗死患者TXB2下降,与治疗前比较有显著性差异;同时与常规组治疗后比较也有显著性差异。而尽管西洛他唑组使TXB2下降更明显,但与通心络组比较无统计学差异。结论通心络和西洛他唑对脑梗死阿司匹林抵抗患者有抗血小板聚集作用,一定程度上可改善脑梗死患者的AR。     

西洛他唑治疗经皮冠脉内介入术后对阿司匹林致上消化道出血患者的随访研究

目的观察经皮冠脉内介入术(percutaneous coronary intervention,PCI)后使用西洛他唑对阿司匹林致上消化道出血患者的外周血血小板聚集率、PGE2及心血管事件发生率的影响。方法 64例确诊冠心病并行PCI术后的患者,服用阿司匹林和氯吡格雷双重抗血小板治疗出现阿司匹林相关上消化道出血,其中32例患者改用西洛他唑加氯吡格雷,而另外32例患者出血治疗后继续原抗血小板治疗方案,随访比较两组患者血小板聚集率、PGE2及心血管事件发生率。结果平均随访(0.9±0.1)年,两组患者血小板聚集率均明显下降,西洛他唑组的血小板聚集率显著低于阿司匹林组(P<0.05),外周血PGE2的浓度高于阿司匹林组(P<0.05),但两组患者临床不良事件发生率差异无统计意义。结论对PCI术后上消化道出血患者,应用西洛他唑替代阿司匹林,联用氯吡格雷进行抗血小板治疗,经过短期的临床观察,其血小板聚集率优于阿司匹林,升高外周血PGE2的浓度,且安全性与阿司匹林相当,可用于预防上消化道出血的复发。     

西洛他唑在经皮冠状动脉介入术抗血小板治疗中的应用简

目的 探讨西洛他唑用于经皮冠状动脉介入术（PCI）抗血小板治疗的疗效.方法 检索SCI,PubMed,CNKI数据库,阅读相关文献,评价西洛他唑用于预防支架内血栓及再狭窄、三联治疗及特殊患者治疗的疗效.结果与结论 RCTs及Meta分析显示,西洛他唑用于PCI术后治疗有效;三联治疗支架内血栓及再狭窄发生率更低,可减少氯吡格雷抵抗,且不会增加出血等不良反应;对于糖尿病和肾功能不全患者,西洛他唑治疗可能获益更多.     

西洛他唑对糖尿病微血管病变患者血小板指标的影响

目的：为了评价西洛他唑对糖尿病微血管病变的防治作用。方法：对120例糖尿病患者测定平均血小板体积（MPV）、血小板压积（PCT）、血小板分布宽度（PDW）、血小板计数（PLT）四项指标，并对60例伴有微血管病变者进行西洛他唑治疗1个月，观察其治疗前后的变化。结果：1．糖尿病患者MPV、PCT、PDW明显高于正常对照组；有微血管病变患者MPV、PCT、PDW增高更明显。2．西洛他唑治疗后微血管病变患者MPV、PDW明显下降。结论：西洛他唑改善血小板参数，预防微血管病变的进展，对防治糖尿病微血管病变起重要作用。     

初次机采血小板献血者的心理分析与护理

目的 通过对初次机采血小板献血者的心理分析,做好初次捐献机采血小板献血者的心理护理.方法 根据献血不同阶段,初次机采血小板献血者不同心理反应,有针对性通过宣传招募、捐献前、中、后三个阶段实施心理护理.结果 心理护理,可有效的缓解献血者的紧张心理,减少献血反应.结论 加强初次机采血小板献血者的心理护理,能够保证献血者的安全,实现机采血小板献血者的保留.     

延续性护理对首次单采血小板献血者持续献血意愿的影响分析

目的 分析延续性护理对首次单采血小板献血者持续献血意愿的影响.方法 选取2015年9月至2016年9月于本院献血的106例首次单采血小板献血者临床资料,根据护理方式不同,分设对照组(53例)与研究组(53例),对照组予以常规护理,研究组予以延续性护理,比对两组持续献血情况、生活方式变化情况以及献血反应发生情况.结果 研究组不再献血小板及持续献血率(0.00％、94.33％)较对照组(22.64％、32.07％)优,且作息紊乱及坚持运动率(5.66％、77.35％)较对照组(15.09％、24.52％)优,献血反应总发生率24.52％较对照组56.60％低(P＜0.05).结论 给予首次单采血小板献血者延续性护理可促使持续献血者增加,改善献血者生活方式,降低献血反应发生率,值得推广.     

