普通冰冻血浆与新鲜冰冻血浆部分血浆组分的比较

目的:比较普通冰冻血浆(FP)和新鲜冰冻血浆(FFP)中血浆组分的差异.方法:随机选择北京市红十字血液中心提供的FP和FFP各20份,血浆融化后即刻分别检测凝血因子、纤溶系统及抗凝蛋白指标等12种血浆组分,即活化的部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血因子Ⅷ(FⅧ)活性、凝血因子V(FV)活性、纤维蛋...     

有机磷农药中毒并发中间综合征的早期防治

目的 :探讨有机磷农药中毒后并发中间综合征 (IMS)的早期防治措施。方法 :将中、重度有机磷农药中毒的 30 5例患者随机开放式分为治疗组 15 8例和对照组 14 7例 ,治疗组采用早期、突击剂量应用胆碱酯酶复活剂的治疗方法 (第 1个 2 4h氯磷啶平均用量 8.4± 1.1g) ,对照组采用传统的治疗方法 (第 1个 2 4h氯磷啶平均用量 3.2 5± 0 .5 g) ,观察两组胆碱酯酶恢复的时间 ,IMS的发生率及病死率 ,胆碱酯酶活力与IMS发生的关系。结果 :治疗组胆碱酯酶平均恢复的时间 (5 .8± 1.5d)较对照组(19.3± 3.5d)明显缩短 (P <0 .0 1) ;治疗组IMS的发生率 (5 .6 6 % )及病死率 (1.89% )较对照组 (2 5 .0 9%和 10 .2 7% )明显降低 (P <0 .0 1) ;并发IMS患者的胆碱酯酶活力均在 6 0 %以下。结论 :早期 (中毒 2h内 )足量 (第 1个 2 4h氯磷啶用量 8～ 10 g)应用胆碱酯酶复活剂是减少有机磷中毒后并发IMS及降低其病死率的有效措施。     

Analysis of Inpatient Use of Fresh Frozen Plasma and Other Therapies and Associated Outcomes in Patients with Major Bleeds from Vitamin K Antagonism

Objective

We conducted an observational study of outcomes and costs associated with fresh frozen plasma (FFP) use in patients receiving warfarin with intracerebral, gastrointestinal, or musculoskeletal bleeding.

Methods

Patients who had at least 1 International Classification of Diseases, Ninth Revision code indicative of anticoagulation history, received ≥1 unit FFP, and had patient costs >$0 were identified from a database of >600 US hospitals. The main outcome was transfusion of additional blood products (eg, cryoprecipitate, red blood cells, or platelets) or vitamin K. Further outcomes included administration of other bleeding-related therapies (eg, recombinant activated factor VII, albumin, or crystalloids), incidence of fluid overload, days in the intensive care unit, discharge status, and total hospital costs.

Results

The most frequently administered products were vitamin K and red blood cells, given to 55.6% to 61.0% and 19.2% to 29.3% of patients, respectively. The number of FFP units transfused correlated highly with fluid overload (r > 0.91) and was associated with inpatient mortality, nonhome discharge, and intensive care unit admittance. For both inpatient mortality and nonhome discharge, the odds ratio was significant when ≥4 units FFP were transfused (P < 0.05). A dose of >2 units FFP was associated with an increased probability of an intensive care unit stay (P < 0.05). Total costs were greater among patients receiving >2 units FFP compared with patients who received 1 unit FFP (P < 0.001), with a substantial increase in costs incurred when ≥4 units FFP were transfused.

Conclusions

In patients with warfarin-related bleeding, inpatient mortality, nonhome discharge, intensive care unit admission, and hospital costs were associated with the number of units of FFP transfused.     

