氟比洛芬酯用于髋关节置换术超前镇痛的效果及对血小板活化的影响

目的观察氟比洛芬酯用于髋关节置换术超前镇痛的效果及对血小板活化的影响。方法选取60例行髋关节置换术患者,随机分成3组,每组各20例,分别为:氟比洛芬酯超前镇痛组(A组),氟比洛芬酯术后镇痛组(B组),对照组(C组)。3组患者术毕均用芬太尼术后静脉自控镇痛(PCIA)。采用视觉模拟评分法评价3组患者术后镇痛效果;采用流式细胞仪检测T0(麻醉前)、T1:(手术结束后2小时)、T2:(手术结束后4小时)、T3:(手术结束后24小时)、T4:(手术结束后48小时)时GPⅡb/Ⅲa与GMP-140的表达。结果 VAS评分:A组相似文献   

重组双功能水蛭素的抗凝防栓作用

目的探讨新药重组双功能水蛭素(RGDHirudin)的抗凝防栓作用。方法新西兰大白兔30只,行颈动脉吻合术后注射生理盐水、GPⅡb/Ⅲa(血小板表面糖蛋白)单抗、野生型水蛭素和RGDHirudin,比较各组动脉造影、术后病理以及血液学指标的差异。结果RGDHirudin(0.2mg/kg)给药1h后活化部分凝血活酶时间(aPTT)、凝血酶原时间(PT)和凝血酶时间(TT)分别延长至(32.92±2.05)s、(22.98±1.56)s、(45.44±9.40)s,血小板最大聚集率降至(0.29±9.68)%;其通畅率与野生水蛭素(0.5mg/kg体重)一致(60%～100%),并优于抗GPⅡb/Ⅲa单抗(0.2mg/kg体重,40%)。结论RGDHirudin具有抗凝血酶和抗血小板聚集双重活性,且治疗剂量较小。     

术前急性高容量血液稀释对食管癌根治术中患者血小板活化的影响

研究拟观察术前急性高容量血液稀释(AHH)对食管癌根治术中患者血小板膜血小板α颗粒膜蛋白(GMP-140)、GPⅡb/Ⅲa及血管性血友病因子(vWF)表达的影响。资料与方法择期行食管癌根治术的患者40例,ASAⅠ或Ⅱ级,年龄35-65岁,体重50-80kg,心、肺、肝、肾、凝血及止血功能均     

血小板数量和功能在肝缺血-再灌注过程中的变化

目的 观察兔肝缺血-再灌注过程中血小板数量、功能及膜蛋白的变化。方法 20只大耳白兔行氯胺酮麻醉，气管切开插管控制呼吸。夹闭肝门30min后恢复灌注造成肝缺血-再灌注模型，于缺血前、肝缺血25min、再灌注后5和10min由颈动脉采血，测血小板数量、粘附率、最大聚集率，用竞争性酶联免疫法测定各时点血小板糖蛋白Ⅰb、Ⅱb、Ⅲa(GPⅠb、Ⅱb、Ⅲa)和颗粒膜蛋白-140(GMP-140)数量。结果 血小板数量、粘附率、聚集率各时相点和缺血前相比均显著降低；GPⅠb数量在各时点和缺血前相比明显减少；各时点GPⅡb数量和缺血前相比，有显著下降趋势；GPⅢa数量在再灌注后5、10min和缺血前及肝缺血25min相比有显著下降趋势；GMP-140变化呈显著上升趋势；肝脏窦状隙电镜观察，大量血小板积聚和脱颗粒。结论 肝缺血-再灌注过程中，血小板数量减少，血小板积聚于肝窦状隙并大量脱颗粒，其粘附、聚集功能下降。     

血小板糖蛋白GPⅡb和GP Ⅲ a在人类肾小球疾病中的变化及作用

目的:本实验观察外周血小板膜上GPⅡb、GPⅢa在各种肾小球疾病中不同肾功能状态及透析与否中的变化,探讨GPⅡb、GPⅢa在肾小球疾病中的作用.方法:测定48例血小板膜上GPⅡb、GPⅢ a、P-140分子量及血浆vWF变化.A组:18例肾功能正常组;B组:10例肾衰竭非透析组;C组:20例肾衰竭透析组;另设D组:20例无肾脏疾病正常对照.结果:外周血小板膜上GPⅡb、GPⅢa、P 140在A组明显升高,B、C组明显下降,vWF在A、B、C组均明显增加.结论:GPⅡb、GPⅢa与肾小球疾病中凝血功能紊乱有关,可能与血小板在肾脏的致病作用相关.     

