内镜下氩离子凝固术治疗非静脉曲张性上消化道出血的护理

探讨内镜下氩离子凝固术(氩气刀)治疗非静脉曲张性上消化道出血的效果与护理方法。回顾性分析了48例应用内镜下氩离子凝固术治疗非静脉曲张性上消化道出血患者的治疗及护理效果。48例患者止血成功率为93 .75%,无1例发生穿孔,一般并发症症状均于1w内消失。内镜下氩离子凝固术治疗非静脉曲张性上消化道出血是一种使用方便、疗效佳、安全性好、副作用少的治疗方法;治疗前、中、后实施合理的护理是保证治疗成功的重要环节。     

D-二聚体水平在NSCLC患者手术期变化及术前水平对术后短期预后的意义

目的探讨血浆D-二聚体水平在非小细胞肺癌(NSCLC)患者术前、术后变化及术前D-二聚体水平对NSCLC患者术后短期预后的意义。方法采用免疫比浊法检测85例NSCLC患者术前、术后,30例良性肺部疾病患者及55例健康对照者的血浆D-二聚体水平。术后随访1年,记录NSCLC患者不良事件。结果 NSCLC患者术前D-二聚体水平高于良性肺部疾病患者和健康对照者,差异有统计学意义(P0.05)。随着肿瘤分期的增加,术前D-二聚体水平明显升高。NSCLC患者不良事件组术前D-二聚体水平为(3.35±3.11)mg/L,显著高于良性事件组的(0.73±3.25)mg/L,差异有统计学意义(P0.05)。结论NSCLC患者为血栓高风险患者,监测术前、术后血浆D-二聚体水平有助于降低血栓风险,改善预后。术前D-二聚体水平可用于预测NSCLC患者术后短期的预后。     

吕梁地区临产孕妇D-二聚体检测及意义

目的探讨健康临产孕妇血浆D-二聚体含量的变化及临床意义。方法选取该院300例就诊女性分为健康非孕育龄妇女50例(健康对照组),健康临产孕妇200例(观察组),妊娠期高血压病患者50例3组(观察组),采用全自动血凝仪检测并分析其血浆D-二聚体水平。结果妊娠期高血压病患者血浆D-二聚体水平[(5.10±1.61)mg/L]较健康临产孕妇[(3.03±2.62)mg/L]及健康对照组[(0.32±0.20)mg/L]明显增高,差异均有统计意义(P<0.01)。结论临产孕妇进行D-二聚体监测对预防弥散性血管内凝血的发生和常规性治疗有重要意义。     

内镜下氩离子凝固术治疗非静脉曲张性上消化道出血的护理

探讨内镜下氩离子凝固术(氩气刀)治疗非静脉曲张性上消化道出血的效果与护理方法。回顾性分析了48例应用内镜下氩离子凝固术治疗非静脉曲张性上消化道出血患的治疗及护理效果。48例患止血成功率为93．75％，无1例发生穿孔，一般并发症症状均于1w内消失。内镜下氩离子凝固术治疗非静脉曲张性上消化道出血是一种使用方便、疗效佳、安全性好、副作用少的治疗方法；治疗前、中、后实施合理的护理是保证治疗成功的重要环节。     

B型钠尿肽及D-二聚体在诊断老年急性心肌梗死中的临床价值

目的评价血浆B型钠尿肽(BNP)和D-二聚体水平在急性心肌梗死(AMI)患者诊治中的临床价值。方法将AMI患者104例作为观察组,同期100例健康体检者作为对照组,血浆BNP检测采用化学发光法,D-二聚体检测采用免疫比浊法,采用SPSS 17.0统计软件进行数据分析。结果观察组患者入院时血浆BNP和D-二聚体含量分别为(570.10±187.20)pg/m L,(3.40±1.32)mg/L,明显高于对照组的(25.04±2.11)pg/m L,(0.22±0.01)mg/L,组间比较差异有统计学意义(P0.05);再灌注治疗后,观察组血浆BNP浓度和D-二聚体含量(162.30±102.00)pg/m L,(1.62±1.07)mg/L均降低,与治疗前(570.10±187.20)pg/m L,(3.40±1.32)mg/L比较差异有统计学意义(P0.05)。结论联合检测血浆BNP和D-二聚体对AMI的诊断和治疗具有重要意义。     

D-二聚体在外伤性进展性颅内出血中的诊断价值

目的:探讨急性颅脑损伤后血浆D-二聚体变化与进展性颅内出血的关系.方法:回顾性分析78例颅脑损伤(进展性出血组36例和非进展件出血组42例)患者的临床资料,比较两者血浆中D-二聚体的含量,分析其与进展性出血的关系.结果:按格拉斯哥预后(GOS)评分,78例患者中恢复良好39例,中残23例,重残11例,死亡5例.进展性出血组的血浆D-二聚体(8.32±4.16)mg/L明显高于非进展性出血组的(3.88±2.57)mg/L,P<0.05.结论:颅脑损伤后血浆D-二聚体水平升高,它可作为外伤后是否出现进展性颅内出血的参考指标之一.     