我院西洛他唑出院带药的医嘱分析

西洛他唑是一种新型的抗血小板药物，属于喹啉类衍生物，其抗血小板作用的特点是可逆地抑制多种化学和物理刺激（ADp、肾上腺素、胶原、花生四烯酸、凝血酶等）诱导的血小板初期和二期的聚集和释放反应，并呈剂量相关性。西洛他唑最初的适应证是治疗间歇性跛行，随着临床研究的不断深入，西洛他唑在防治血栓栓塞性疾病的临床应用也不断拓展。为规范医院医嘱管理，保障医疗安全，促进合理用药。依据卫生部《医院处方点评管理规范（试行）》规定，我们对西洛他唑临床应用的现状和存在的问题进行医嘱点评，现报道如下。     

献血者服用药物与输血安全研究进展

目的提高血液制品的安全性,制定使用药物献血者的推迟时间及管理措施,为输血安全提供参考。方法根据药物药效学和药代动力学特性以及国内外文献,提出服用药物献血者的延迟期以及管理办法。结果及结论建议为12岁以下儿童制定特殊的血液制品。经过药物延迟期为药峰时间以及5个血浆消除半衰期(Tmax+5 T1/2),献血者血浆中所含的药物会达到低于3%治疗浓度范围。对于使用致畸的药物、影响血小板功能的药物和基因毒性药物,必须长时间观察等待。对献血者进行认真面谈和信息采集是任何捐赠者健康检查的重要组成部分,建议联网系统管理患者用药记录。     

Blood donors on medication

OBJECTIVES: Drugs and their metabolites in transfused blood components may cause effects in the recipient. If the treated disorder is not to be regarded as an exclusion criterion from blood donation, donors on medication should be deferred for a period consistent with the drug's pharmacokinetics. GENERAL PRINCIPLES AND METHODS: Peak plasma drug concentrations of 3% or less of the therapeutic concentration were regarded to be safe for the recipient of a blood product. For teratogenic drugs a much lower safety level of less than 0.000001% has been proposed. For the calculation of deferral periods, both the type of blood component to be prepared and the drug's pharmacokinetics for a given formulation were considered. SUGGESTED WAITING PERIODS: For drugs with known teratogenic risks, we suggest a deferral period of 28 plasma-elimination half-lives. For non-teratogenic drugs, a simple, conservative approach could be based on waiting for five plasma-elimination half-lives, thus reaching the required 3% safety level already in any donor. If, however, the type of blood component to be prepared is also considered, a more differentiated approach appears to be appropriate: for blood components containing 50 ml or less plasma from a single donor, donor medication may be disregarded because of the high dilution in the recipient's plasma volume, whereas for blood components with higher plasma contents (250 ml on average) from a single donor on medication the 3% safety level will be achieved by observing the deferral period of five plasma-elimination half-lives mentioned. A guideline for 191 drugs and drug classes has been elaborated accordingly.     

Drug treatment of intermittent claudication

The US FDA has approved two drugs for the management of intermittent claudication: pentoxifylline and cilostazol. The mechanism of action that provides symptom relief with pentoxifylline is poorly understood but is thought to involve red blood cell deformability as well as a reduction in fibrinogen concentration, platelet adhesiveness and whole blood viscosity. The recommended dose of pentoxifylline is 400 mg three times daily with meals. Cilostazol is a potent, reversible, phosphodiesterase III inhibitor. The inhibition of phosphodiesterase allows for the increased availability of cyclic adenosine monophosphate (cAMP). cAMP mediates many agonist-induced platelet inhibitory, vasodilatory and vascular antiproliferative responses. Cilostazol, at a dose of 100 mg twice daily, is recommended to be taken 30 minutes before or 2 hours after breakfast and dinner. In addition to pentoxifylline and cilostazol, clinical trials indicate many other drugs may relieve the symptoms of intermittent claudication. Ginkgo biloba, available as an over-the-counter extract, provides symptom relief comparable to pentoxifylline. Two European agents, naftidrofuryl and buflomedil, also have efficacy that is reported to be similar to pentoxifylline. Policosanol is a mixture of fatty alcohols derived from honeybee wax which, according to very limited data, reduces symptoms of claudication. Amino acids, certain peptides and prostaglandins may have a therapeutic role. Finally, novel approaches including angiogenesis mediated by growth factors, are currently under investigation.     

