储血器放置不同高度对术中自体回收红细胞溶血损伤的影响

目的探讨储血器放置不同高度对脊柱手术患者自体回收红细胞溶血损伤的影响。方法选择拟在全麻下行脊柱手术的择期患者90例,男47例,女43例,年龄33～65岁,体重53～82 kg,ASAⅠ或Ⅱ级,术中均使用自体血液回收机行血液回收。采用随机数字表法随机分为三组:进血口高置组(H组)、进血口正常组(N组)和进血口低置组(L组),每组30例。H组:储血器进血口高于手术野水平30 cm;N组:储血器进血口与手术野同一水平;L组:储血器进血口低于手术野水平30 cm。手术结束前,对储血器内回收的血液进行离心、洗涤,抽取洗涤后的血样,行红细胞渗透脆性实验,计算在不同浓度的低渗NaCl溶液中红细胞的溶血率;分别于洗涤血样静置即刻(T_0)、1 h(T_1)和2 h(T_2)时检测洗涤血样上清液中游离血红蛋白(FHb)的浓度。结果在NaCl浓度为0.48%～0.68%时洗涤血红细胞溶血率H组明显高于N组和L组(P0.05)。与T_0时比较,T_1、T_2时H组FHb浓度明显升高,T_2时N组和L组FHb浓度明显升高(P0.05);与T_1时比较,T_2时三组FHb浓度均明显升高(P0.05)。T_1、T_2时H组FHb浓度明显高于N组和L组(P0.05)。结论在血液回收过程中,储血器进血口位于手术野同一水平或低于手术野30 cm时对回收红细胞造成的溶血损伤低于放置在手术野上方30 cm者。     

A validated computational fluid dynamics model to estimate hemolysis in a rotary blood pump

A major part of developing rotary blood pumps requires the optimization of hemolytic properties of the entire pump. Application of a suited computational fluid dynamics (CFD)-based hemolysis model allows approximation of blood damage in an early phase of the design process. Thus, a drastic reduction of time- and cost- intensive hemolysis experiments can be achieved. For the MicroDiagonal Pump (MDP), still under development at Helmholtz-Institute in Aachen, Germany, different pump configurations have been analyzed, both numerically and experimentally. The CFD model of the pump has been successfully validated based on the comparison of the pressure head curves (H-Q curves), as discussed in a prior publication. In the present study, the authors focus on the development of a semiempiric blood damage model using the CFD and in vitro hemolysis data. On the one hand, mean key characteristics (shear stress and exposure time) and other characteristics affecting blood damage have been calculated based on numerical data. On the other hand, in vitro hemolysis tests have been accomplished in order to determine the hemolytic curves of two different pump configurations (with the same impeller but different tip clearances). Finally, a new function based on a general power law has been defined by means of the mean key characteristics. The unknown constants of the function have been determined by multidimensional regression analysis using the hemolytic curves. For the final validation of this new blood damage model, the calculated and the in vitro obtained hemolysis indices at the specific VAD operating point have been compared for all pump configurations. The comparison showed an excellent agreement, both qualitatively and quantitatively.     

滤除白细胞对自体回收血诱发大出血手术患者全身炎性反应的影响

目的 评价滤除白细胞对自体回收血诱发大出血手术患者全身炎性反应的影响.方法 选择预计大出血手术需进行自体血液回输患者24例,年龄28～56岁,体重53～78kg,随机分为2组(n=12):对照组(C组)和白细胞滤除组(T组).C组不使用白细胞过滤器,T组于泵后串联LG6型白细胞过滤器,分别于自体血回输前即刻、回输后5、10、30、60 min时抽取桡动脉血3 nd,测定血浆肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6和IL-8的浓度,计数白细胞(WBC)和中性粒细胞(PMN).结果 与自体血回输前即刻比较,自体血回输后各时点两组血浆TNF-α、IL-6、IL-8的浓度及WBC和PMN计数均升高(P<0.05);与C组比较,T组于自体血回输后各时点WBC和PMN计数降低,血浆TNF-α、IL-6、IL-8浓度降低(P<0.05).结论 滤除自细胞可减轻自体回收血诱发大出血手术患者全身炎性反应的程度.     

