冰冻单采血小板与冷沉淀联合输注在外科手术中的应用

目的：研究冰冻单采血小板与冷沉淀联合输注在外科手术输血治疗中的止血疗效。方法：选择输血量大于2000ml的外科手术患者随机分组,将冰冻单采血小板或冷沉淀单独输注者与联合输注者作了对比观察。观察指标（输注前与输注后1～2h）：①凝血酶时间（TT）;②凝血酶原时间（PT）;③活化部分凝血活酶时间（APTT）;④纤维蛋白原（Fbg）;⑤血小板计数PLT;⑥24h内有效止血率;⑦平均止血时间。结果：3组患者组内比较输注后1～2h比输前的TT、PT及APTT显著缩短,Fbg及ALT显著增加（P〈0．05或P〈0．01）;联合输注组与单采血小板对照组比较,TT、PT、24h止血率及平均止血时间差异有统计学意义（P〈0．05或P〈0．01）;与冷沉淀对照组比较,TT、PT、APTT、PLT、24h止血有效率及平均止血时间差异有统计学意义（P〈0．05或P〈0．01）;2个对照组比较Fbg及ALT差异有统计学意义（P〈0．05或P〈0．01）。结论：在外科手术患者输血治疗中,联合输注组比冰冻单采血小板组及冷沉淀单独输注组具有更为显著的止血效果。     

正常妊娠和妊娠期高血压妇女凝血指标变化

目的：观察比较正常妊娠和妊娠期高血压妇女血浆凝血因子的变化及临床意义。方法：检测正常妊娠和妊娠期高血压孕妇各30例及非妊娠妇女20例的血浆凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（Fg）及D-二聚体（D-D）的含量．并进行比较分析。结果：正常妊娠和妊娠期高血压两组血浆Fg、D—D含量均高于非孕妇女（P均〈0．01），妊娠期高血压组的高于正常妊娠组（P〈0．01）。妊娠期高血压组轻、中、重度患者血浆Fg、D-D含量随病情加重逐渐升高，并有非常显著差异（P〈0．01）。重度妊娠高血压组与正常妊娠及轻、中度妊娠高血压组比较，PT、APTT均缩短（P〈0．01）。结论：动态检测孕妇血浆中凝血指标对于妊娠期高血压的早期诊断与防治有重要意义。     

凝血纤溶系统疾病6项指标联合检测的临床意义

目的：为了解凝血纤溶系统疾病血液凝固和纤维蛋白溶解状态,指导临床医师对凝血纤溶系统疾病患者适时干预治疗和判断预后。方法：运用全自动血凝分析,对脑血栓,脑外伤,妊高症患者的凝血、纤溶等6项指标进行检测分析。结果：血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）在妊高症组未见显著变化（P〉0．05）;脑血栓形成组和脑外伤组PT延长（P〈0．01）,APTT、TT在3组疾病中无显著变化（P〉0．05）。纤维蛋白原（FIB）,纤维蛋白原降解产物（FDP）,D-二聚体在3组疾病中均显著升高（P〈0．01）。结论：凝血与纤溶6项指标联合检测能较全面反应患者出凝血系统的状态,对临床医师监测病情即时有效治疗,防止DIC的发生和判断预后有重要意义。     

连续性肾替代治疗对危重患者凝血功能的影响

目的：评价连续性肾替代治疗方法对危重患者的安全性。方法：回顾性统计60例行连续性肾替代治疗患者的病历资料,按治疗累计总时间将患者分为〈72h组和〉72h组,比较治疗前、后血小板及凝血指标的变化和出血发生率。结果：〈72h组在治疗24h后与治疗前比较PLT、纤维蛋白原（FIB）下降,PT、APTT延长（P〈0．05）;〉72h组在24h、72h后各项指标有同样变化,且72h后PLT、FIB下降更多（P〈0．01）,PT、APTT延长更明显（P〈0．05、P〈0．01）。〉72h组继发出血情况较〈72h组严重（P〈0．01）。结论：连续性肾替代治疗连续多次治疗后可引起血小板减少、凝血时间延长,出血发生率增加。治疗期间应加强凝血功能监测,治疗次数和时间控制在一定范围,病情改善及时停止治疗,避免增加出血几率。     