羟考酮与吗啡术后镇痛对结肠癌根治术患者血小板活性和细胞免疫功能的影响

目的评价羟考酮与吗啡术后镇痛对结肠癌根治术患者血小板活化和细胞免疫功能的影响。方法择期行腹腔镜结肠癌根治术患者40例,男23例,女17例,ASAⅠ或Ⅱ级,随机分为羟考酮组(O组)和吗啡组(M组),每组20例。O组PCIA泵配方为羟考酮1 mg/kg加托烷司琼6mg,M组为吗啡1mg/kg加托烷司琼6 mg。于麻醉诱导前5 min(T_0)、手术结束后4h(T_1)、24h(T_2)、48h(T_3)采集静脉血样,测定血小板膜糖蛋白(GPⅡb/Ⅲa)、P-选择素(CD62P)、NK细胞、NKT细胞、自然调节性T(nTreg)细胞含量和血小板聚集率(PAR)。结果与T_0时比较,T_1时O组,T_1、T_2时M组GPⅡb/Ⅲa、CD62P、PAR和nTreg细胞含量明显升高(P0.05);T_1时O组,T_1~T_3时M组NK、NKT细胞含量明显降低(P0.05)。与M组比较,T_2、T_3时O组GPⅡb/Ⅲa、CD62P、PAR和nTreg细胞含量明显降低,NK、NKT细胞含量明显升高(P0.05)。结论与吗啡比较,羟考酮术后镇痛可抑制血小板过度活化,对细胞免疫功能抑制较轻,此作用对防治结肠癌根治术患者围术期肿瘤细胞血行转移或有积极意义。     

不同胶体溶液急性高容血液稀释对结肠癌根治术患者围术期GPⅡb/Ⅲa、P-选择素表达的影响

目的观察羟乙基淀粉(HES)溶液和琥珀酰明胶(GEL)溶液急性高容血液稀释(AHHD)对结肠癌患者围术期血小板膜糖蛋白Ⅱb／Ⅲa(GPⅡb／Ⅲa)、P-选择素表达的影响。方法择期在全身麻醉下行结肠癌根治术患者60例,ASAⅠ或Ⅱ级,随机分为3组(n=20):术前以15 ml·kg-1剂量分别在30min内经颈内静脉输注HES溶液(组Ⅰ)、GEL溶液(组Ⅱ)或乳酸钠林格氏(RL)溶液(组Ⅲ)。抽取静脉血标本,采用流式细胞仪测定AHHD前即刻(T0)、手术开始后30 min(T1)、手术开始后2 h(T2)和术毕1 h(T3)GPⅡb／Ⅲa与P-选择素的表达。结果与T0比较,组ⅠT1、T2和T3时GPⅡb／Ⅲa和P-选择素表达均降低;组Ⅱ,T1、T2时GPⅡb／Ⅲa和P-选择素表达降低,T3时GPⅡb／Ⅲa表达降低;组ⅢT1、T3时P-选择素表达增强(P<0．05)。与组Ⅱ比较,组ⅠT3时GPⅡb／Ⅲa表达降低;与组Ⅲ比较,组Ⅰ与组ⅡT1、T2和T3时GPⅡb／Ⅲa和P-选择素表达降低(P<0．05)。结论术前采用HES溶液或GEL溶液AHHD能抑制结肠癌根治术患者围术期血小板的过度活化,对防止肿瘤细胞转移和术后深静脉血栓形成可能有一定作用。     

