体外循环对血小板的影响及维生素C对其的保护作用

为观察心脏直视手术中体外循环对血小板的损害作用及维生素Ｃ其的保护作用，将１７例未合并肺动脉高压的室间隔缺损进行心脏直视手术的病人随机分为对照组（１０例）和维生素Ｃ组（７例），应用透射电镜观察体外循环过程中血小板的超微结构的变化，并对维生素Ｃ组应用维生素Ｃ进行保护。结果表明：体外循环期间，对照组的血小板聚集堆逐渐增多，以转流３０ｍｉｎ时最为明显，同时崩解型血小板也增多；而维生素Ｃ组血小板数量下降程度、血小板聚集堆及崩解型血小板增加程度远较对照组小。结果提示：体外循环对血小板超微结构形态有明显损害，而维生素Ｃ对其有明确的保护作用。     

妊娠合并血小板减少症对产后出血的影响

目的探讨妊娠合并血小板减少症对产后出血的影响。方法回顾性分析172例妊娠合并血小板减少患者的临床资料。结果妊娠合并血小板减少症172例中发生产后出血29例(16.86%),且出血量较血小板正常者明显增多,血小板计数与产后出血量呈负相关。结论妊娠合并血小板减少症对产后出血有明显影响,产时以产科指征决定是否剖宫产,但宜适当放宽手术指征。     

类风湿性关节炎血小板参数变化与病情活动相关性的研究

目的探讨类风湿性关节炎患者血小板参数与病情活动的关系。方法用麦道—尼克血细胞分析仪测定47例类风湿性关节炎(病情活动者34例、临床缓解期13例)及24例正常人的血小板参数,同时检测反应病情活动的实验室指标如血沉、C反应蛋白、类风湿因子,观察血小板参数的变化以及相关性。结果血小板参数中,类风湿性关节炎活动期患者的血小板计数和血小板比容明显高于临床缓解期患者及正常对照组(P<0.05);类风湿性关节炎患者血小板参数中的血小板计数和血小板比容分别与血沉、C反应蛋白、类风湿因子呈正相关(r=0.475,0.527,0.468;r=0.648,0.478,0.434,P均<0.01)。结论血小板参数中血小板计数和血小板比容可作为类风湿性关节炎患者病情活动性和治疗效果评价的简便有效的实验室指标。     

妊娠期特发性血小板减少性紫癜的诊断及治疗方式选择

目的 探讨妊娠期特发性血小板减少性紫癜(GITP)的临床及实验室特点,以提高这种疾病的诊断和治疗水平.方法 回顾性采集了44例GITP患者的诊断治疗经过及相关临床和实验室资料,以同期住院的148例妊娠期血小板减少症(GT),18例妊娠高血压病相关的血小板减少(GHT)以及同一年龄段的42例女性非妊娠ITP患者为对照,进行对比分析和统计学处理.结果 与GT组患者相比,GITP患者发病较早,临床出血倾向较重,初发血小板和病程中最低血小板计数均明显低于前者.GITP组患者血小板相关免疫球蛋白(PAIgG)阳性率高于GT和GHT组.GITP组剖宫产率高于GT组,与GHT组相当.3组患者术中和产后出血的发生率及新生儿Apgar评分异常的比例无显著性差异.GITP组新生儿体重与其他两组比较,差异不显著,而GHT组新生儿体重明显低于GT组.GITP组新生儿血小板减少的发生率高于其它两组,但差别无统计学意叉.GT和GHT孕妇分娩后,血小板数目多可恢复正常.GITP组分娩后也有改善,但血小板变化不如其他两组显著,常需要进一步治疗.和单纯ITP患者相比,GITP患者病情较轻,对糖皮质激素的反应率差别不大.结论 GITP患者病情较GT为重,但处理适当,对母体及新生儿影响不大.因此应早期诊断和密切监测.妊娠本身不会加重ITP 病情,但分娩也不会明显减轻症状,GITP患者分娩后多需要进一步治疗.     