The Alterations in Methylene Blue/Light-Treated Frozen Plasma Proteins Revealed by Proteomics

IntroductionThe aim of this study was to investigate the modified proteins in methylene blue/light-treated frozen plasma (MB-FP) compared with fresh frozen plasma (FFP) in order to gain a better application of MB/light-treated plasma in clinic transfusion.MethodsMB-FP and FFP were collected from Changchun central blood station, and a trichloroacetic acid/acetone precipitation method was used to remove albumin for the enrichment of lower abundance proteins. The plasma protein in MB-FP and FFP were separated using two-dimensional gel electrophoresis (2-DE) and the differentially expressed protein spots were analyzed using mass spectrometry. Finally, the differentially expressed proteins were tested using Western blot and enzyme-linked immunosorbent assay (ELISA).ResultsApproximately 14 differentially expressed protein spots were detected in the MB-FP, and FFP was chosen as the control. After 2-DE comparison analysis and mass spectrometry, 8 significantly differentially expressed protein spots were identified, corresponding to 6 different proteins, including complement C1r subcomponent (C1R), inter-alpha-trypsin inhibitor heavy chain H4 (ITI-H4), keratin, type II cytoskeletal 1 (KRT1), hemopexin (HPX), fibrinogen gamma chain (FGG), and transthyretin (TTR). Western blot showed no significant difference in the expression level of KRT1 between MB-FP and FFP (p > 0.05). Both Western blot and ELISA indicated that the level of HPX was significantly higher in FFP than in MB-FP (p < 0.05).ConclusionThis comparative proteomics study revealed that some significantly modified proteins occur in MB-FP, such as C1R, ITI-H4, KRT1, HPX, FGG, and TTR. Our findings provide more theoretical data for using MB-FP in transfusion medicine. However, the relevance of the data for the transfusion of methylene blue/light-treated plasma remains unclear. The exact modification of these proteins and the effects of these modified proteins on their functions and their effects in clinical plasma infusion need to be further studied.     

Survival Pattern in Patients with Acute Organophosphate Poisoning Receiving Intensive Care

Background. Approximately 35% of patients acutely poisoned with organophosphates (OP) in developing countries like Sri Lanka require intensive care and mechanical ventilation. However, death rates remain high. Objective. To study the outcomes and predictors of mortality in patients with acute OP poisoning requiring intensive therapy at a regional center in Sri Lanka over a period of 40 months. Methods. Retrospective analysis of all intensive care records of patients with acute OP poisoning admitted to the Intensive Care Unit (ICU) between March 1998 and July 2001. Results. During the study period, 126 subjects were admitted to the ICU with acute OP poisoning. Records of 10 patients were lost and those of 37 were incomplete and hence were excluded. All the remaining 71 patients (59 male) had required endotracheal intubation and mechanical ventilation for a period of four (median) days (range 1–27) in addition to gastric lavage and standard therapy with atropine and oximes and adequate hydration. Of these 71 patients, 36 (28 male) had died. Life table analysis demonstrated a steep decline in the cumulative survival to 67% during the first three days. Systolic blood pressure of < 100 mmHg and FiO₂ of > 40% to maintain a SpO₂ of > 92% within the first 24 h were recognized as poor prognostic indicators among mechanically ventilated patients. Conclusion. Mortality following OP poisoning remains high despite adequate respiratory support, intensive care, and specific therapy with atropine and oximes. One‐third of the subjects needing mechanical ventilation and reaching intensive care units die within the first 72 h of poisoning. Systolic blood pressure of less than 100 mmHg and the necessity of a FiO₂ > 40% to maintain adequate oxygenation are predictors of poor outcome in patients mechanically ventilated in the ICU.     

血栓弹力图在血浆输注中的应用

目的探讨血栓弹力图（TEG）在非血液病患者手术后凝血功能监测中的应用价值;并根据检测结果对术后患者输注新鲜冰冻血浆（FFP）的疗效进行评估。方法选择非血液病患者38例,于术后输注FFP前、输注200 ml及输注400ml FFP后分别进行TEG及传统凝血象检测。对两种实验方法的结果进行分析,并对3种状态下TEG检测结果进行比较。结果在输注FFP前、输注200 ml及输注400 ml FFP后3种状态下,R时间、K时间、Angle值及凝血综合指数CI值的差异有统计学意义（F值分别为23.405、20.869、19.978和31.243,P值均〈0.01）,但最大振幅（MA）值在上述3种情况下的差异没有统计学意义（F=1.651,P〉0.05）。3种状态下,PT、APTT、纤维蛋白原含量及凝血酶时间的差异均有统计学意义（F值分别为5.374、8.382、117.049和23.029,P值均〈0.01）。3种状态下凝血象与TEG-CK检测结果比较,显示2种检测方法的差异有统计学意义（χ^2=4.433,P〈0.05）。结论TEG适用于患者术后凝血功能监测。TEG结果显示,输注不同量FFP后患者凝血功能得到显著改善。     