不同羟乙基淀粉急性高容量血液稀释对大面积烧伤患者围术期凝血功能的影响

目的 评价羟乙基淀粉130/0.4(HES 130/0.4)与羟乙基淀粉200/0.5(HES 200/0.5)急性高容量血液稀释(AHH)对大面积烧伤患者围术期凝血功能的影响.方法 拟行早期切痂术的大面积烧伤患者40例,年龄18～49岁,ASAⅡ级,随机分为HES 200/0.5组(HES 200组)与HES 130/0.4组(HES 130组),每组20例,另选20名健康志愿者为正常对照组(C组).麻醉诱导开始时HES 200组和HES 130组经30 min分别静脉输注HES 200/0.5、HES 130/0.4 15 ml/kg,行AHH,C组不予任何处理.于麻醉诱导前(T0)、AHH结束即刻(T1)、AHH后1 h(T2)、术后1 h(T3)时采用流式细胞仪检测血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)、CD62P的表达水平,采用血栓弹力图描记仪测定以下指标:反应时间(R).凝血时间(K)、α角、最大振幅(MA)和凝血指数(CI).结果 与C组比较,HES 200组和HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R、K缩短,α角、MA、CI增大(P<0.05);与HES 200组比较,HES 130组血小板GPⅡb/Ⅲa、CD62P表达上调,R缩短,α角、MA和CI增大(P<0.05);与T0时比较,HES 200组AHH后血小板GPⅡb/Ⅲa、CD62P表达下调,R、K延长,α角、MA、CI减小(P<0.05),HES 130组R、K延长,α角、CI减小(P<0.05),MA和血小板GPⅡb/Ⅲa、CD62P差异无统计学意义(P>0.05).结论 HES 200/0.5 AHH可抑制大面积烧伤患者围术期血小板过度活化,其减轻血液高凝状态的效应强于HES 130/0.4.     

原发性系膜增生性肾炎患者血小板活化状态的研究

目的 探讨血小板活化标志物：血小板膜糖蛋白(GPⅡb/Ⅲa,CD41／CD61)及P-选择素(GMP140,CD62P)与人类原发性系膜增生性肾炎的关系。方法 采用流式细胞技术对35例原发性系膜增生性肾小球肾炎患者及激素治疗半年后的部分患者,检测其血中CD41、CD61、CD62P表达。结果 系膜增生性肾小球肾炎患者,血清CD62P显著高于正常人,而激素治疗半年后上述3项指标明显低于正常,且活化部份凝血活酶时间,纤维蛋白原显著高于正常。结论 CD41、CD61、CD62P介导了肾内血小板活化、聚集、炎症反应过程,与系膜增生性肾小球肾炎的发病密切相关。     

采用流式细胞术检测体外循环对血小板膜糖蛋白Ⅱb-Ⅲa的影响

体外循环是一种非生理性灌注。各种因素的综合影响可导致血小板结构和功能的变化,引起血小板的激活及聚集功能的严重损伤。血小板膜糖蛋白Ⅱb—Ⅲa(GPⅡb—Ⅲa)与血小板聚集功能密切相关。流式细胞术是近年来发展起来的一种自动分析细胞的高新技术。本文综述运用流式细胞术检测体外循环对血小板膜糖蛋白Ⅱb-Ⅲa(GPⅡb-Ⅲa)的影响。     

AECOPD患者治疗前后呼出气冷凝液pH值的变化

目的探讨AECOPD患者呼出气冷凝液中pH变化的临床意义。方法选择2005年7月～2010年10月笔者所在医院就诊的AECOPD患者115例,另选同期健康体检者100例。比较AECOPD治疗前后EBCpH的变化及与健康对照组EBCpH比较,探讨AECOPD治疗前EBCpH与肺功能（FEV1、FEV1/FVC、FEV1%预计值）的相关性。结果 AECOPD组治疗前后比较,pH明显升高,差异具有统计学意义（P〈0.05）;治疗前后与对照组比较,pH明显降低,差异有统计学意义（P〈0.05）。但AECOPD的EBC中pH与肺功能无明显相关性（P〉0.05）。结论 AECOPD患者EBCpH显著降低,气道酸化明显,EBC中pH可作为监测气道酸碱度和COPD急性发作的有效指标之一,但不能反映肺功能和病情严重情况。     

Platelet proinflammatory activity in clinically stable patients with CF starts in early childhood

BackgroundEarly onset chronic inflammation is present in CF. Platelets may contribute to inflammation by cytokine release and interaction with leukocytes.MethodsParameters of platelet proinflammatory function (soluble CD62P, soluble CD40L, the percentage of platelet–leukocyte aggregates, platelet CD62P) and platelet procoagulatory function (PAC-1-binding to activated integrin α_IIbβ₃ and expression of integrin α_IIbβ₃ = CD41a) were measured in patients and controls.ResultsLevels of sCD62P, sCD40L were increased in CF irrespective of age and activity of inflammation. The number of platelet–leukocyte aggregates was elevated in older CF patients. PAC-1-binding to platelets decreased with growing activity of inflammation. Exocytosis of CD41a upon platelet activation was reduced.ConclusionIn CF, platelet proinflammatory activity is increased at very young age already and might promote inflammation and tissue damage. On the other hand, platelets seem to downregulate the activation of their most important integrin (α_IIbβ₃) for clot formation.     