回收式自体输血对手术患者凝血及免疫功能的影响

目的探讨回收式自体输血（BS）对机体凝血状态和T淋巴细胞亚群、NK细胞功能的影响。方法选择骨科大手术患者40例，随机分为自体输血组（BS组）和异体输血组（异体组）各20例，术中分别采用BS及输异体血，分别于术前、输血后1h及输血后24h测定血常规、APTT、PT、FIB及ACT；流式细胞仪测定输血后第1天、第5天T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋值及NK细胞。结果输血后1h两组APTT、PT、ACT均延长，FIB和PLT计数均降低（P〈0．05），但尚在正常范围内，组间比较元显著性差异（P〉0．05）。异体输血组输血后第1天和第5天CD3^＋、CD4^＋、CD8^＋、NK变化显著低于BS组（P〈0．01）；BS前后上述指标元明显变化（P〉0．05）。结论．BS对凝血功能的影响与异体输血相似，大量回输时应注意补充凝血因子和血小板；BS对机体细胞免疫功能元明显抑制作用。     

去白细胞输血对恶性血液病患者免疫活性细胞的影响

目的：观察应用输血治疗的恶性血液病化疗患者外周血T细胞亚群及NK细胞活性，探讨去白细胞输血对恶性血液病患者免疫活性细胞的影响。方法：将120例化疗期间需要接受输血治疗的恶性血液病患者分为2组：A组59例接受去白细胞输血；B组61例接受常规输血。2组每次的输血量、输血次数及化疗方案基本相同。对2组治疗前后的T细胞及NK细胞活性进行检测，并与对照组进行比较。结果：①恶性血液病患者各项免疫活性细胞表达均低于对照组（P〈0．01）；②治疗前A、B2组免疫活性细胞表达差异无统计学意义，治疗后A组的NK细胞活性明显高于B组（P〈0．01）；A组治疗后CD^3-、CD4^＋、CD4^＋／CD8^＋、NK细胞活性明显高于治疗前（P〈0．05）；③B组发生非溶血性发热反应（NHFTR）率明显高于A组（P〈0．01）。结论：T细胞亚群、NK细胞活性在恶性血液病患者中受到明显抑制；与常规的输血治疗方法相比，去白细胞输血能明显改善恶性血液病患者的细胞免疫功能，尤其是对NK细胞，并能有效预防NHFTR。     

尼麦角林治疗糖尿病性脑梗死43例

糖尿病性脑梗死患者共86例，随机分为治疗组、对照组各43例。治疗组给予尼麦角林注射液8mg加入生理盐水250ml静脉滴注，每日1次，疗程20天；对照组给予维脑路通注射液400mg。结果：治疗组总有效率显著优于对照组（P〈0．01）；神经功能缺损和日常生活能力评分优于治疗前（P〈0．01）和对照组（P〈0．05）；全血和血浆粘度、红细胞刚性指数、红细胞聚集指数和血浆比粘度的变化也优于治疗前（P〈0．01）及对照组（P〈0．05）。结论：尼麦角林治疗糖尿病性脑梗死安全有效。     

术中自体血回输量对患者凝血功能的影响

目的观察术中自体血回输量对患者凝血功能的影响。方法将90例手术患者随机分为A、B、C组各30例,均于术中采用血液回收机系统进行自体血液网收,手术止血完成后将回收的自体洗涤红细胞回输,总量为A组〈400ml、B组400—800ml、C组800～1200ml。三组术中均不输注异体红细胞及血浆,C组术后当日输入血浆200～400ml。分别于术前、自体血回输后1h及术后24、48h测定Hb、红细胞压积（Hct）、PLT及凝血指标PT、APTT、激活全血凝固时间（ACT）、TT、纤维蛋白原（FIB）。结果自体血回输后1hA组PLT显著低于术前（P〈0．05）,但在正常范围内;B、C组Hb、Hct、PLT及FIB较术前均降低（P〈0．05）,C组PT、APTT输血后1、24h较术前明显延长（P〈0．05）。结论术中自体血回输量〈1200ml相对安全,〉1200ml时应采取必要的止血干预措施,防止出现凝血功能障碍。     

冰冻单采血小板与冷沉淀联合输注治疗产后大出血

目的：研究冰冻单采血小板与冷沉淀联合输注在治疗产后大出血患者中的疗效。方法：选择输血量〉2000ml的产后大出血患者随机分组，将冰冻单采血小板或冷沉淀单独输注者与联合输注者作了对比观察。观察指标输注前及输入后1～2h患者：①凝血酶时间（TT）；②凝血酶原时间（PT）；③活化部分凝血活酶时间（APTT）；④纤维蛋白原（Fbg）；⑤血小板计数PLT；⑥24h内有效止血率；⑦平均止血时间。结果：患者输注后1～2h比输前的TT、PT及APTT显著缩短，Fbg及ALT显著增加（P〈0．01），平均止血时间为2．45±1．36h，24h止血有效率为96．15％。结论：在产后大出血患者输血治疗中，应用冰冻单采血小板组及冷沉淀联合输注有着显著的止血效果。     

