血液透析对尿毒症患者凝血及纤溶系统的影响

目的：观察血液透析对尿毒症患者凝血、纤溶系统的影响。方法：选取尿毒症维持血液透析患者52例及同期正常对照组45例，分别对透析组与对照组，和血液透析前后患者血浆凝血酶调节蛋白（TM）、血管性血友病因子（VWF）、凝血酶-抗凝血酶复合物（TAT）、纤溶酶-抗纤溶酶复合物（PAP）浓度进行比较分析。结果；透析组血液中TM、vWF、TAT、PAP浓度均较正常对照组明显增高（P〈0．001）。透析组患者透析后TM、vWF、TAT、PAP浓度较透析前明显升高（P〈0．01）。结论：尿毒症患者存在明显凝血、纤溶功能紊乱，血液透析加重其紊乱程度。     

创伤骨科病人围手术期凝血、纤溶活性的临床观察

目的　探讨骨折创伤后机体的凝血与纤溶活性变化及与发生血栓性疾病的关系。方法　选择创伤骨科手术患者 6 0例 ,分别于术前、术后 2 4h、术后 4d采集外周静脉血液标本 ,检测凝血酶原时间 (PT)、活化的部分凝血活酶时间 (APTT)、纤维蛋白原 (FG)、凝血酶抗凝血酶复合物 (TAT)、凝血酶原片段 (F1+2 )、纤溶酶抗纤溶酶复合物 (PAP) 6项指标。结果　与对照组结果比较 ,不同围术期F1+2、TAT水平明显增高 (P <0 0 5 ) ,其中术后 2 4h为最高 [F1+2 (3 6± 1 2 )nmol/L、TAT(8 5± 1 6 )μg/L],术后 4d稍有下降 [F1+2 (3 1± 1 1)nmol/L、TAT(7 1± 2 2 )μg/L],但差异无显著性意义 (P >0 0 5 ) ;PAP水平改变不明显 ,与对照组比较 ,差异无显著性 (P >0 0 5 ) ;FG含量明显升高 ,与对照组比较 ,差异有显著性 (P <0 0 5 ) ,其中以术后 2 4h为最高 [(5 4 6± 1 13)g/L ,P <0 0 5 ],术前与术后 4dFG水平差异并无显著性 (P >0 0 5 ) ;围术期PT、APTT差别无显著性 (P >0 0 5 )。结论　骨折创伤后凝血系统分子标志物TAT、F1+2水平增高 ,但PAP水平改变不明显 ,标志着机体凝血活性的增强 ,提示创伤后机体处于高凝状态 ,有发生血栓性疾病的可能。     

血栓性血少板减少性紫癜病人的凝血酶生成

血栓性血少板减少性紫癜(TTP)主要由内皮细胞损伤或原发性血小板凝集引起.为了评价TTP患者在急性期体内凝血酶生成情况,本研究测定了10例急性TTP病人的血浆凝血酶-抗凝血酶Ⅲ复合物(TAT)和纤维蛋白溶解酶-α_2-抗纤维蛋白溶解酶复合物(PAP),并与10例正常人比较.10例急性期TTP病人的血浆TAT均值±SD为6.7±3.7μg/L(范围3.0-15.8)μg/L),比正常对照组的1.7±0.3μg/L(1.3-2.1μg/L)明显为高(P<0.001),PAP值为2.1±1.2mg/L(范围1.0-4.3mg/L)亦比对照组的0.2±0.1mg/L(范围0.1-0.4mg/L)为高(P<0.001).病人的TAT、PAP值均不在正常范围内,TTP患者的TAT和PAP之间未发现有显著相关性(r=-0.134,p=0.7).血浆FDP与TAT和PAP浓度亦未发现有显著的相关性(分别为r=-0.251,P=0.5及r=0.344,P=0.3).     