血清淀粉样物质A在慢性阻塞性肺疾病急性加重中的临床意义

目的探讨血清淀粉样物质A（SAA）在诊断慢性阻塞性肺疾病急性加重（AECOPD）中的临床意义。方法收集2007年6月至2008年12月AECOPD患者86例,慢性阻塞性肺疾病（COPD）缓解期患者46例。采用ELISA法测定sAA,对AECOPD与COPD缓解期患者进行比较,并比较AECOPD患者治疗前后SAA、WBC、中性粒细胞计数、C反应蛋白（CRP）的变化。结果AECOPD患者SAA水平较COPD缓解期患者明显升高[分别为（182．33±50．12）、（6．24±3．05）ms／L,P〈0．05]。AECOPD患者随着抗生素治疗的起效,SAA、CRP逐渐下降,WBC、中性粒细胞计数也有下降趋势。SAA对诊断AECOPD患者肺功能严重程度较CRP敏感。结论SAA对AECOPD的诊断及评价其肺功能严重性具有重要的临床意义。     

Active infective endocarditis with idiopathic thrombocytopenic purpura: a case report]

This is a case report of infective endocarditis with idiopathic thrombocytopenic purpura (ITP). Open heart surgery to the patient with ITP has a problem of perioperative hemorrhage. Usually, treatment for ITP is performed before operation, and platelet transfusion is provided for hemorrhage. However, in our patient, we had to perform emergency operation because of progressive heart failure without treatment of ITP. Emergency operation should be performed without treatment of ITP, not to delay operative timing in such a case of progressive heart failure from active infective endocarditis.     

Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease

BACKGROUND: Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. METHODS: Data were retrieved from electronic records for patients admitted with AECOPD with lower respiratory tract infection in 2001-2. The patients were grouped according to blood glucose quartile (group 1, <6 mmol/l (n = 69); group 2, 6.0-6.9 mmol/l (n = 69); group 3, 7.0-8.9 mmol/l (n = 75); and group 4, >9.0 mmol/l (n = 71)). RESULTS: The relative risk (RR) of death or long inpatient stay was significantly increased in group 3 (RR 1.46, 95% CI 1.05 to 2.02, p = 0.02) and group 4 (RR 1.97, 95% CI 1.33 to 2.92, p < 0.0001) compared with group 1. For each 1 mmol/l increase in blood glucose the absolute risk of adverse outcomes increased by 15% (95% CI 4 to 27), p = 0.006. The risk of adverse outcomes increased with increasing hyperglycaemia independent of age, sex, a previous diagnosis of diabetes, and COPD severity. Isolation of multiple pathogens and Staphylococcus aureus from sputum also increased with increasing blood glucose. CONCLUSION: Increasing blood glucose concentrations are associated with adverse clinical outcomes in patients with AECOPD. Tight control of blood glucose reduces mortality in patients in intensive care or following myocardial infarction. A prospective study is now required to determine whether control of blood glucose can also improve outcomes from AECOPD.     

A surgical case of mitral regurgitation due to active infective endocarditis with idiopathic thrombocytopenic purpura

A 71-year-old woman with idiopathic thrombocytopenic purpura (ITP), who had been treated with steroid and cyclosporine, was admitted in an emergency with fever and dyspnea. The diagnosis was mitral regurgitation due ton infective endocarditis. Although she received treatments for infection and cardiac failure, the cardiac failure could not be controlled. After high-dose γ-globulin therapy, an emergency operation was performed during the active phase of infective endocarditis. Rapid platelet transfusion was administered after weaning from extracorporeal circulation. She recovered and was discharged without postoperative bleeding and re-infection.The treatment course of elective cardiac surgery complicated with ITP has been established, but the course of emergency surgery has not been established because of the small number of cases reported. Since few patients have undergone emergency surgery for active infective endocarditis, we had difficulty in deciding the time of surgery and treatment for increasing the number of platelets before surgery, it was considered that the case provided us with useful suggestion for the future treatment for urgent surgery complicated with ITP.     