A new model of centrifugal blood pump for cardiopulmonary bypass: design improvement, performance, and hemolysis tests

A new model of blood pump for cardiopulmonary bypass (CPB) application has been developed and evaluated in our laboratories. Inside the pump housing is a spiral impeller that is conically shaped and has threads on its surface. Worm gears provide an axial motion of the blood column. Rotational motion of the conical shape generates a centrifugal pumping effect and improves pumping performance. One annular magnet with six poles is inside the impeller, providing magnetic coupling to a brushless direct current motor. In order to study the pumping performance, a mock loop system was assembled. Mock loop was composed of Tygon tubes (Saint-Gobain Corporation, Courbevoie, France), oxygenator, digital flowmeter, pressure monitor, electronic driver, and adjustable clamp for flow control. Experiments were performed on six prototypes with small differences in their design. Each prototype was tested and flow and pressure data were obtained for rotational speed of 1000, 1500, 2000, 2500, and 3000 rpm. Hemolysis was studied using pumps with different internal gap sizes (1.35, 1.45, 1.55, and 1.7 mm). Hemolysis tests simulated CPB application with flow rate of 5 L/min against total pressure head of 350 mm Hg. The results from six prototypes were satisfactory, compared to the results from the literature. However, prototype #6 showed the best results. Best hemolysis results were observed with a gap of 1.45 mm, and showed a normalized index of hemolysis of 0.013 g/100 L. When combined, axial and centrifugal pumping principles produce better hydrodynamic performance without increasing hemolysis.     

自体血回输及异体输血前后病人血浆IL-2及IL-6的变化

目的 比较全麻下骨科手术自体血回输及异体输血对病人血浆白介素－2（IL－2）及白介素－6（IL－6）的影响。方法 57例骨科病人，随机分为两组：Ⅰ组，自体血回输，31例：Ⅱ组，异体输血，26例。两组均于麻醉前、术后第2天、第7天采外周静脉血3ml，肝素抗凝离心后取血浆冷冻备检测。结果 术后第2天，Ⅱ组IL－2较术前及Ⅰ组明显下降（P＜0.05）；IL－6在术后第2天、第7天两组病人都有升高；术后第2天Ⅰ组较术前和Ⅱ组升高非常显著（P＜0.01），术后第7天Ⅰ组升高显著（P＜0.05）。结论 自体血回输组病人IL－2下降不明显，IL－6明显升高，对病人的免疫功能影响较小；异体输血组IL-2明显下降，IL－6升高不显著，对病人的免疫功能有一定的抑制作用。     

自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用

目的观察术前自体血小板分离联合术中自体血回输对骨科手术患者凝血功能的影响作用。方法60例骨科择期手术患者（预计出血量〉1000ml,ASAⅠ～Ⅱ级）,随机分为3组,每组20例患者。Ⅰ组采用术前自体血小板分离联合术中自体血回输,Ⅱ组采用单纯术中自体血回输,Ⅲ组不进行任何血液保护措施。各组分别于麻醉前、血小板分离后10min、保存的血小板或自体血回输前10min、回输后10min、术后24h、术后48h检测相应时点的血红蛋白水平、凝血功能、血小板水平和聚集功能、术中术后出血量及异体输血情况。结果三组的一般资料、术中出血量、术中术后的血红蛋白水平比较未见明显差异。与Ⅰ组相比,Ⅱ、Ⅲ组术后24h和术后48h的血小板水平和聚集功能明显降低（P〈0．05）,术后出血量及异体输血率则明显增高（P〈0．01）。结论术前自体血小板分离联合术中自体血回输可明显改善骨科手术患者的凝血功能,并有效降低术后出血量和异体血的输注。     