病毒性肝炎和妊娠肝炎患者凝血因子和纤溶指标的临床意义

目的探讨凝血因子和纤溶指标在病毒性肝炎和妊娠肝炎中的变化和意义。方法将142例病毒性肝炎分为急性肝炎、慢性肝炎轻度、慢性肝炎中／重度、肝硬化和重症肝炎五组，妊娠肝炎35例，同步检测凝血因子V活性（FV：C）、凝血因子Ⅶ活性（FⅦ：C）、凝血因子X活性（FX：C）、纤溶酶活性（PL：A）、组织纤溶酶原激活剂活性（t-PA：A）、纤溶酶原激活物抑制剂活性（PAI：A）、D-二聚体（D-D）和纤维蛋白降解产物（FDP）八项指标，并分别与90例正常对照组和32例正常晚孕组测定结果相比较。结果与正常对照组比较，急性肝炎FV：C增高（P〈0．05），其余各类肝炎FV：C、Ⅶ：C、FX：C的血浆水平均有不同程度的降低（P〈0．05～〈0．01）：妊娠肝炎组的凝血因子水平高于正常对照组，但低于正常晚孕组。除慢性肝炎轻度组D-D外．各型肝炎其余指标与正常对照组比较，差异均有统计学意义（P〈0．05～〈0．01），PAI：A均显著下降．PL1A、t—PA：A、D-D、FDP均显著升高，它们的改变与肝脏损害严重程度呈一致的趋势。妊娠肝炎组与正常晚孕组比较，纤溶指标差异均有统计学意义（P〈0．05～〈0．01）。结论病毒性肝炎和妊娠肝炎患者凝血因子和纤溶指标测定将有助判断肝炎严重程度，防治出血、推测预后和观察疗效。     

成分输血抢救治疗产科失血性休克DIC前兆18例

目的：分析成分输血抢救治疗产科失血性休克,DIC前兆的疗效。方法：选择2007年1月—2008年12月产科DIC前兆患者18例,参照DIC前兆诊断标准与治疗原则,制定成分输血等综合治疗方案,合理输注悬浮红细胞、血小板、新鲜冰冻血浆、冷沉淀等。检测血常规,凝血功能,观察临床治疗效果。结果：18例产科失血性休克,DIC前兆患者成功救治。结论：成分输血在产科失血性休克,DIC前兆抢救治疗中效果显著。     

原位肝移植患者围手术期成分输血探讨

目的:探讨原位肝移植围手术期成分输血疗效及手术前血液成分的准备,总结成分输血经验,降低用血量,减少输血反应。方法:44例肝移植患者来自不同的地区,其中1例来自韩国的患者,1例蒙古族患者;2例行肝肾联合移植的患者。部分受体与供体之间有血缘关系,ABO、RH血型相合。将44例肝移植患者按照病情诊断,分为肝硬化组18例(40.1%),男13例、女5例;肝恶性肿瘤组26例(59.1%),男24例、女2例。根据患者手术中、手术后的不同出血情况,给予不同的血液成分治疗,所用红细胞悬液均进行白细胞过滤。结果:肝硬化组成分用血量大于肝恶性肿瘤组(肝癌)。不同病情的肝移植患者需要的血液成分差异很大。讨论:术前明确患者的诊断及病程,探讨患者围手术期的出血量,提供安全、合理、有效的成分输血治疗,应用白细胞过滤技术,减少输血反应,降低输血总量是保障原位肝移植手术取得成功的关键环节。     

Clinical prognostic markers in patients with severe sepsis: a prospective analysis of 139 consecutive cases

OBJECTIVES: To analyze the clinical characteristics and determine predictive factors of mortality in previously healthy individuals suffering from severe sepsis. METHODS: The study included 139 patients with severe sepsis, admitted to the Department of Medicine over a two years period. Data recorded on admission included demographic information, blood pressure, core temperature, white blood count, hepatic and renal function tests, coagulation factors, blood gases, serum lactic acid levels, simplified acute physiology score (SAPS-II) and Glasgow Coma Scale (GCS). RESULTS: On admission, 62 patients were hypotensive, 52 had signs of diffuse intravascular coagulation (DIC), 72 had renal and 27 hepatic dysfunction. The overall mortality rate was 27.3%. Twenty-nine patients had septic shock on admission with a mortality rate of 62.07%. Hypoxemia, metabolic acidosis and the presence of DIC were more frequent in non-survivors, who also had significantly higher SAPS-II on admission and days 3 and 7. Independent factors associated with mortality were older age, septic shock, DIC and acute renal failure on admission, as well as SAPS-II at all time points and lactic acid levels on day 7. CONCLUSIONS: Septic patients with advanced age, septic shock, renal failure, DIC and metabolic acidosis on admission are at increased risk of mortality. The sustained presence of high SAPS-II and lactacidemia one week after admission are also important risk factors of poor outcome.     