Estimation of anti-platelet drugs on human platelet aggregation with a novel whole blood aggregometer by a screen filtration pressure method

1. The effects of anti-platelet drugs on human whole blood aggregation were evaluated using a novel whole blood aggregometer by a screen filtration pressure (SFP) method. 2. The SFP whole blood aggregometer was found to successfully detect whole blood aggregation induced by ADP, collagen and TRAP by measuring the SFP of blood samples. The platelet aggregation threshold index (PATI), the concentration of agonist required with an inducing pressure rate of 50%, varied time-dependently after collection of blood. High values for ADP and collagen were noted immediately after blood collection, suggesting low aggregation activity of platelets, and gradually increase thereafter. 3. Cilostazol (phosphodiesterase 3 inhibitor), dipyridamole, aspirin and tirofiban all inhibited whole blood aggregation in vitro. Inhibitory effects of cilostazol and dipyridamole, but not tirofiban, were markedly enhanced 6 or 7 fold by long pre-incubation (60 min), compared with short pre-incubation (2 min). Such enhancement was only observed with ADP- and not collagen-induced whole blood aggregation. A similar phenomenon was also observed for aggregation with platelet rich plasma (PRP). Cilostazol inhibition of ADP-induced platelet aggregation was more potent with PRP than whole blood (PATI(200)=3.80+/-0.95 microM for whole blood; 2.04+/-0.61 microM for PRP). Inhibitory effects of dipyridamole were attenuated in PRP without erythrocytes. 4. These results demonstrate that the SFP aggregometer can sensitively detect anti-platelet aggregatory effects of various kinds of drugs. So that it is a useful tool for evaluation of anti-platelet drugs.     

Cilostazol down-regulates the height of mural platelet thrombi formed under a high-shear rate flow in the absence of ADAMTS13 activity

Cilostazol is an anti-platelet drug that reversibly inhibits phosphodiesterase III (PDE-III), which is ubiquitously expressed in platelets and various tissues. PDE-III converts cyclic adenosine monophosphate (cAMP) to 5'-AMP and up-regulates the intracellular concentration of cAMP, a potent inhibitor of platelet aggregation. Unlike other anti-platelet drugs, cilostazol is unique because patients receiving this drug do not have a significantly prolonged bleeding time, but the reasons for this difference are still unknown. In this study, we have examined how cilostazol inhibits platelet thrombus formation using anti-coagulated normal whole blood in which the platelets were labeled with a fluorescent dye in comparison with the anti-GPIIb/IIIa agent, tirofiban. We used an in vitro assay to examine mural platelet thrombus growth on a collagen surface under a high-shear rate flow in the absence of ADAMTS13 activity. These experimental conditions mimic the blood flow in patients with thrombotic thrombocytopenic purpura. Using this model, we clearly determined that cilostazol down-regulates the height of mural platelet thrombi formed on a collagen surface in a dose-dependent manner, without affecting the surface coverage. The concentration of cilostazol used in this study was relatively high (60-120μM) compared to clinically relevant concentrations (1-3μM), which may be due to the in vivo synergistic effects of PDE-III present in other tissues aside from platelets. Cilostazol does not affect the initial formation of platelet thrombi, but does inhibit the height of thrombi. These results showed a sharp contrast to tirofiban, and address why cilostazol does not significantly prolong bleeding time, despite its strong anti-platelet activity.     