全麻手术中自体血液回输和异体输血病人T淋巴细胞及其亚群改变的比较

目的 比较自体血液回输及异体输血对病人Ｔ淋巴细胞及其亚群的影响。方法 ６０例脊柱四肢非肿瘤无免疫系统疾病病人随机分为三组,Ⅰ组：自体输血组（ｎ＝２１）,Ⅱ组：异体输血组（ｎ＝２０）,Ⅲ组：不输血组（ｎ＝１９）。三组病人于麻醉前、术后第２ｄ、第７ｄ检测外周静脉血内ＣＤ３＾＋、ＣＤ４＾＋４＾＋／ＣＤ８＾＋比值。结果 三组病人术前各项指标无明显差异（Ｐ〉０．０５）;Ⅰ组和Ⅲ组术后第２ｄ、第７ｄ与术前比较及两组间比较无明显差异（Ｐ〉０．０５）;Ⅱ组病人术后第２ｄ与术前比较及与Ⅰ组、Ⅲ组术后第２ｄ比较ＣＤ３＾＋、ＣＤ４＾＋、ＣＤ８＾＋明显下降（Ｐ〈０．０５）,ＣＤ４＾＋／ＣＤ８＾＋比值无明显改变（Ｐ〉０．０５）,术后第７ｄ各组指标与术前比较及组间比较无明显差异（Ｐ〉０．０５）。结论 自体血液回输对病人Ｔ细胞免疫功能影响较     

腕投掷运动时腕关节韧带长度变化的活体研究

目的 探讨腕关节在投掷运动过程中腕关节韧带长度的变化.方法 对6例志愿者腕关节进行CT扫描,获取腕关节在投掷运动过程中的5个位置,即桡偏20°背伸60°,桡偏10°背伸30°,中立位,尺偏20°掌屈30°,尺偏40°掌屈60°时各腕骨、尺桡骨远段的三维重建图像,在重建图像基础上利用Mimics软件测得在腕关节投掷运动过程中掌、背侧腕关节韧带的长度.结果 腕关节由中立位至桡偏20°背伸60°时桡舟头韧带、长桡月韧带、尺头韧带、尺三角韧带长度显著伸长,分别延长(3.4±0.5)、(2.0±0.2)、(2.6±0.5)、(2.1±0.4)mm,差异均有统计学意义(P<0.05);腕关节由中立位至尺偏400掌屈60°时背侧桡腕韧带、背侧骨间韧带止于小多角骨部分长度显著伸长,分别延长(1.7 ±0.2)、(3.8 ±0.4)mm,差异有统计学意义(P<0.05).尺月韧带、背侧骨问韧带止于舟骨部分在投掷运动过程中其长度均较中立位时旱增长趋势.结论 腕关节在桡背伸至尺掌屈运动过程中,桡舟头韧带、长桡月韧带、尺头韧带、尺三角韧带缩短,提示张力减低,背侧桡腕韧带、背侧骨间韧带止于小多角骨部分伸长,张力增大,尺月韧带、背侧骨间韧带止于舟骨部分于中立位时张力最小,其变化规律有助于指导临床腕关节韧带损伤的修复.     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