分子标物及常规血凝学指标测定在DIC临床诊断中的价值对比分析

目的对比分析常见血凝学指标和几种血栓前状态分子标志物定量测定在DIC诊断中的价值.方法收集了30例正常人和63例DIC患者标本,根据DIC病程分为DIC早期(初发高凝血期)、中期(消耗性凝血障碍期)和晚期(继发性纤溶亢进期),测定了常规血凝学指标,并用ELISA法测定了血栓前状态分子标志物凝血酶原F1+2、凝血酶-抗凝血酶复合物(TAT)、栓溶二聚体(D-dimer,D-D)含量.结果各期DIC患者的部分常规血凝学指标有一定规律;而分子标志物变化不同.早期DIC中,D-D含量为(1.62±1.46)mg/L,NC组为(0.51±0.12)mg/L;F1+2含量为(4.96±2.78)nmol/L,NC组为(0.73±0.42)nmol/L;TAT含量为(33.11±20.59)μg/L,NC组为(1.64±3.04)μg/L;中期DIC中D-D含量为(6.85±8.37)mg/L;F1+2含量为(4.36±2.44)nmol/L,TAT含量为(22.53±20.98)μg/L;晚期DIC中D-D含量为(10.32±5.85)mg/L,F1+2的含量为(6.44±3.51)nmol/L,TAT含量为(36.64±20.09)μg/L.F1+2与TAT在所有DIC患者中有显著性相关(r=0.679,P＜0.0001),而F1+2与D-D、TAT与D-D无相关性.结论综合应用不同的血栓前状态分子标志物的定量测定和常用血凝学指标,不但有助于早期诊断DIC,并且可用于判断DIC的发展情况.     

脑梗死急性期血栓调节蛋白、纤溶酶-抗纤溶酶复合物变化与内皮细胞损伤

目的：为探讨急性动脉血栓形成过程中血液病理生理变化，对脑梗死患者急性期的血浆中血栓调节蛋白(thrombomodulin，TM)、纤溶酶-抗纤溶酶复合物(plasmin-α2-antiplasmin complexes，PAP)水平进行测定。方法：设立脑梗死组(n=48)和对照组(n=44)，前组按梗死体积不同分为较大体积梗死亚组和腔隙性梗死亚组，分别测定急性期血浆TM，PAP水平。检测法为ELISA法。结果：脑梗死组TM为(3．98&;#177;0．86)μg／L，PAP为(474．30&;#177;191．54)μg／L，较对照组(3．51&;#177;0．32)，(345．11&;#177;174．20)μg／L，明显升高(t=2．954，2．901，P&;lt;0．05)。较大体积梗死患者PAP为(553．9&;#177;148．63)μg／L，较腔隙梗死组(364．78&;#177;115．52)μg／L显著升高(t=4．239，P&;lt;0．05)。结论：脑梗死患者急性期TM的水平升高，反映局部动脉内皮细胞损伤严重，可根据PAP水平选择相应的治疗手段。     

脑梗死急性期血栓调节蛋白、纤溶酶-抗纤溶酶复合物变化与内皮细胞损伤

目的:为探讨急性动脉血栓形成过程中血液病理生理变化,对脑梗死患者急性期的血浆中血栓调节蛋白(thrombomodulin,TM)、纤溶酶-抗纤溶酶复合物(plasmin-α2-antiplasmincomplexes,PAP)水平进行测定。方法:设立脑梗死组(n=48)和对照组(n=44),前组按梗死体积不同分为较大体积梗死亚组和腔隙性梗死亚组,分别测定急性期血浆TM,PAP水平。检测法为ELISA法。结果:脑梗死组TM为(3.98±0.86)μg/L,PAP为(474.30±191.54)μg/L,较对照组(3.51±0.32),(345.11±174.20)μg/L,明显升高(t=2.954,2.901,P<0.05)。较大体积梗死患者PAP为(553.9±148.63)μg/L,较腔隙梗死组(364.78±115.52)μg/L显著升高(t=4.239,P<0.05)。结论:脑梗死患者急性期TM的水平升高,反映局部动脉内皮细胞损伤严重,可根据PAP水平选择相应的治疗手段。     

联合检测血管内皮损伤标志物在急性胰腺炎诊治中的价值

目的 探讨急性胰腺炎不同阶段血管内皮细胞损伤标志物内皮素(ET-1)、血栓调节蛋白(TM)、血管性假血友病因子(vWF)水平变化及其临床意义.方法 采用放射免疫吸附法和酶联免疫吸附测定法,分别测定轻症急性胰腺炎患者(50例)、重症急性胰腺炎患者(21例)、健康对照组(15例)的血管内皮细胞损伤标志物ET-1、,TM、vWF浓度.结果 重症急性胰腺炎患者血管内皮细胞损伤标志物ET-1[(116.8±16.70)ng/L]、TM[(65.7±12.27)μg/L]、vWF[(176±38)%]含量升高,与轻症组[分别为:(95.6±21.8)ng/L、(9.8±6.98)μg/L、(131±30)%]和健康对照组[分别为:(51.2±8.12)ng/L、(4.26±O.92)μg/L、(106±21)%]比较差异均有统计学意义(P均<0.05).结论 急性胰腺炎患者均存在不同程度的血管内皮细胞损伤及凝血和纤溶系统的激活,联合检测血管内皮损伤标志物ET-1、TM、vWF含量可作为急性胰腺炎病情进展、预后判定的指标之一.     