新生儿血小板减少症46例临床分析

目的分析新生儿血小板减少的临床特点及可能原因,探讨其预防和治疗措施。方法回顾性分析本院2008年1月～2009年7月诊断新生儿血小板减少症所有患儿的临床资料。结果早发型血小板减少患儿临床上多无特殊表现,预后较好;迟发型血小板减少症多发生于早产儿,小于胎龄儿,通常由于合并严重感染所致,病情严重,需要输注血小板来治疗。结论围产期有高危因素母亲,其新生儿出生后要常规监测血常规,对于宫内发育不良或低出生体质量儿生后一旦合并感染要警惕血小板减少,甚至DIC的发生。     

1例PCI术后盐酸替罗非班诱导的极重度血小板减少的护理

目的 探讨冠状动脉介入术后患者盐酸替罗非班诱发的极重度血小板减少症的临床特点及护理情况,为替罗非班诱导的血小板减少症患者护理提供临床参考。方法 2017年11月我院收治1例急性冠状动脉综合征患者,PCI术后应用盐酸替罗非班致极重度GIT的临床资料及护理情况进行报告。结果 患者PCI术前血小板计数正常,术后应用盐酸替罗非班6 h后出现全身多处瘀斑,血小板计数严重下降至0×109/L,立即停用替罗非班、阿司匹林、氯吡咯雷,并输注血小板、冷冻血浆及使用糖皮质激素治疗,做好防出血护理、用药护理、生活护理、心理干预,血小板计数逐渐升高,约84 h恢复正常。结论 PCI患者应用盐酸替罗非班有诱导的GIT发生风险,积极监测患者血小板变化,加强防出血护理及心理干预,能促进病情恢复。     

危重烧伤患者GPⅡb/Ⅲa、CD62p变化与病情及预后的相关性研究

目的探索血小板变化与危重烧伤患者病情及预后的关系。方法对67例危重烧伤患者进行分组,A组（特重烧伤组）选择烧伤总面积〉50%TBSA或（及）Ⅲ度烧伤面积〉20%TBSA的患者;B组（重度烧伤组）为烧伤总面积为30%～49%或（及）Ⅲ度烧伤面积10%～19%的患者,选择伤后3、5、7、14、28天测定两组的PLT、GPⅡb/Ⅲa、CD62p值并进行统计分析。结果 A组患者的PLT、GPⅡb/Ⅲa较B组患者的PLT、GPⅡb/Ⅲa显著降低（P〈0.05）,A组患者的CD62p较B组患者的CD62p显著增高（P〈0.05）。结论血小板的变化是影响危重烧伤患者病情及预后重要因素之一,血小板水平和功能变化越明显,病情越重,预后越凶险。动态观测血小板（PLT、GPⅡb/Ⅲa、CD62p）的变化对病情的判定及预后的估计有很好的预见性。     

主动脉夹层患者手术前后血小板参数变化

目的:分析主动脉夹层(AD)患者手术前后血小板相关参数变化。方法:AD患者43例,采用自动化血球仪,检测其手术前及手术后1天、1月、3月的血小板计数(PLT)、血小板压积(PCT)、大血小板比率(P-LCR)、平均血小板体积(MPV)和血小板分布宽度(PDW),分析各时相上述参数的动态变化。结果:AD患者术后1天与术前各项参数无明显差异(P0.05)。术后1月时PLT、PCT较术后1天升高,P-LCR、MPV和PDW较术后1天降低(均P0.01);术后3月各项指标与术后1月相比,PLT明显下降,P-LCR、MPV及PDW显著上升(均P0.05)。结论:AD患者术后1月、3月血小板参数异常,存在凝血风险。     

重症社区获得性肺炎血小板值动态变化及其意义

监测重症社区获得性肺炎（CAP）血小板计数的动态变化及其在重症CAP预后的意义，分普通CAP组40例，重症CAP组36例对比分析。发现重症组血小板计数显著下降，早期进行性降低提示病情危重，预后差。     