目的 评价Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性.方法 拟行剖宫产术的Rh(D)阴性血型病人30例,年龄20～35岁,体重50～80 kg,ASA分级Ⅰ或Ⅱ级.静脉输注乳酸钠林格氏液7 ml/kg后经桡动脉采血,采血速率60～80 ml/min,采血同时静脉输注与采血等速率的6%羟乙基淀粉130/0.4.采集的自体血经2个循环的直接法分离为富含血小板血浆、贫血小板血浆和浓缩红细胞,每个循环以分离出红细胞后15 s时停止采血.出血量≥全身血容量的20%时立即回输自体血;出血量<全身血容量20%者,在缝合子宫后回输,依次回输富含血小板血浆、输贫血小板血浆和输浓缩红细胞.监测母体生命体征指标和胎儿心率.记录自体血采集过程中低血压和心动过速的发生情况.分别于采血前(基础状态)、采血结束时、自体血回输前和术后24 h时采集外周静脉血样,测定Hb、Hct、Plt、PT、APTT、INR和Fib.胎儿娩出后采集脐动脉血样,进行血气分析.于胎儿娩出后1、5min时行Apgar评分.记录术中出血量和异体输血情况.结果 自体血采集过程中未见低血压和心动过速的发生,胎儿HR维持在正常范围.与基础状态比较,其他时点SpO2、Hb、Hct、Plt、PT、APTT、INR和Fib差异无统计学意义(P>0.05).脐动脉血pH值、BE和乳酸浓度均在正常范围内.胎儿娩出后1、5 min时Apgar评分分别为(9.0±0.8)、(9.2±0.8)分;术中出血量(405±28)ml,所有病人未输注异体血.结论 Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性良好.

Abstract：

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.     

输去白红细胞血对肿瘤患者围术期细胞免疫功能的影响

目的　探讨输去白红细胞血对胃癌、结肠癌患者围术期T淋巴细胞亚群及自然杀伤(NK)细胞的影响。方法　 30例胃癌、结肠癌手术患者 ,随机分为三组 :输盐水组 (Ⅰ组 ) ,输全血组(Ⅱ组 ) ,输去白红细胞组 (Ⅲ组 ) ,每组 10例 ,分别于术前、术后第 1、5天抽取外周静脉血 ,用流式细胞仪测定血T淋巴细胞亚群CD3+ 、CD4 + 、CD8+ 、CD4 + /CD8+ 比值及CD5 6 + 的变化。结果　与术前相比 ,术后第 1天三组患者CD3+ 、CD4 + 、CD8+ 、CD4 + /CD8+ 及CD5 6 + 均显著降低 (P <0 0 5 )。术后第 5天Ⅱ组CD3+ 、CD4 + 、CD8+ 、CD5 6 + 明显低于术前水平 (P <0 0 5 ) ;而Ⅰ组及Ⅲ组各指标均接近术前水平 (P >0 0 5 )。结论　围术期异体输血严重抑制患者的免疫功能。输去白红细胞血对机体的免疫抑制轻 ,术后免疫功能较快恢复。因此 ,在确实要输异体血时 ,最好滤除白细胞 ,以减轻异体血对肿瘤患者免疫功能的抑制作用。     

Frequency of homologous blood transfusion in patients undergoing cleft lip and palate surgery

Aim:

The study aims to determine the frequency of homologous blood transfusion in patientsundergoing cleft lip and palate surgery at the Lagos University Teaching Hospital, Nigeria.

Setting and Design:

A prospective study of transfusion rate in cleft surgery conducted at the Lagos University Teaching Hospital, Nigeria.

Material and Methods:

One hundred consecutive patients who required cleft lip and palate surgery were recruited into the study. Data collected included age, sex and weight of patients, type of cleft defects, type of surgery done, preoperative haematocrit, duration of surgery, amount of blood loss during surgery, the number of units of blood cross-matched and those used. Each patient was made to donate a unit of homologous blood prior to surgery.

Results:

There were 52 females and 48 males with a mean age of 64.4 ± 101.1 months (range, 3-420 months). The most common cleft defect was isolated cleft palate (45%) followed by unilateral cleft lip (28%). Cleft palate repair was the most common procedure (45%) followed by unilateral cleft lip repair (41%). The mean estimated blood loss was 95.8 ± 144.9 ml (range, 2-800ml). Ten (10%) patients (CL=2; CP=5, BCL=1; CLP=2) were transfused but only two of these were deemed appropriate based on percentage blood volume loss. The mean blood transfused was 131.5 ± 135.4ml (range, 35-500ml). Six (60%) of those transfused had a preoperative PCV of < 30%. Only 4.9% of patients who had unilateral cleft lip surgery were transfused as compared with 50% for CLP surgery, 11% for CP surgery, and 10% for bilateral cleft lip surgery.