农药中毒高磷酸血症需否机械通气探讨

目的 探讨有机磷农药中毒所致中间型综合征患机械通气脱机后单纯性高碳酸血症时有无再用机械通气的必要。方法 回顾性分析脱机后单纯性二氧化碳滞留病人３６例,分机械通气组（１６例）和停机观察组（２０例）,对比两组继续住院日数和院内肺部感染率,以及停机观察组不同时间的心率、呼吸、血压、血气分 肾功能和电解质。结果 停机观察组的继续住院日数和际内肺部感染率均小于机械通气组（Ｐ〈０．０１或Ｐ〈０．０５）,停机     

急性有机磷农药中毒中间综合征17例分析

目的：探讨急性有机磷农药中毒中间综合征（IMS）的临床特点及临床处理对策。方法：对17例急性有机磷农药中毒中间综合征患者的临床资料进行分析。结果：IMS出现在中毒后1～5d,经积极救治17例中完全治愈13例,好转1例,死亡3例。结论：中间综合征以对症支持治疗为主。急性期应用阿托品的同时,及早、足量、重复应用肟类复能剂以及适时应用机械通气可有效防治中间综合征。     

无偿献血者血管性血友病因子的含量及临床意义

目的通过检测献血者血浆中血管性血友病因子(vWF),为其制备冷沉淀和临床应用提供依据。方法应用酶联免疫吸附法检测无偿献血者血浆和普通冰冻血浆中vWF含量。结果无偿献血者血浆中vWF含量为(125.81±48.71)%,去冷沉淀血浆中含量为(25.52±9.29)%。结论无偿献血者血液采集后6h内分离的血浆,其vWF含量稳定,可用于冷沉淀制备和临床应用。     

药锤与导引疗法治疗肩周炎的疗效观察

我科于1989年12月开始用药锤疗法配合导引治疗肩周炎110例,其中治愈44例,显效49例,好转16例,无效1例,显效率为84.5％。其中30例治疗前后经 WQ-9E 型痛阈测量仪测定,治疗后痛阈、耐痛阈均有明显提高,P<0.01。结果表明本疗法疗效明显,简便易行,是治疗肩周炎较理想的新方法。     

阿托品对急性有机磷农药中毒患者预后的影响

目的探讨阿托品对急性有机磷农药中毒患者预后的影响。方法对87例急性有机磷农药中毒患者进行回顾性研究,Ⅰ组(服毒后4h内达到阿托品化)47例,Ⅱ组(服毒4h后达到阿托品化)40例,比较两组并发症发生率和病死率。结果与Ⅰ组相比,Ⅱ组病死率高,并发症发生率高,并且达到阿托品化的时间与CK、CK-MB、ALT分别呈正相关。结论急性有机磷农药中毒患者达到阿托品化越早,临床预后越好。     

血浆纤维蛋白原水平在肾小球疾病中的临床意义

目的：分析肾小球疾病患者血浆纤维蛋白原（Fibrinogen,FIB）浓度的影响因素,并探讨其临床意义。方法测定246例肾活检肾小球疾病患者血浆FIB浓度。按尿蛋白排泄量（UP）分为肾病范围蛋白尿患者60例,非肾病范围蛋白尿186例,同时检测血清白蛋白（ALB）水平、总胆固醇（TC）、甘油三酯（TG）、UP以及血肌酐值（SCr）等指标,并分析血浆FIB浓度与上述指标之间的相关性。并观察不同病理类型与上述临床指标之间的相关性。结果1.肾病范围蛋白尿组血浆FIB浓度显著高于非肾病范围蛋白尿组,差异具有统计学意义（F=9.226,P＜0.01）。2.肾病范围蛋白尿组血浆FIB浓度与ALB呈负相关关系（r=-0.363,P＜0.05）,与TC（r=0.327,P＜0.05）、TG（r=0.285,P＜0.05）及UP（r=0.361, P＜0.05）均呈正相关关系,与SCr无相关性（r=0.003,P＞0.05）。3.非肾病范围蛋白尿组血浆FIB浓度与ALB呈负相关关系（r=-0.464,P＜0.05）,与TC（r=0.304,P＜0.05）、TG（r=0.175,P＜0.05）、SCr（r=0.277,P＜0.05）及UP （r=0.302,P＜0.05）均呈正相关关系。4.肾病范围蛋白尿微小病变性肾炎组血浆FIB浓度、UP较其余4组显著升高（P＜0.05）,ALB水平较其余4组明显降低（P＜0.05）,TC、TG与其余组间比较差异无统计学意义（P＞0.05）。非肾病范围蛋白尿微小病变性肾炎组血浆FIB浓度显著低于其余4组（P＜0.05）,TG较其余4组明显降低（P＜0.05）;膜性肾病组UP显著高于系膜增生、微小病变组（P＜0.05）,ALB水平明显低于其余各组（P＜0.05）。结论高FIB血症与低白蛋白血症密切相关,与肾脏病理类型无直接关系。     