特发性血小板减少性紫癜患者GPIIb/IIIa、CD62P表达探讨

目的检测原发性血小板减少性紫癜 (ITP)患者血小板表面GPIIb/IIIa、CD62P的表达情况 ,以探讨其在ITP患者中的临床应用价值。方法采用美国BD公司的FACSCalibur流式细胞仪 ,对32例ITP患者、17例非免疫性血小板减少、21例其它自身免疫性疾病及20例健康正常人的血小板表面GPIIb/IIIa、CD62P的表达情况进行了分析测定。结果ITP患者GPIIb/IIIa血小板阳性表达率明显高于其它三组 (P<0.01) ,但CD62P血小板阳性表达率四组无明显差别(P>0.05) ,15例无临床症状ITP患者GPIIb/IIIa表达明显高于17例有临床症状ITP患者的表达(P<0.01)。结论GPIIb/IIIa作为监测血小板活化指标 ,对ITP的鉴别诊断及监测病情发展、判断预后具有重要意义 ;ITP患者的GPIIb/IIIa表达明显增高 ,但CD62P表达并不增高 ,CD62P并非监测ITP患者循环中活化血小板的理想标志物     

Acquired pseudo-pseudo Bernard-Soulier syndrome complicating Gaucher's disease.

AIMS--To investigate the abnormality in platelet function in two patients with type I Gaucher's disease causing a chronic bleeding tendency despite normalisation of the platelet count after spleen removal. METHODS--Routine laboratory methods were used to assess baseline coagulation. Platelet aggregometry was used to assess platelet responses to a range of agonists, and abnormalities were further assessed in mixing experiments using washed platelets and patients' plasma. RESULTS--Platelets from both patients with Gaucher's disease failed to agglutinate to ristocetin, despite normal platelet surface glycoprotein (GP) Ib and plasma von Willebrand factor activity. The agglutination of normal washed platelets was abolished by incubation in patient plasma. The inhibitory activity did not lie in the IgG fraction of patient plasma, and was found to be loosely associated with the patient platelet surface. CONCLUSIONS--The inhibition of ristocetin induced platelet agglutination in patients with Gaucher's disease causes a prolonged skin bleeding time. This could be due to the accumulated glucocerebroside in the plasma coating the platelet membrane. It is suggested that the term pseudo-pseudo Bernard-Soulier syndrome would be appropriate, as on initial screening, the abnormality has the features of Bernard-Soulier syndrome, but further investigation shows normal plasma von Willebrand activity and platelet surface GP Ib concentrations. The inhibitory activity is not due to a platelet specific antibody as is the case in pseudo-Bernard Soulier syndrome.     

Plasmapheresis. A therapeutic option in the management of heparin-associated thrombocytopenia with thrombosis

Heparin-associated thrombocytopenia with thrombosis (HATT) is an uncommon syndrome that is estimated to occur in 1-5% of patients with heparin-induced thrombocytopenia. Early diagnosis requires careful clinical surveillance, and the management of these patients can be complex. Cessation of heparin therapy and substitution or addition of oral anticoagulants, antiplatelet agents, dextrans, and prostacyclin analogues have been advocated. The authors are aware of only two case reports in the literature that examine the use of plasmapheresis as a therapeutic alternative. The authors report a case of a 53-year-old white man who developed HATT after a single protamine-reversed exposure to heparin. Controlled platelet aggregation studies performed before and after apheresis sessions documented a dramatic response and rapid normalization of platelet number and function in the patient. The authors conclude that plasmapheresis could be a valuable adjunct in the successful management of patients with HATT. When done in conjunction with platelet aggregation studies, an objective measurement of therapeutic efficacy can be achieved.     

Platelet function in hairy-cell leukaemia

A quantitative study of various aspects of platelet function was carried out in eight patients with typical hairy-cell leukaemia (HCL). In at least two patients platelet aggregation was convincingly reduced to more than one aggregating agent (ADP, adrenaline, collagen, thrombin, and ristocetin). Granular storage capacity for {(14)C} 5-HT was reduced in five of the six patients tested. The two patients with definitely abnormal aggregation had the greatest reduction in granular storage pool and the longest bleeding times of those tested but, like the other patients, they did not have a clinical haemostatic defect. It was concluded that a granular storage pool defect (SPD) was at least partly responsible for aggregation abnormalities in HCL since the platelet release reaction in response to thrombin appeared to be normal. All our patients ran a chronic course uncomplicated by any of the factors known to predispose to a platelet SPD acquired in the circulation. Although in the one patient tested before and after splenectomy there was some improvement in platelet aggregation after operation, there was no clear general relationship between defective platelet function and either previous splenectomy or platelet count. Since a direct involvement of the megakaryocytic series in the underlying cell proliferation of HCL seems unlikely, it is concluded that the platelet defect can most reasonably be attributed to the production of abnormal platelets as a result of marrow fibrosis and/or infiltration by hairy cells.     

