ITP病人血小板计数方法比较研究

目的 :探讨实用于原发性血小板减少性紫癜 (idiopathicthrombocytopenicpurpura ,ITP)的血小板计数的方法。方法 :用流式细胞技术半导体激光法、电阻抗法与手工方法比较。结果 :血小板计数在 (1～ 2 0 )× 10 9/L(治疗前 )组 ,流式细胞技术半导体激光法与手工方法计数的结果没有显著性差异 (P >0 0 5 ) ,相关性较好 ,r=0 98,而电阻抗法与手工方法有显著性差异 (P <0 0 5 ) ,相关性也较差 ,r=0 78。血小板在 5 4～ 136× 10 9/L (治疗有效 )组 ,虽然三种方法之间没有显著性差异 ,但流式细胞技术半导体激光法与手工方法的相关性较电阻抗法好 ,其相关系数分别为 0 97和 0 80。结论 :对ITP病人标本 ,XE - 2 10 0全自动血细胞分析仪的流式细胞技术半导体激光法计数血小板 ,较电阻抗法准确     

三种流式细胞术计数血小板方法的比较研究

目的　探讨 3种流式细胞术计数血小板方法的临床应用价值。方法　用二维激光散射法 (ADVIA 12 0法 )、红细胞与血小板比值法 (RBC/PLT R法 )、荧光微球绝对计数法 (TruCOUNT法 ) 3种流式细胞术 (FCM)方法计数血小板 ,并与电阻抗法比较。结果　 3种FCM方法计数血小板具有高度相关性 (P <0 0 0 1) ,血小板计数在 ( 1～ 6 46 )× 10 9/L的较宽范围内时 ,相关系数 (r) >0 99;血小板计数在 ( 1～ 89)× 10 9/L的较低范围内时 ,相关系数 (r) >0 95。与TruCOUNT法血小板计数相比 ,ADVIA12 0法计数值偏高 ,RBC/PLT R法偏低。TruCOUNT法与ADVIA 12 0法的相关性最好 (P <0 0 0 1) ,在较低范围血小板计数时的相关系数 (r) >0 98。低血小板计数时 ,ADVIA 12 0法的变异系数 ( 3 46 % )最小 ,TruCOUNT法 ( 5 2 % )次之 ,RBC/PLT R法 ( 5 84% )稍高。电阻抗法与 3种FCM法均有相关性 (P <0 0 0 1) ,但血小板计数比 3种FCM法偏低 (P <0 0 1) ,而且对部分病例标本的血小板计数存在较大误差。结论　 3种FCM法计数血小板均优于电阻抗法。ADVIA 12 0全自动血细胞分析系统最适合于临床常规计数血小板 ,TruCOUNT法是较为低血小板计数和校准血细胞分析仪。对严重血小板减少症的患者 ,若临床需要采取预防性血小板输血时     

机采血小板2U的质量保证和供者安全性的探讨

目的　探讨机器采集血小板的 2U质量及其对供者安全性的影响。方法　用MCS○R+血细胞分离机采集血小板 2U后 ,收集供者采后抗凝全血 1ml检测血常规 ,收集机采血小板成品 1ml(原液 )作血小板计数。结果　①机采血小板终成品计数检测≥ 2 5× 1 0 1 1 /U达 87 3%。②所有被检测的供者采后血小板平均计数 1 6 0× 1 0 9/L。结论　对身体健康、采前Plt≥ 2 5 0× 1 0 9/L、体重 >5 5kg的供者机采血小板 2U是安全的。有选择性机采血小板 2U既能保证血小板质量满足临床应用 ,也能达到缓解供者不足以及降低机采成本的目的。     

血液分析仪及手工法计数血小板的影响因素分析

血细胞分析仪进行血小板计数的影响因素甚多 ,笔者在工作中就几种常见因素作了观察分析 ,报道如下。材料与方法1　标本　健康体检者血标本 45份 ;小细胞性贫血患者标本 2 5份 ;溶血标本 2 7份 ;低血小板患者 6份。2　方法　仪器法血小板计数采用美国雅培 CD-1 60 0型血细胞分析仪及进口配套试剂 ;手工法采用显微镜计数 ,采用许汝和法[1 ] 。2　在 8℃条件下 ,对 45份健康体检者 EDTA-K2 抗凝静脉血 ,用血细胞分析仪进行血小板计数 ,结果为 ( 1 0 7± 76.5 )×1 0 9/ L,手工法为 ( 1 95± 68.2 )× 1 0 9/ L,经统计学分析 ,t=5 .76,P<0 .…     

相差显微镜血小板计数法对血液分析仪测定“血小板计数减少”结果的复核作用

血液分析仪计数血小板具有快速简便、重复性好等优点 ,然而血小板易于粘附、聚集、破坏 ,许多文献认为 ,当血小板实际血浓度低于正常值时 ,血液分析仪在计数血小板的结果距离真实值有一定的误差 ,从而给临床准确诊断疾病带来了困难。为此 ,我们选择血液分析仪计数血小板数结果偏低 (<10 0× 10 9/L)的患者标本 ,用相差显微镜法进行复查比较。一、材料和方法1.材料　收集瑞金医院病房及门诊血液分析仪(Coulter STKS)计数血小板数 <10 0× 10 9/L的患者标本共 2 6 6份。正常人标本 (10 0～ 30 0 )× 10 9/L 37份。血常规管均为硅化的EDTA…     