Conclusions:

The frequency of blood transfusion in cleft lip and palate surgery was 10% with a cross-match: transfusion ratio of 10 and transfusion index of 0.1. A "type and screen" policy is advocated for cleft lip and palate surgery.     

银屑病患者血细胞参数及血脂分析的临床意义

目的：探讨血细胞参数及血脂有关项目测定对银屑病的临床意义。方法我院银屑病患者52例和正常对照100例同时检测11项血细胞参数及胆固醇和血脂。结果银屑病及其进行期MCV、RDW、MPV、PDW、CH、TG均显著高于对照人群。结论银屑病与心血管疾病的病理及生理基础有相同之处,所以银屑病患者易发心血管疾病与血细胞参数及血脂的变化有关。     

围手术期输血对恶性肿瘤患者的影响

输血可以促进肿瘤患者术后复发,并且降低5年生存率.即使是处于肿瘤早期,少量输血也有明显影响.输血引起肿瘤复发的机制可能是由于输血抑制了受血者的免疫功能,从而使残余肿瘤细胞得以迅速增长.本文就肿瘤患者围手术期输血的几个相关问题进行探讨,提出如何权衡输血对肿瘤患者的利弊,以及在肿瘤患者输血中如何进行自体输血和血液替代品的应用,从而严格掌握肿瘤患者输血指征,提高输血治疗的质量.     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.     

强直性脊柱炎血液流变学的变化

目的 研究强直性脊柱炎（ＡＳ）患者血液流变学的变化。方法 对５２例ＡＳ患者和５０例健康成人分别进行血液流变学测定。包括红细胞压积、红细胞沉降率、纤维蛋白原、全血表观粘度值、血浆粘度值、红细胞和血小板电泳时间等指标的测定。结果 患者组红细胞压积、纤维蛋白原、全血表观粘度（４Ｓ＾－１￣２００Ｓ＾－１）均明显增加,血浆粘度、红细胞电泳时间及血小板电泳时间均增加。结论 ＡＳ患者疼痛发作期血液流变学有明显改变,血液呈微凝态。     

静脉血栓栓塞症患者外周血嗜酸性粒细胞与血小板、凝血功能指标、C-反应蛋白的相关性分析

目的:探讨静脉血栓栓塞症(VTE)患者外周血嗜酸性粒细胞(EOS)绝对计数与血小板(PLT)计数、凝血功能指标、C反应蛋白(CRP)的潜在相关关系。方法:回顾性收集2014年4月—2017年6月收治的908例深静脉血栓形成(DVT)和肺血栓栓塞症(PE)患者的临床资料和入院初次血液学检查结果,比较不同特征患者外周血EOS绝对计数、PLT计数、血浆凝血酶原时间(PT)、国际标准化比值(INR)、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)、抗凝血酶Ⅲ活性(AT-Ⅲ)、CRP的变化,并分析EOS绝对计数与其他指标的相关性。结果:不同性别、不同DVT分型、不同分期患者的外周血EOS绝对计数不同,男性高于女性,混合型患者高于周围型患者,亚急性期和慢性期患者高于急性期患者(均P0.05);所有其他指标也均在部分特征分组中存在明显差异(均P0.05)。EOS绝对计数与PLT计数、PT、INR、APTT、D-D、CRP存在相关关系,且相关程度随着患者年龄的变化而变化(均P0.05)。结论:EOS可通过多条途径激活和促进凝血,同时影响抗凝系统,最终导致血栓形成。不同类型VTE患者外周血EOS水平存在差异,EOS绝对计数与PLT、凝血功能指标、CRP表现出潜在的相关性,提示外周血EOS在VTE的病情判断和预后评估中具有一定的临床意义。     

Restrictive blood transfusion protocol in malignant upper gastrointestinal and pancreatic resections patients reduces blood transfusions with no increase in patient morbidity

Background

The purpose of this study was to determine the impact of a restrictive blood transfusion protocol on the number of transfusions performed and the related effect on patient morbidity.