联合检测血管内皮损伤标志物在急性胰腺炎诊治中的价值

目的 探讨急性胰腺炎不同阶段血管内皮细胞损伤标志物内皮素(ET-1)、血栓调节蛋白(TM)、血管性假血友病因子(vWF)水平变化及其临床意义.方法 采用放射免疫吸附法和酶联免疫吸附测定法,分别测定轻症急性胰腺炎患者(50例)、重症急性胰腺炎患者(21例)、健康对照组(15例)的血管内皮细胞损伤标志物ET-1、,TM、vWF浓度.结果 重症急性胰腺炎患者血管内皮细胞损伤标志物ET-1[(116.8±16.70)ng/L]、TM[(65.7±12.27)μg/L]、vWF[(176±38)%]含量升高,与轻症组[分别为:(95.6±21.8)ng/L、(9.8±6.98)μg/L、(131±30)%]和健康对照组[分别为:(51.2±8.12)ng/L、(4.26±O.92)μg/L、(106±21)%]比较差异均有统计学意义(P均<0.05).结论 急性胰腺炎患者均存在不同程度的血管内皮细胞损伤及凝血和纤溶系统的激活,联合检测血管内皮损伤标志物ET-1、TM、vWF含量可作为急性胰腺炎病情进展、预后判定的指标之一.     

糖尿病患者血浆凝血酶-抗凝血酶和D-二聚体检测

目的　探讨糖尿病患者血浆凝血酶抗凝血酶复合物 (TAT)、D 二聚体 (D D)水平的临床意义。方法　选取 2型糖尿病患者 4 0例 ,分为微血管病变组 2 4例及单纯糖尿病组 16例 ;正常对照组 30例。采用酶联免疫吸附试验 (ELISA)测定血浆TAT和D D水平。结果　糖尿病组、正常对照组血浆TAT和D D水平分别为 (14 .95± 6 .5 4 )μg/L、(1.5 6± 0 .72 )mg/L ;(2 .6 5± 1.2 2 ) μg/L、(0 .19± 0 .0 8)mg/L ,两组相比差异有统计学意义。糖尿病微血管病变组较单纯糖尿病组及正常对照组TAT、D D含量均明显增高 (前两者TAT分别为 (2 1.34± 8.91) μg/L、(9.6 7±2 .72 ) μg/L ;D D分别为 (2 .95± 0 .84 )mg/L、(0 .2 8± 0 .0 9)mg/L ,而单纯糖尿病组较正常对照组仅TAT增高差异有统计学意义 ,D D未见明显增高。结论　糖尿病患者体内存在凝血及纤溶的变化 ,血浆TAT及D D的检测对其早期诊治有重要意义     

冠心病患者凝血指标、纤溶检测指标与低密度脂蛋白水平的关系研究

目的探讨冠心病患者凝血指标、纤溶检测指标与低密度脂蛋白(LDL)水平的关系。方法将2019年6月至2021年9月我院收治的冠心病患者80例设为观察组,根据SYNTAX评分分为0~22分组35例、23~32分组30例和33分以上组15例。另选取同期健康体检者57例为对照组。对各组LDL水平、血浆凝血酶调节蛋白(TM)、凝血酶抗凝血酶复合物(TAT)及纤溶酶-纤溶酶抑制物复合物(PAP)水平、血浆D-二聚体(D-D)、活化的部分凝血活酶时间(APTT)、抗凝血酶(AT)及纤维蛋白原(Fbg)水平进行检测,并对冠心病患者凝血、纤溶指标和LDL进行相关性分析。结果观察组TM、TAT、PAP、D-D、Fbg及LDL水平高于对照组(P<0.05),APTT水平低于对照组(P<0.05)。33分以上组TM、TAT、PAP、D-D、Fbg及LDL水平高于0~22分组、23~32分组(P<0.05);APTT水平低于0~22分组和23~32分组(P<0.05);23~32分组TM、TAT、PAP、D-D、Fbg及LDL水平高于0~22分组(P<0.05);APTT水平低于0~22分组(P<0.05)。Pearson相关性分析结果表明,冠心病患者LDL水平与APTT呈负相关性(P<0.05);与TM、TAT、PAP、D-D、Fbg及LDL水平呈正相关性(P<0.05)。结论冠心病患者常伴有凝血指标及纤溶检测指标异常,能反映患者疾病严重程度,且与LDL存在强相关性,加强凝血、纤溶检测指标测定可辅助LDL对冠心病的预测。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.