Successful surgical intervention for active infective endocarditis on a hemodialysis patient with cerebral infarction and disseminated intravascular coagulopathy

A 48-year-old woman on hemodialysis developed congestive heart failure, neurologic deficits and disseminated intravascular coagulopathy (DIC) caused by methicillin resistant staphylococcus aureus infective endocarditis. Echocardiography showed large vegetation attached to the anterior leaflet of the mitral valve, severe mitral and aortic regurgitation, and poor left ventricular function. Computed tomography findings revealed recurrent embolic events including cerebral and splenic infarction, but no evidence of intracranial bleeding. Abnormal laboratory findings included DIC in addition to the administration of the daily dose of ticlopidine hydrochloride. Aortic and mitral valves were urgently replaced with bio-prosthetic valves after the transfusion of fresh frozen plasma and platelet. During the follow-up period of one year, she was free from any cardiac events and infectious signs. Even though this report is limited to a case and its follow-up, it is sensible to conclude that only aggressive and timely surgical intervention can be the only lifesaving action for patients with highly infective endocarditis.     

Surgical aspect of active infective endocarditis

Twenty patients with active infective endocarditis, 11 with native valve endocarditis (NVE) and 9 with prosthetic valve endocarditis (PVE), were treated surgically from 1975 through April 1987 at Kyushu University Hospital. The operative indications were congestive heart failure mainly due to massive aortic regurgitation in 18, periannular abscess in 6, major embolism in 5 and severe hemolysis in 3 patients. In the group of NVE, single aortic valve replacement was performed in 4 patients and multiple valve replacement in the remainder. One patient died early postoperatively from LOS. Two patients with recurrent infective endocarditis, which occurred within 60 days after previous prosthetic valve replacement, were operated subsequently as early PVE. All other patients became NYHA class I postoperatively except for one patient who died from thrombosed valve. In the group PVE, re-AVR was done in 3, re-MVR in five, double valve replacement in two and re-fixation of the prosthesis to the aortic annulus in one patient. Two patients with early PVE died from recurrent endocarditis late postoperatively. One of 7 patients with late PVE, who had suffered from myocardial and cerebral infarction before reoperation, died from multiple organ failure. There were 3 patients with perivalvular leakage due to late active PVE, whose preoperative signs of inflammation were negative or minimum. As recurrent perivalvular leakage due to persistent infective endocarditis might frequently occur in such cases, complete resection and debridement of infected foci should be emphasized.     

Spondylodiscitis and infective endocarditis: case studies and review of the literature

STUDY DESIGN: This study evaluated the association between infective endocarditis and infective spondylodiscitis and its clinical features. OBJECTIVES: To report case studies of patients with spondylodiscitis complicating infective endocarditis. SUMMARY OF BACKGROUND DATA: Early diagnosis of infective endocarditis as the source of the spondylodiscitis is often difficult because clinical and radiologic patterns are similar to those present in spondylodiscitis alone. METHODS: The case records of the patients with infective endocarditis admitted to our Department from 1991-1998 were reviewed. The diagnosis of spondylodiscitis was made on the basis of clinical features and of typical radiologic signs. RESULTS: Among 30 patients affected by infective endocarditis, three also were affected by spondylodiscitis. All patients fully recovered after appropriate antibiotic therapy. CONCLUSIONS: In all patients with spondylodiscitis, infective endocarditis should be excluded, particularly in patients with a history of heart valve disease.     

Mitral valve repair for mitral insufficiency due to infective endocarditis in a patient with idiopathic thrombocytopenic purpura.

A 63-year-old woman with an 18-year history of idiopathic thrombocytopenic purpura (ITP) was admitted with a persistent fever of unknown cause. Blood culture was positive for alpha-Streptococcus and echocardiography revealed severe mitral regurgitation and vegetation on the mitral valve. After antimicrobial therapy for six weeks, she underwent mitral valve repair using a Cosgrove ring. The platelet count increased and remained stable by perioperative treatment with intravenous high-dose gamma-globulin and platelet transfusion without steroids therapy or splenectomy. The hospital course was uneventful. Perioperative high-dose gamma-globulin therapy and platelet transfusion for the cardiac operation were useful to increase and maintain the platelet count for an ITP patient complicated with infective endocarditis.