内镜下氩离子凝固术序贯治疗食管静脉曲张疗效观察

目的探讨内镜下氩离子凝固术序贯治疗食管静脉曲张的临床应用价值。方法 30例经内镜下硬化或套扎治疗2次及以上的食管静脉曲张性上消化道出血患者,采用内镜下氩离子凝固术,治疗其直径<0.3cm的曲张血管,并与另一组基线资料匹配、单纯采用内镜下硬化或套扎治疗的30例患者进行比较。结果经内镜下氩离子凝固术序贯治疗30例,随访观察6个月,2例再发出血,再出血率6.7%;而另一组单纯硬化或套扎治疗2次及以上的30例,随访观察6个月,再发出血8例,再出血率26.7%。结论内镜下氩离子凝固术序贯治疗食管静脉曲张预防上消化道出血具有疗效确切、安全快速、并发症少、患者痛苦小等特点,临床应用价值较高。     

妇科恶性肿瘤患者凝血功能及D-二聚体水平变化及意义

目的探讨妇科恶性肿瘤患者的凝血功能及D-二聚体水平变化及临床意义。方法妇科恶性肿瘤患者228例为恶性肿瘤组,其中子宫内膜癌51例,宫颈癌93例,卵巢癌84例;TNM分期Ⅰ~Ⅱ期148例,Ⅲ~Ⅳ期80例;同期体检健康女性200例为对照组。检测并比较2组凝血酶原时间(prothrombin time,PT)、凝血活酶时间(activated partial thromboplasin time,APTT)、纤维蛋白原(fibrinogen,Fib)、凝血酶时间(thrombin time,TT)、血小板计数(blood platelet,PLT)及D-二聚体水平;观察不同临床分期和不同类型肿瘤患者凝血功能及D-二聚体水平差异。结果恶性肿瘤组PLT[(240.71±104.92)×10~9/L]、Fib[(2.91±0.96)g/L]、D-二聚体[(2.06±1.45)mg/L]水平高于对照组[(192.35±59.96)×10~9/L、(2.69±0.54)g/L、(0.59±0.32)mg/L],APTT[(30.49±5.44)s]长于对照组[(30.07±4.33)s](P0.05),2组PT、TT比较差异无统计学意义(P0.05);Ⅲ~Ⅳ期恶性肿瘤患者PLT[(285.88±127.77)×10~9/L]、D-二聚体[(2.68±2.33)mg/L]高于Ⅰ~Ⅱ期患者[(216.30±80.72)×10~9/L、(1.67±0.15)mg/L](P0.05);卵巢癌患者D-二聚体水平[(3.26±2.63)mg/L]高于子宫内膜癌患者[(0.55±0.23)mg/L]和宫颈癌患者[(0.51±0.16)mg/L](P0.05)。结论部分凝血指标及D-二聚体水平对妇科恶性肿瘤的诊断、分期及预后评估有一定价值。     

老年冠心病患者D-二聚体和超敏C-反应蛋白水平变化的意义

目的 探讨D-二聚体和超敏C-反应蛋白(hs-CRP)对早期诊断老年冠心病并判断其急危重症的临床意义.方法 122例老年冠心痛患者,分为4个亚组:陈旧性心肌梗死(OM1)组27例、稳定型心绞痛(SAP)组29例、急性冠状动脉综合征(ACS)组32例、陈旧性心肌梗死新发急性冠状动脉综合征(OMI+ACS)组34例.30例非冠心病患者作为对照组.应用免疫比浊法测定各组的hs-CRP,应用免疫散射法测定各组的D-二聚体,并进行比较分析.结果 各组间患者D-二聚体水平进行两两比较,OMI组[(0.25±007)mg/L]与SAP组[(0.27±0.08)mg/L]、OMI+ACS组[(0.58±0.80)mg/L]与ACS组[(0.56±0.72)mg/L]差异均无统计学意义(P均>0.05);OMI组与对照组比较差异有统计学意义(P<0.05);其余各组间比较差异均有统计学意义(P均<0.01).各组间患者hs-CRP水平进行两两比较,OMI组[(3.76±0.61)mg/L]与SAP组[(3.90±0.81)mg/L]、OMI+ACS组[(6.57±2.09)mg/L]与ACS组[(6.19±1.84)mg/L]差异均无统计学意义(P均>0.05);其余各组差异均有统计学意义(P均<0.01).老年冠心病患者D-二聚体与hs-CRP水平之间存在显著正相关(r=0.81,P<0.01).结论 D-二聚体和hs-CRP可作为判断老年人冠心病发生或存在的指标.D-二聚体和hs-CRP可作为临床判断冠状动脉斑块是否处于稳定期,是否发生急性冠状动脉综合征的指标;可作为陈旧性心肌梗死患者是否新发急性冠状动脉综合征的指标.但不能用于鉴别发生急性冠状动脉综合征的患者是否已经存在陈旧性心肌梗死.老年冠心病患者D-二聚体与hs-CRP水平存在正相关性.     