急性砷化氢中毒的预后因素分析

目的 评估急性砷化氢中毒患者的临床预后,指导早期干预和治疗。 方法 回顾性分析2010年7月－2014年1月收治的20例急性砷化氢中毒患者的临床资料,通过单因素分析,比较死亡和存活患者中毒至首次救治的时间,尿砷浓度、血常规和肝肾功能检查、电解质、心肌酶及动脉血气分析等指标的差异性。并根据单因素分析结果,将上述有阳性意义的指标进行logistic回归分析,探寻可能影响患者生存的影响因素。 结果 死亡组患者中毒至救治的时间、尿砷浓度、血清总胆红素、肌酐、肌酸激酶明显高于存活组,而pH值、HCO3？、碱乘余值均低于存活组,差异有统计学意义（P＜0. 05）。logistic 回归分析显示,上述指标对生存有显著影响。 结论 急性砷化氢中毒后救治时间窗,心、肝、肾等脏器受损和酸碱失衡的程度与患者的生存预后密切相关,及早地掌控上述情况,并根据结果积极开展救治,有助于改善患者的预后。     

产后应用血浆置换治疗HELLP综合征30例临床效果及微循环变化

目的观察产后应用血浆置换（TPE）治疗HELLP综合征的临床效果及微循环变化。方法30例HELLP综合征患者,产后常规治疗48h效果不佳,病情迁延,应用TPE进行治疗,TPE前后观测甲襞微循环变化。观察临床疗效,应用,检验对微循环参数变化进行统计学分析。结果30例HELLP综合征患者治愈出院26例,死亡4例,死亡率为13．3％。健康存活的26例中,血小板计数在TPE后48～72h恢复正常,肝酶在TPE后1～2周恢复正常,血压在2～5d后恢复正常。患者甲襞微循环管襻形态、血液流态、襻周状态及总积分值均有改善（P〈0．05）。结论产后应用TPE可有效治疗病情迁延的HELLP综合征,纠正微循环障碍。     

大鼠急性氧化乐果中毒呼吸衰竭与救治

目的　探讨氧化乐果中毒致呼吸肌麻痹的形成过程,寻找防治呼吸肌麻痹的合理方案。方法　所有实验大鼠均给予同等程度(2LD     

A Study of Comparative Antihemophilic Factor Levels in Fresh Frozen Plasma in Vitro and in Vivo

The stability of AHF in fresh frozen plasma stored at −30 C. was found to be the same for plasma stored in glass containers, silicone-coated or plastic containers. Less than 24 per cent of the original AHF was lost during storage for periods up to 126 days. Shaking the plasma during thawing was shown to have a deleterious effect on the AHF activity. The rate of loss of AHF activity from plasma kept at room temperature after thawing was rapid, regardless of the nature of the storage vessel.
In vivo experiments demonstrated good correlation between AHF levels in fresh frozen plasma and the actual rise in AHF activity of a patient with severe hemophilia.     

