The respiratory system im chronic pyelonephritis

The respiratory system was studied in 221 patients with chronic pyelonephritis (CP), satisfactory renal function and varying arterial pressure (AP) using tests of systemic hemodynamics, echocardiography, zonal rheography of the lungs and rheospirography. Ventilation-perfusion correlations were also taken into account. It is shown that the respiratory system, along with circulatory organs, is involved in the pathological process at early stages of pyelonephritic inflammation. Patients with the so-called "normal high AP" develop vascular dysfunction in the lungs manifesting in enlarged pulmonary artery base without an increase in pressure gradient in it, gradual growth of resistance of not only systemic vascular bed of the greater but lesser circulation as well, ventilation dysfunction of the lungs by the restrictive type, imbalance between the ventilatory reserve and reserve of pulmonary and systemic blood flow with progression of arterial hypertension.     

不同镇痛方法对妊高症患者剖宫产术后凝血的影响

目的 研究硬膜外自控镇痛和静脉自控镇痛对妊高症患者剖宫产术后凝血状态及血栓形成的影响.方法 妊高症行剖宫产手术患者60例,随机分为三组,硬膜外自控镇痛组(P组,n=20例);静脉自控镇痛组(V组,n=20例);未用镇痛组(C组,n=20例).分别于术前、术后12h、术后24 h、术后48 h测定血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fib)、D-二聚体(D-D).结果 P组PT术后各时点明显较V组和C组延长,差异有统计学意义(P＜0.05) ;APTT术后12h、24 h较V组和C组明显延长,差异有统计学意义(P＜0.05) ;D-D术后各时点明显较V组和C组含量低,差异有统计学意义(P＜0.05).V组和C组间无明显差异(P＞0.05).TT、Fib各组间无明显差异(P＞0.05).结论 硬膜外自控镇痛对妊高症患者剖宫产术后凝血系统有抑制作用;静脉自控镇痛对妊高症患者剖宫产术后凝血状态无明显影响.     

妊娠期高血压患者与正常妊娠凝血功能及血栓前状态对比观察

目的：比较观察妊娠期高血压患者与正常妊娠患者凝血功能、血小板指标及血栓前状态（PTS）分子标志物水平。方法选择妊娠期高血压患者妊娠晚期50例,分为妊娠期高血压26例,轻度子痫前期组 l1例和重度子痫前期组13例;另外选择正常妊娠晚期（正常组）50例。所有病例均于入院后空腹抽取静脉血,分离血浆,采用酶联免疫吸附试验（ELISA）,严格按照试剂盒说明书,检测凝血功能（凝血酶时间、活化部分凝血活酶时间、血浆凝血酶原时间及纤维蛋白原）及血小板指标（PLT、MPV、PDW）,血栓前状态分子标志物 D 二聚体（D-D）、血管性血友病因子（vWF）水平。结果重度子痫前期组凝血功能、vwF 水平均明显高于妊娠期高血压组及轻度子痫前期组（P ＜0．05）,高于正常（P ＜0．01）。妊娠期高血压组及轻度子痫前期组与正常组比较,差异均无统计学意义（P ＞0．05）。结论重度子痫前期妊娠晚期患者血小板相关 PTS 分子标志物水平较正常妊娠晚期患者显著升高,其存在 PTS。且随着妊娠期高血压疾病加重,PTS 风险增高。     

The effects of combined platelet and leukapheresis on the blood coagulation system

Analysis of blood coagulation was done on samples of blood collected from ten donors undergoing combined platelet and leukapheresis using the Haemonetics Model 30 Blood Processor. Blood samples were obtained from the donors prior to, during, and following pheresis. Blood was also obtained from the blood-return line after the first collection of leukocytes and platelets, but before it was returned to the donor. Although the citrate anticoagulant was returned to the donor and there were some decreases in the concentrations of fibrinogen, platelets, and factors V and VIII, there were no changes of sufficient degree to suggest that development of a potential bleeding disorder. In addition there was no evidence to suggest that any activation of blood coagulation occurred during the pheresis or that thrombogenic substances were returned to the donors. Combined platelet and leukapheresis using the Haemonetics Model 30 Blood Processor, therefore, do not appear to subject the donor to risks for either bleeding or thrombotic complications.     

Severe acute pancreatitis and abnormalities in blood coagulation and fibrinolysis system

In acute pancreatitis, coagulo-fibrinolytic abnormalities may easily result in disseminated intravascular coagulation (DIC). The prognosis will become very poor, once bleeding necrosis or circulatory failure also occur in important internal organs other than the pancreas, leading to multiple organ failure. Changes in blood coagulation and fibrinolysis system may be greatly involved in the severity of acute pancreatitis. In medical treatment, it is necessary to be cautious of predictors of severity, and to perform the early diagnosis of DIC along with quick and positive intensive management.     

乌司他丁对人工关节置换术患者凝血和纤溶系统的影响

目的观察乌司他丁对人工关节置换术患者凝血和纤溶系统的影响。方法选择60例无血液疾病及凝血功能障碍、肝肾功能异常或服用相应药物的择期行全髋、半髋关节、人工股骨头置换术的骨科患者[美国麻醉师协会(ASA)Ⅰ～Ⅱ],随机分为乌司他丁组(Ⅰ组,n=30)和生理盐水组(Ⅱ组,n=30),分别在围术期静脉注射乌司他丁和生理盐水。在给药前(T0)、给药后1 h(T1)、给药后2 h(T2)采血测定凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、国际标准化比率(INR)及血小板的最大聚集率(PAGM)。结果与T0时比较,乌司他丁组T1时APTT、PT明显延长(P<0.05);T2时TT明显延长(P<0.05);与生理盐水组比较,T1时PT、APTT显著性延长(P<0.01);T2时PT、TT明显延长(P<0.05),两组用药前后及组间比较PAGM差异均无显著性。结论围术期静脉滴注5 000 U/kg乌司他丁可降低人工关节置换术患者术中的高凝血状态,预防术后深静脉血栓形成有积极作用。     

正常高值血压孕产妇凝血指标与妊娠结局的临床分析

目的:探讨正常高值血压孕产妇的凝血指标与妊娠结局。方法:回顾性分析2015～2017年在本院产检并分娩的1 500例孕妇的临床资料,其中正常高值血压组、正常血压组、妊娠期高血压疾病(HDP)组各500例,将一般资料、孕晚期血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)与妊娠结局进行分析。结果:正常高值血压组孕产妇孕次、产次、孕前体质指数(BMI)、孕期增重(GWG)以及孕晚期PT、FIB、剖宫产率,与正常血压组孕产妇差异有统计学意义(P0.05)。正常高值血压组孕产妇孕前BMI,孕晚期PLT、MPV、PDW、PT、APTT,胎盘早剥、产后出血、剖宫产率、早产、羊水过少、小于孕龄儿及胎儿窘迫,与HDP组孕产妇差异有统计学意义(P0.05)。结论:正常高值血压孕产妇部分凝血指标发生变化,除剖宫产率升高外,不良妊娠结局并未显著增加,临床一般无需特别纳入妊娠期高血压疾病管理。