D-二聚体在急性上消化道出血中血浆水平的研究

目的:研究D-二聚体在急性上消化道出血的血浆水平.方法:采用Nyco Card胶体金标法,对60例急性上消化道出血进行血浆D-二聚体测定.其中上消化道良性病变26例(消化性溃疡12例、急性胃黏膜病变8例、贲门撕裂6例);上消化道恶性肿瘤12例(胃癌8例、食道癌4例);肝病出血22例(肝硬化15例、肝癌7例).结果:上消化道良性病变组D-二聚体水平在正常范围;上消化道恶性肿瘤组较良性病变组D-二聚体水平明显升高:肝病组较上消化道恶性肿瘤组、上消化道良性病变组D-二聚体水平明显升高.结论:D-二聚体在几种急性上消化道出血中血浆水平有明显差异,对疾病鉴别诊断和评估有一定意义.     

Partial plasma protein replacement in therapeutic plasma exchange

We wished to determine whether subtotal replacement of protein in plasma removed at plasma exchange would be adequate to prevent hypovolemia and hypoproteinemia. Seven well nourished outpatients with chronic progressive multiple sclerosis underwent 60 plasma exchanges in which two liters of plasma were replaced with 750 ml saline followed by 1250 ml of a 5% albumin solution (62.5% albumin replacement). Total serum protein, protein electrophoresis, and immunoglobulin levels were measured before and after each exchange. Clinically, the exchanges were well tolerated. Total serum protein dropped by a mean of only 18% during the study and mean preexchange serum albumin levels were unchanged, even though immunoglobulins decreased by 57–72%. We conclude that in well nourished patients, partial albumin replacement of this magnitude is an adequate substitute for plasma removed in a plasma exchange.     

Dissemination of contact activation in plasma by plasma kallikrein

The dissemination of contact activation of plasma was examined by measuring the cleavage of Hageman factor (HF) molecules on two separate sets of kaolin particles, one of which contained all of the components of the contact activation system, HF, prekallikrein (PK) and high molecular weight kininogen (HMWK) in whole normal plasma, and the second set of particles containing only HF and HMWK, being prepared with PK-deficient plasma. After mixing of the particles, cleavage of HF on the second set of particles occurred at a rate similar to that occurring on the first set of particles. This indicated that rapid dissemination and burst of activity of the contact reaction takes place in fluid phase. A supernatant factor, responsibel for the dissemination of the contact reaction, was identified as kallikrein. A rapid appearance of cleaved PK (kallikrein) and HMWK on both the kaolin surface and in the supernate was observed. Within 40 s, > 70-80% of the PK and HMWK in the supernate was cleaved. On the surface, approximately 70% of each radiolabeled protein was cleaved at the earliest measurement. Cleavage of PK by activated HF occurred at least 17 times faster on the surface than in the fluid phase, as virtually no cleavage of PK occurred in fluid phase. Each molecule of surface-bound, activated HF was calculated to cleave at a minimum, 20 molecules of PK per minute. It is concluded that the contact activaton of plasma may be divided into three phases: (a) the reciprocal activation of a few molecules of zymogen HF and PK on the surface, with HMWK acting as cofactor to bring these molecules into apposition; (b) the rapid release of kallikrein into the fluid phase and the continued conversion of PK to kallikrein by each surface-bound molecule of activated HF; and (c) the activation by fluid-phase kallikrein of multiple surface-bound HF molecules, and the cleavage of multiple molecules of MHWK both in fluid phase and on the surface by the soluble kallikrein. The evidence suggests that steps b and c account for a great majority of the generation of contact activation of plasma.     