无偿机采血小板穿刺不成功的影响因素分析

目的探讨无偿捐献机采血小板穿刺不成功的影响因素,并提出对策。方法以2006年10月～2007年9月到本站捐献机采血小板的1115名献血者为观察对象,并对静脉穿刺不成功的原因进行分析。结果1115名献血者中,共出现44名献血者穿刺不成功,占机采血小板人数的3.95%。穿刺不成功的影响因素中,技术因素造成的有31人,占70.46%;心理因素造成的有8人,占18.18%;环境因素造成的有5人,占11.36%。结论在机采血小板采集过程中,静脉穿刺技术是穿刺不成功的主要因素,献血者的紧张心理及献血的环境也对静脉穿刺造成影响。     

多次连续捐献2U机采血小板对献血者的影响

目的探讨连续多次机采2U血小板对献血者的影响。方法120例连续献血>10次的机采血小板献血者,随机分为A组、B组,每组60例。A组机采血小板1U/次,B组机采血小板2U/次。比较两组献血者单采前后血小板计数(PLT)以及首次、10次后外周血象指标[PLT、红细胞计数(RBC)、血红蛋白(Hb)、红细胞压积(HCT)]。结果A组献血者上次单采前PLT为(271±30)×10^9/L,下次单采前PLT为(269±31)×10^9/L;B组献血者上次单采前PLT为(273±31)×10^9/L,下次单采前PLT为(268±34)×109/L。两组献血者单采前后PLT组内比较差异无统计学意义(P>0.05)。两组献血者首次与10次后PLT、RBC、Hb、HCT组内及组间比较,差异均无统计学意义(P>0.05)。结论献血者采集血小板前后的血常规改变不明显,根据国家规定的健康体格检查标准,献血者采集血小板前PLT>230×10^9/L,体重>50 kg,连续多次采集2U血小板血常规无显著变化,对献血者健康状况无明显影响。由于献血者人数限制,需要扩大样本量进一步探讨。     

首次单采血小板献血者的心理分析及护理

目的：分析首次单采血小板献血者的心理状态,并探究护理措施的效果。方法选择自2014年7月至2015年7月期间于我站首次单采血小板120位献血者作为研究对象,随机分为实验组和对照组,每组各60例,对照组实施常规护理,实验组在常规护理的基础上加用心理护理措施。观察比较两组献血者护理前后的心理状态。结果两组献血者组内比较,护理后献血者的心理状态显著优于护理前,差异显著,具有统计学意义（P＜0.05）;护理前两组献血者的心理状态评分,差异不明显（P>0.05）,不具有统计学意义;护理后两组献血者组间比较,观察组献血者的心理状态明显优于对照组献血者,具有统计学意义（P＜0.05）。结论对首次单采血小板献血者采取心理护理干预措施能够有效的改善献血者的心理状态,增加献血者的热情,可以在献血工作中推广应用。     

个性化整体护理对无偿献血者的影响

目的探讨实施个性化整体护理对无偿献血者的影响。方法对2005年29837名献血者实施个性化整体护理(从献血者选择开始献血,医护人员开始对献血者实施心理护理至献血完成)。观察无偿献血者发生献血反应人数以及固定献血者人数,并与2004年29818名献血者未实施整体护理相比较。结果发生献血反应的人数由2004年553人下降至2005年的83人,二者有显著性差异。2005年固定献血者人数达2808人,占无偿献血者人数9.4%,2004年固定无偿献血者人数为1198人,占无偿献血者人数4.0%,二者有显著性差异。结论对无偿献血者实施个性化的整体护理可以减少献血反应,扩大固定献血者队伍。     

机采血小板无偿献血者初筛脂浆血分析

目的:分析机采血小板无偿献血者初筛脂浆血可能原因,实施干预对策,以保证血液质量,充分利用血液资源.方法:自2011年1月25日至10月25日期间,对参加机采血小板无偿献血者初筛检验血型、ALT、HBsAg、PLT、血常规.对合格者将含抗凝剂的全血标本离心后,肉眼观察上清液是否属脂浆血.对脂浆血者,通过询问其饮食情况给予干预,并再次采抗凝全血标本离心,根据肉眼观察结果判断能否采集机采血小板.结果:共8 827人次献血者参加了机采血小板采前初筛检测,初筛脂浆血者769人,占总人次8.71％.可能原因为4～6h内进食高脂肪、高热量饮食(占67.36％),10 ～ 12 h内进食高脂肪、高热量饮食(占24.58％),脂肪代谢障碍(占8.06％).最终因脂肪血淘汰182人,初筛脂浆血者成功采集率76.33％.结论:通过对机采血小板无偿献血者初筛脂浆血可能原因分析,并实施干预措施,大多数初筛脂浆血者都能成功采集机采血小板,干预措施对于更好地利用血液资源是有效的.