Effects of Adenine on Clotting Factors in Fresh Blood, Stored Blood, and Stored Fresh Frozen Plasma

The addition of small quantities of adenine to whole blood may prolong the useful shelf life of bank blood. The present study was undertaken to evaluate the effects of adenine on the clotting factors in blood containing ACD and CPD. Units of whole blood were collected in ACD, ACD-adenine, CPD and CPD-adenine, and each was stored 42 days under standard blood bank conditions. Samples of fresh frozen plasma containing these anticoagulants were stored three to four months at -30 C. Assays of Factors V, VIII (AHF), IX (PTC), X (Stuart Factor), fibrinogen, and prothrombin were performed on fresh blood, stored blood and stored fresh frozen plasma. The presence of small quantities of adenine did not appear to produce any appreciable alteration in the activity of the clotting factors in fresh blood. Further, adenine did not appear either to improve or worsen the survival of the procoagulants in whole blood stored 42 days or in fresh frozen plasma stored three to four months. There was significant deterioration of Factors V and VIII in whole blood stored 42 days in ACD, ACD-adenine, CPD, and CPD-adenine, but the degree of storage loss was independent of the anticoagulant employed. Factor X, fibrinogen, and prothrombin remained stable in blood stored 42 days regardless of the anticoagulant used, but Factor IX activity increased during storage possibly as the result of contact activation. Fresh frozen plasma stored three to four months showed a uniform slight loss of Factor VIII in all four anticoagulants, but Factors V, IX, X, fibrinogen, and prothrombin remained stable in stored fresh frozen plasma regardless of the anticoagulant employed.     

盐酸戊乙奎醚及阿托品治疗急性有机磷农药中毒效果的Meta分析

目的评价我国文献报道的盐酸戊乙奎醚与阿托品治疗急性有机磷农药中毒（acuteorganophosphoruspes-ticidepoisoning,AOPP）的效果及安全性。方法检索维普中文科技期刊、万方医学数据库、中国知网2000年1月-2010年12月收录的文献中有关盐酸戊乙奎醚与阿托品治疗AOPP效果的比较研究,以Peter等的文献质量评价系统对纳入文献进行质量评价,采用RevMen5．0软件进行Meta分析。结果共纳入6篇文献480例,试验组（采用盐酸戊乙奎醚治疗）229例,对照组（采用阿托品治疗）251例。6篇文献均为中、高质量文献,基线资料比较无显著差异。Meta分析结果显示试验组治愈率较对照组高14％[RR：1．14,95％CI（1．08,1．20）,P〈0．00001],平均住院时间较对照组缩短4．45d[MD=-4．45,95％CI（-6．56,-2．35）,P〈0．0001],不良反应发生率较对照组降低92％[RR=0．08,95％CI（0．04,0．15）,P〈0．00001]。结论从现有临床证据看,盐酸戊乙奎醚治疗AOPP效果较阿托品好,但由于可供分析的样本量有限,尚需更多大宗病例的随机临床对照试验结果进一步验证。     

活性炭血液灌流对有机磷农药敌敌畏和解毒药阿托品的作用

目的评估活性炭血液灌流对有机磷农药敌敌畏和解毒药阿托品的作用。方法在人血样(由解放军307医院血库提供的正常人血样)中加入敌敌畏和阿托品后,分成空白对照组和血液灌流组,观察灌流前后血中敌敌畏浓度和阿托品浓度以及血清中胆碱酯酶活力的变化。结果活性炭血液灌流中敌敌畏和阿托品的吸附率分别为(0.98±0.05)%和(0.68±0.01)%。在混合吸附试验中,吸附后的阿托品和敌敌畏之比较吸附前浓度之比增加。同时,吸附后假性胆碱酯酶活力比吸附前增长了近3倍。结论虽然在体外人血中活性炭血液灌流对人血中敌敌畏的吸附率较低(与空白组比较,P>0.05),但大大提高了血清中胆碱酯酶活力,同时提高了血中阿托品和敌敌畏的浓度之比,从而更易到达阿托品化。     

联合血浆置换治疗急性重症有机磷农药中毒31例临床分析

目的:探讨血浆置换(PE)治疗急性重症有机磷农药中毒(ASOPP)的疗效。方法:将2011年1月-2014年5月收治的ASOPP患者62例随机分为对照组和研究组各31例,分别常规疗法和联合应用PE治疗,比较两组的临床疗效。结果:与对照组相比,研究组阿托品化、显著效果的时间和住院时间均明显缩短,中间综合征、反跳例数、死亡率均明显减少,治愈率明显增高,P均0.05。结论:在常规治疗的基础上联合PE治疗ASOPP的抢救成功率高,死亡率低,并发症少。