Fresh-frozen plasma, pathogen-reduced single-donor plasma or bio-pharmaceutical plasma?

Three types of therapeutic plasma are available that differ in their manufacturing processes, composition, clinical efficacy, and side effects. Quarantine-stored, not pathogen-reduced fresh-frozen plasma (QFFP) is prepared from single whole blood or plasma donations. The manufacture of pathogen-reduced single-donor plasmas such as methylene blue-light treated (MLP) or amotosalen-ultraviolet light treated plasma (ALP) involves the addition of a chemical followed by irradiation and subsequent removal of the chemical. Both plasma types show substantial fluctuation of clotting factor and inhibitor levels according to interindividual variations, and both carry the risk of inducing transfusion-associated lung injury (TRALI). Photo-oxidation in pathogen-reduced single-donor plasmas reduces clottable fibrinogen and other clotting factors markedly, and there is a lack of clear evidence showing whether this is harmful or not. MLP also appears to be less effective clinically than QFFP. Like clotting factor or inhibitor concentrates, solvent/detergent-treated plasmas (SDP) are bio-pharmaceutical preparations derived from large plasma pools, and variations in plasma protein levels from batch-to-batch are for that reason low. The SD manufacturing process inevitably involves a considerable reduction of plasmin inhibitor (PI), and moderate reduction of all other clotting factors and inhibitors in the final plasma bags. Clinical studies and broad clinical use have however shown that this does not significantly reduce clinical efficacy or increase adverse events. SDPs obviously do not induce TRALI and the risk of allergic reactions is significantly lower than for QFFP. Common to all three plasma types is that the time between donation and freezing the plasma, and whether plasma from whole blood or apheresis plasma is used as starting material, are decisive determinants for the clotting factor and inhibitor potencies in the final bags. Plasma frozen 3-6h after donation, and apheresis plasma, contain markedly greater amounts of clotting factors and inhibitors than plasma frozen 15-24h after collection or plasma from whole blood. Lyophilisation and the pooling of single-donor plasma units with ABO blood group in suitable proportions (Uniplas) facilitate SDP handling and logistics without loss of clinical efficacy. SDP is obviously at least as cost-effective as QFFP if non-infectious adverse events including TRALI are taken into account, at least in younger patients and patients with good prognosis.     

Anaphylatoxins in fresh-frozen plasma

BACKGROUND: Fresh-frozen plasma (FFP) is widely used in patients with coagulation disorders and simultaneous complement activation. Complement activation in FFP itself is poorly investigated. STUDY DESIGN AND METHODS: The concentration of anaphylatoxins C3a and C5a, the complement precursors C1q and factor B, and complement function were measured in 40 consecutively administered FFP units in two pediatric neonatal intensive care units. In 12 samples, the measurements were also performed after incubation with inulin. RESULTS: In 15 of 40 FFP units, both anaphylatoxin concentrations were below the upper cutoff levels reported for healthy humans (C3a, 500 microg/L; C5a, 5 microg/L). Anaphylatoxin levels were higher in FFP units produced by apheresis than in those from blood donation. Complement activation of FFP by inulin increased anaphylatoxin concentration, whereas C1q and factor B levels, and complement function remained unchanged. CONCLUSION: Elevated concentrations of anaphylatoxin are frequently found in FFP units produced by apheresis. Studies are necessary to investigate the reasons for complement activation and the possibilities of prevention during apheresis. As the concentrations of complement precursors and complement function did not change with activation in FFP, these studies should include measurement of the anaphylatoxins C3a and C5a.     

The efficacy of plasma exchange in the removal of plasma components

The efficacy of plasma exchange in the removal of immunoglobulins (IgG, IgM, IgA), complement components (C1q, C4, C3), alpha 1-antitrypsin, alpha 2-macroglobulin, and transferrin was studied by analysis of pre- and postexchange serum samples and the plasma removed both in a healthy volunteer and in five patients undergoing therapeutic plasma exchange. In the healthy volunteer, the measured reduction in serum concentration and the measured amount removed for each component was compared with values predicted by a physical model. For all components except IgM, the sum of the measured amount removed during the procedure and the calculated amount present in the circulation progressively exceeded the calculated intravascular amount present before plasma exchange. This was particularly the case for C4, C3, alpha 1-antitrypsin, and alpha 2-macroglobulin and may be explained by influx from the extra- to the intravascular compartment during the procedure. Influx also occurred in the patients. We conclude that, except for IgM, the actual amount of a component that has been removed should be assessed for proper evaluation of the efficacy of PE.     