替罗非班对急性冠脉综合征患者围手术期血小板和C反应蛋白的影响

目的观察替罗非班对接受双重抗血小板治疗（阿司匹林＋氯吡格雷）的不稳定型心绞痛、非ST段抬高心肌梗死（NSTE-ACS）患者,经皮冠状动脉介入治疗（PCI）围手术期血小板最大聚集率（mPAR）和高敏C反应蛋白（hs-CRP）的影响,探讨两者的相关性。方法125例行择期PCI的高危NSTE-ACS患者随机分为阿司匹林＋氯吡格雷＋替罗非班组（简称替罗非班组）、阿司匹林＋氯吡格雷组（对照组）。替罗非班组患者在PCI前直接冠脉内弹丸式注射替罗非班10μg／k,时间不少于3min,随后以0．15μg／（kg·min）^-1持续泵点8h。检测两组患者PCI围手术期不同时间点mPAR及hs-CRP并分析两者的相关性。结果术前,替罗非班组与对照组mPAR、hs-CRP无统计学差异。术后6h,替罗非班组mPAR、hs—CRP低于术前及对照组;对照组mPAR较术前显著升高,hs—CRP虽较术前轻度升高,但无统计学差异。术后24h及术后7d,两组之间mPAR及hs-CRP无统计学差异。替罗非班组PCI围手术期不同时间点hs—CRP对数值与mPAR呈直线相关。术前及术后24h,对照组hs-CRP对数值与mPAR呈直线相关。术后6h及术后7d,对照组未见相关关系。结论PCI术后6h,在双重抗血小板治疗的基础上,替罗非班对接受PCI术的NSTE-ACS患者的血小板功能和炎症反应有抑制作用;mPAR与hs-CRP呈正相关,hs—CRP对血小板的聚集状态有一定的预测价值。     

Serious hemolytic anemia after mitral valvuloplasty

A patient with mitral insufficiency is described who developed severe hemolytic anemia six months after mitral valvuloplasty. Various laboratory tests suggested that the cause of the hemolysis was mechanical. A second heart operation was therefore performed which revealed intact valve function. With respect to the mechanical cause of hemolysis a bioprosthesis was implanted, but the patient died shortly after this operation. Since similar cases are not reported in the literature the authors invite for discussion of this case.     

Depression, alterations in platelet function, and ischemic heart disease

Platelets, the smallest corpuscular component of human blood, are central to various crucial biologic pathways in the human body. Diminished platelet function is thought to contribute to the increased risk of ischemic heart disease in patients with major depressive disorder, and to the increased morbidity and diminished survival of depressed patients after an index myocardial infarction. We reviewed both recent studies that evaluated platelet function in various patient groups and recent information regarding the potential beneficial effects of selective serotonin reuptake inhibitors on platelet reactivity.     

Platelet factor 4 and the response to plasma exchange in the treatment of thrombotic thrombocytopenic purpura

Summary We report two patients with thrombotic thrombocytopenic purpura who were subjected to plasma exchange. In one case, the plasma levels of platelet factor 4, measured shortly after plasma exchange, increased significantely during plasma exchange. This was followed, however, by a failure to respond to therapy. Repeated plasmapheresis over 3 weeks gave no therapeutic benefit and reversible deep coma occurred. This patient recovered completely after treatment with vincristine. In the second patient, a decline in platelet factor 4 was observed after plasma exchange. This was accompanied by improvement of the patient's condition and a slow rise in platelet count. Plasma exchange was again carried out in this patient because of a recurrence of thrombotic thrombocytopenic purpura 3 years later; again decreased platelet factor 4 plasma levels were observed after plasma exchange and again a therapeutic response followed. Platelet factor 4, therefore, seems to be an effective and early index for the therapeutic benefit of plasma exchange in thrombotic thrombocytopenic purpura.Abbreviations PF4 platelet factor 4 - TG beta-thromboglobulin - PE plasma exchange - TTP thrombotic thrombocytopenic purpura - 5% HSA 5% human albumin     