定量检测残留白细胞方法的建立及在辐照血小板中的应用

目的建立定量检测单采血小板中残留白细胞的流式细胞术方法,探讨经血液辐照仪辐照前后血小板中白细胞的含量变化。方法应用绝对计数管内的定量微球(Beads)调整流式细胞仪参数,确定流式细胞仪检测条件。血小板样品经过RNA酶、固定剂、渗透剂作用后,再经碘化丙啶标记,通过流式细胞仪计数经标记的白细胞,建立检测残留白细胞含量的方法。采用血细胞分离机采集单采血小板16人份,通过血液辐照仪25Gy照射310s,应用建立的流式细胞术方法跟踪检测单采血小板辐照前及辐照后0、1、3、5d的白细胞含量,比较白细胞含量的变化。结果单采血小板中残留白细胞含量范围为1.85×106～1.3×108/袋。单采血小板中残留白细胞计数于辐照前与辐照后0d相比没有变化,与辐照后1d相比残留白细胞数量的减少有显著性(P<0.05);辐照后1d白细胞计数与辐照后3d和5d相比没有改变。结论流式细胞术方法具有较好的准确性、客观性和重复性,可以成为评估血小板质量的监控手段。辐照不立即改变血小板中残留白细胞的计数,辐照后1d残留白细胞的数量减少。     

不同疾病低血小板样本阻抗法与手工法计数的评价

目的 探讨不同疾病引起的低血小板样本在阻抗法血细胞分析仪与手工法血小板计数时存在的差异。方法 将239例低血小板(<80×10~9/L样本,其中肝病73例、恶性肿瘤化疗后58例、血液病108例,分别采用阻抗法血细胞分析仪和手工法同时计数血小板,再接仪器检测结果将不同疾病的血小板数分为<25×10~9/L、25～50×10~9/L、50～80×10~9/L三组,然后将两法结果进行比较分析。结果 当血小板数<25×10~9/L时,三类病仪器法均明显低于手工法(P<0.01);血小板数在25～50×10~9/L时,血液病样本两法结果无显著性差异(P>0.05),而肝病和恶性肿瘤化疗后的样本仪器法仍明显低于手工法(P<0.05);血小板数在50～80×10~9/L时,三类疾病两法结果均无显著性差异(P>0.05)。结论 阻抗法自动血细胞分析仪计数血小板时,对肝病和恶性肿瘤化疗后的患者血小板计数<50×10~9/L的样本应进行手工计数复检,而血液病患者血小板手工复检计数范围可放宽到<25×10~9/L的样本。     

冷球蛋白干扰光学和阻抗法计数血小板,不干扰CD61免疫法计数血小板

作者以ＣＤ4 0 0 0系统光学法和阻抗法计数血小板时 ,遇到4例由冷球蛋白导致的血小板计数假性高值。患者 1为淋巴浆细胞样淋巴瘤 ,因为测定时ＣＤ4 0 0 0分析仪出现有异常淋巴细胞信号 ,所以做了末梢血涂片检查 ,证实有淋巴瘤细胞的存在 ,同时发现为血小板减少症。然而用自动阻抗和光学法计数血小板值为 35 5× 10 9/Ｌ左右。用计数池计数血小板为 38×10 9/Ｌ ,在ＣＤ4 0 0 0上用ＣＤ6 1免疫法计数血小板为 4 2× 10 9/Ｌ ,进一步证实了形态学结论 ,可见光学和阻抗法所计数的血小板值假性过高 ,但ＣＤ4 0 0 0却未给出警告。作者指出 :如果…     

苏州地区plt和MPV个体变化的调查

目的　调查苏州地区 10 6例健康成人血小板计数 (plt)和平均血小板容积 (MPV)在不同时间内的变化情况。方法　用自动BeckmanCoulterinc.的ModelSTKS计数仪和与仪器匹配试剂由专人检测。结果　 2 0 0 2年 5月份的plt为(172± 4 8)× 10 9/L ,9月份为 (14 5± 4 7)× 10 9/L(P <0 .0 0 0 1)。两次检查plt的平均值 ,9月份比 5月份降低了 14 % ;但从个体的变化情况看 ,减少率最大为 6 2 % (5月份为 16 5× 10 9/L ,9月份为 6 2× 10 9/L) ,增加率最大为 4 0 % (5月份为 99× 10 9/L ,9月份为 139× 10 9/L)。此外 ,MPV值也有变化。观察plt呈低值的血液涂片标本 ,巨大血小板或大型血小板的出现频率增高。结论　苏州地区健康成人plt和MPV值有个体变化。     

血液稀释法自体献血血小板各参数的动态变化

本文用 CD- 140 0 EX血细胞分析仪对 18例脑外科手术病人在血液稀释法自体献血过程中 ,血小板计数 (Plt)血小板比容 (PCT) ,平均血小板体积 (MPV)及血小板分布宽度 (PDW)各参数变化进行动态观察。 14例献血量在 40 0～ 80 0 m l之间 ,4例自体献血量为 10 0 0 ml,患者的 MPV和 PDW在献血前后无显著性差异 (P>0 .0 5 ) ,Plt和 PCT在献血后均降低 ,有显著性差异 (P<0 .0 5 )。一例自体献血 10 0 0 m l后 ,Plt降至 5 0× 10 9/ L,PCT降至0 .0 3%。患者对自体献血均能耐受 ,术后无并发症 ,恢复良好。提示手术中血液稀释法自体献血 ,具有临床应用前景。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.