Methods

A cohort study was performed using our prospective database with information from January 1, 2000, to June 1, 2013. The restrictive blood transfusion protocol was implemented in September 2011, so this date served as the separation point for the date of operation criteria.

Results

For the study, 415 patients undergoing operation for an abdominal malignancy were reviewed. After the restrictive blood transfusion protocol, the percentage of patients who received blood dropped from 35.6% to 28.3%. The percentage of patients who experienced perioperative complication was significantly higher in transfused patients compared with those who did not receive blood (P = .0001). There was no statistical significance observed between the 5 groups for the length of stay at the hospital after their procedure.

Conclusions

The restrictive blood transfusion protocol resulted in a reduction of the percentage of patients transfused, and there was no evidence to suggest that it negatively affected the outcomes of patients in this group.     

围术期输血对肺癌患者外周血T细胞亚群、肿瘤坏死因子的影响

目的　探讨围术期输血对肺癌患者免疫功能的影响。方法　分别以流式细胞仪和酶联免疫吸附法检测 60例非小细胞肺癌患者术前、术中 60min、术后 1、7d外周血T细胞亚群及血浆肿瘤坏死因子 (TNF)水平的变化。 3 5例健康人员为正常对照。结果　肺癌患者外周血中CD3 、CD4 、CD4 /CD8 明显低于健康对照组 ,CD4 /CD8 变化尤为明显 (1.92± 0 .5、0 .5 0±0 .1,P <0 .0 1) ,而TNF、CD8 明显高于对照组。输血组在术后表现为CD3 、CD4 /CD8 的降低和CD8 的明显升高 ,与未输血组比较差异有显著性 ,术后 1dCD4 下降显著 (16.5± 1.7、2 2 .5±1.7,P <0 .0 1)。围术期TNF变化不明显 ,术后 7dT细胞亚群和TNF趋于恢复。结论　肺癌患者免疫功能处于抑制状态 ,围术期输血可加重患者免疫功能的紊乱     

Postoperative blood loss in patients undergoing coronary artery bypass surgery after preoperative treatment with clopidogrel. A prospective randomised controlled study

Objective: The optimal timing for discontinuation of clopidogrel before surgery remains under debate. The purpose of this study is to determine the effect of preoperative clopidogrel administration on postoperative blood loss and the total requirements of homologous blood products after coronary artery bypass grafting (CABG). We also evaluated the perioperative complications. Methods: Consecutive patients (n = 130) undergoing elective CABG were recruited and randomised between 2006 and 2007. In 38 patients (group 1), treatment with clopidogrel was discontinued 5 days prior to surgery, in 40 patients (group 2) 3 days before surgery and in 40 other patients (group 3) clopidogrel was stopped on the day of surgery. Results: Significantly more postoperative blood loss was observed in group 3 compared to group 1 (929 ± 472 ml vs 664 ± 312 ml; p = 0.009). Other group comparisons were not significant. Blood loss after 12 h and at drain removal was also significantly higher in group 3. Patients in group 3 also had higher total requirements of homologous blood products (p = 0.046) and a significantly higher need for fresh frozen plasma (FFP) transfusion (p = 0.034). Univariable regression analyses revealed that continuing clopidogrel till the day of surgery (group 3) was predictive for postoperative blood loss (β = 0.289; p = 0.007) and the total requirements of homologous blood products after surgery (β = 0.280; p = 0.008). These effects remained the same in multivariable analyses. Conclusions: Continuation of clopidogrel until the day of surgery induces significantly more postoperative blood loss and increases significantly the total requirements of homologous blood products and FFP transfusion after surgery. The blood loss and the use of blood products in the group that stopped at 3 days preoperatively were similar to that of the group that stopped at 5 days preoperatively.