Influence of splenectomy on platelet morphometry and function

Summary Functional and morphometric platelet abnormalities may be influenced by splenectomy and thus contribute to postoperative thrombohaemorrhagic complications, especially in patients with splenomegaly and/or platelet defects. We investigated platelet function, platelet secretion, and platelet morphometry before and one week after splenectomy in seven patients with normal platelet production and normal spleen size (Hodgkin's disease) and five patients with splenomegaly and platelet abnormalities (4 with myeloproliferative disorders and 1 with chronic myelomonocytic leukemia).Severe postoperative thrombohaemorrhagic complications occurred only in patients with myeloproliferative disorders, although platelet count and mean platelet volume increased in almost all patients after splenectomy. Four patients with myeloproliferative disorders had impaired platelet aggregation before splenectomy that improved in only one patient after surgery. Platelet buoyant density in this patient group was decreased before splenectomy and normalised thereafter. Concomitantly, intraplatelet concentrations of-granular proteins increased. Before splenectomy, there was a positive correlation between platelet density and platelet volume in patients with Hodgkin's disease (r=0.59,p<0.001), but not in patients with myeloproliferative disorders. There was no correlation between platelet density and platelet volume after splenectomy in either patient group.In conclusion, morphometric platelet abnormalities were found in all patients after splenectomy. In patients with myeloproliferative/myelodysplastic disorders, decreased platelet buoyant density normalised and intraplatelet concentrations of-granule proteins were elevated after splenectomy. However, platelet function defects in this patient group were not corrected and may have been a major cause of thrombohaemorrhagic complications in the postoperative period.Abbreviations ABVD Adriamycin, bleomycin, vinblastine, dacarbazine - ADP Adenosine diphosphate - Ara-C Cytosine arabinoside - BS Busulfan - CML Chronic myelogenous leukemia - CMML Chronic myelomonocytic leukemia - COPP Cyclophosphamide, vincristine, procarbazine, prednisone - HD Hodgkin's disease - HU Hydroxyurea - MDS Myelodysplastic syndrome - MOPP Nitrogen mustard, vincristine, procarbazine, prednisone - MPD Myeloproliferative disorders - MPV Mean platelet volume - PF4 Platelet factor 4 - PRP Platelet rich plasma - PV Polycythemia vera - TG -thromboglobulin     

骨上皮样血管内皮细胞瘤9例诊治分析

目的 探讨骨上皮样血管内皮细胞瘤(B-EHE)的诊断、治疗方法。方法 回顾性分析2002年2月—2015年9月解放军东部战区总医院骨科收治的9例B-EHE患者的临床资料。其中男6例、女3例,年龄15~64岁。术前X线及CT检查均表现为溶骨性改变,1例MRI可见周围软组织受累,1例出现肺部转移灶。3例选择病灶刮除、植骨内固定;1例腰椎病灶选择肿瘤切除椎板减压内固定;3例近关节病灶选择肿瘤切除假体置换,其中1例术后化疗;1例多发病灶伴肺转移选择活检确诊后化疗治疗;1例病理性骨折伴出血选择行截肢术后综合治疗。结果 9例中失访1例,其余随访时间8～72个月。现7例存活。3例行病灶刮除植骨内固定,2例局部复发,二次手术后治愈。1例腰椎肿瘤切除减压固定,术后恢复良好。3例行肿瘤切除假体置换术,1例失访;2例术后治愈,关节功能良好,其中1例术后辅助化疗,未出现局部复发和病灶转移。1例多发病灶伴肺部转移行化疗,肺部无进展,局部无进展。1例行截肢术后综合治疗者,肿瘤复发迁延性出血,最终因器官衰竭死亡。结论 B-EHE为低-中度恶性肿瘤,术前影像学无特异性,诊断困难,主要依靠术后病理结果诊断。治疗首选边界切除,辅以化疗或放疗,可降低局部复发率和远处转移。     

Single lung transplantation--one year follow-up

Lung transplantation is now generally accepted as a modality of care for patients with end-stage lung diseases who demonstrate declining of lung function despite optimal therapy. This paper describe a case of single lung transplantation performed in patient with advanced obstructive pulmonary diseases and pulmonary fibrosis. One year follow-up with special regard to complications after operation is presented.