Dilution of plasma with Tris buffer increases measured catecholamines in plasma

We investigated the effects of dilution of plasma samples on the measured concentrations of catecholamines. Diluting samples of human plasma 10-, 50-, and 100-fold with Tris buffer (100 mol/L, pH 8.6) improved analytical recovery of internal standards, suggesting that it decreases the commonly observed inhibition of methylation in radioenzymatic assays of catecholamines in plasma. However, the dilution is not associated with a proportional decrease in counted radioactivity. This extra amount of radioactivity, which is unlikely to be nonspecific in origin, accounts for a significant increase in the calculated catecholamine concentration. Tentatively, we suggest that Tris buffer releases both catecholamines and conjugated catecholamines bound to some unidentified low-molecular-mass component of plasma.     

The concentration of plasma fibronectin in burns patients treated with fresh frozen plasma or plasma protein fraction

A group of 10 patients with 30-70% burns were given intravenous infusions during the first 48 h following hospital admission either with fresh frozen plasma (FFP) or human plasma protein fraction ( HPPF ). FFP contained 300-400 mg/dl plasma fibronectin whereas none was detectable in HPPF . Circulating plasma fibronectin levels fell quickly in those patients receiving HPPF and levels remained low for 2-3 weeks. In those receiving FFP, plasma fibronectin remained normal during the 48-h transfusion period but fell subsequently. Fibronectin may be an important determinant in the resistance to shock and infections. Consideration should therefore be given to the use of blood products which contain fibronectin and to the monitoring of plasma levels both during the acute and recovery periods after burn injury.     

长期供血浆者血浆蛋白含量变化统计分析

目的探讨长期稳定供血浆者血浆总蛋白、白蛋白、球蛋白变化情况。方法选择长期供血浆者,供浆年龄5年以上,与初次供血浆者进行比较。结果长期稳定供血浆者总蛋白、白蛋白、球蛋白与初次供血浆者比较无显著差异。结论采浆后损失的总蛋白、白蛋白、球蛋白是在机体代偿的允许范围内,无损于供血浆者的身体健康。     

Triglyceride lipase activity in postheparin plasma and plasma lipoproteins in liver disease.

Hepatic lipase activity and lipoprotein lipase activity were studied in postheparin plasma from 14 patients with various liver disorders. Plasma lecithin: cholesterol acyltransferase (LCAT) activity and lipoprotein composition and structure were also estimated. Five patients had lower hepatic lipase activity than the lowest control value, and in three of these no hepatic lipase activity was detected. Lipoprotein lipase was low in 5 patients, but in only one of them was hepatic lipase activity also low. Hepatic lipase was not significantly correlated to the concentration of plasma triglycerides, either in controls or in patients, whereas lipoprotein lipase was negatively correlated with plasma triglycerides both in controls and patients. Lipoprotein lipase and LCAT activity, but not hepatic lipase, was negatively correlated to the triglyceride content of the low density lipoproteins (density 1.019-1.063 g/ml) from the patients. No specific lipid or lipoprotein pattern was found in plasma from the patients with a low or without any hepatic lipase activity. The results suggest an important role of lipoprotein lipase and LCAT, for the increased content of triglycerides in the low density lipoproteins in patients with liver disease. The role of hepatic lipase remains unclear.     

Comparison of immunoreactive renin and plasma renin activity in human plasma

Measurement of immunoreactive plasma renin concentration (PRC) using direct radioimmunoassay (RIA) was compared with the common procedure, measurement of plasma renin activity (PRA). The sensitivity of the PRC assay was 5 pg/ml. In 67 normal subjects aged 45.2 +/- 1.2 year, the mean PRC value was 17.0 +/- 0.9 pg/ml in the recumbent position and 38.0 +/- 5.4 pg/ml in the upright position. In patients with high renin essential hypertension and renovascular hypertension, discrepancies were observed between changes in PRA and PRC at 60 min after the administration of captopril. In a patient with Bartter's syndrome PRC was markedly elevated (393 pg/ml) and the changes in PRA and in PRC after captopril were very different (452% vs. 1249%). In all 10 cases of primary hyperaldosteronism PRC was less than 5 pg/ml. The correlation coefficient between PRC and PRA was 0.85 (n = 227, p less than 0.01). The slope of the regression line between PRA and PRC decreased in proportion to PRC values. Direct RIA for PRC is likely to be useful for the determination of plasma active renin when renin levels are high or substrate concentrations are abnormal. Moreover, the combined use of PRA and PRC measurements might be useful in assessing abnormalities in renin substrate concentration as well as in PRC.