Clinical bleeding events and laboratory coagulation profiles in acute promyelocytic leukemia

Background: Bleeding is the leading cause of death for patients with acute promyelocytic leukemia (APL). Blood component transfusion to correct coagulopathy is the keystone in reducing bleeding. The benefit of fresh frozen plasma transfusion is unproven. Using laboratory profiles to predict bleeding is important guidance for the determination of transfusion policies in the treatment of APL. Design and methods: For 116 patients of APL, bleeding events were collected and correlated with various hematologic and coagulation parameters, including leukemic cell percentages, white blood cell (WBC) and platelet counts, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen levels, and disseminated intravascular coagulation (DIC) scores. Results: Overt DIC occurred in 77.6% of patients. Severity of DIC was associated with bone marrow leukemic cell percentages but unrelated to bleeding. Patients with bleeding had significantly higher WBC counts (26.73 ± 6.18 vs. 13.03 ± 3.03 per μL, P = 0.026) and more prolonged PT (4.85 ± 0.70 vs. 2.59 ± 0.28 s, P = 0.002) and APTT (3.98 ± 1.68 vs. 0.96 ± 0.93 s, P = 0.017). Fibrinogen levels, platelet counts, and leukemia cell percentages were not significantly different between bleeding and non‐bleeding patients. PT is valuable in prediction of bleeding. Patients with PT ≧ 5 s had a relative risk of 6.14 for bleeding. Seven patients had severe bleeding before initiation of all‐trans retinoic acid (ATRA). Conclusions: Patients with APL are susceptible to DIC and subsequent bleeding events. Prompt ATRA administration is crucial in preventing hemorrhagic events. High WBC counts, prolonged PT, and APTT are associated with clinical bleeding in our series. PT is the most accurate parameter in predicting bleeding. Based on these findings, supportive care should be directed toward correction of coagulopathy to prevent bleeding complications and fresh frozen plasma appears to be indicated for coagulopathy associated with APL.     

新生儿换血治疗49例分析

目的：探讨导致新生儿换血的病因,换血前后患儿胆红素水平及血常规、血生化等内环境指标的变化。方法：对49例北京儿童医院新生儿换血病例,统计分析导致换血病因;换血前后分别检测患儿胆红素、血生化、血气分析及血常规,并进行比较。结果：49例患儿中因母婴血型不合导致换血41例,遗传型球型红细胞增多症3例,红细胞葡萄糖-6-磷酸脱氢酶缺乏症2例,原因不明的高胆红素血症患儿3例。换血治疗前后血清总胆红素和间接胆红素水平下降52%,血小板、白细胞计数显著减少。患儿的血钾、血氨明显下降（P〈0.01）,血钠和血钙水平换血前后差异无统计学意义（P〉0.05）,但血糖水平显著升高（P〈0.01）。换血治疗前后血气分析指标无明显波动（P〉0.05）。结论：母婴血型不合是导致新生儿换血的主要原因。换血治疗新生儿高胆红素血症可以有效降低患儿体内胆红素水平,对患儿血液内环境有一定影响。     

重组人白细胞介素-2序贯治疗36例高龄急性髓系白血病的临床观察

目的:探讨重组人白细胞介素-2序贯治疗高龄急性髓系白血病(AML)的临床疗效.方法:36例高龄患者随机分为治疗组及对照组,治疗组在对照基础上给予白介素-2治疗,对照组给予间断成分输血、抗感染及止血药物治疗.结果:2组治疗缓解率差异无统计学意义;治疗组治疗前后骨髓原始细胞百分率差异无统计学意义;治疗组中位OS为25.2周...     

Influence of blood transfusion on development of infection in patients with malignant neoplasms of the digestive system

BACKGROUND: Anemia affects up to 90% of cancer patients, with more than 60% requiring blood transfusion during or after treatment. AIM: To determine the influence of the allogeneic blood transfusion as a possible related factor to infection in patients with malignant neoplasms of the gastrointestinal system. PATIENTS AND METHOD: Charts of 400 oncological patients were randomly selected and divided into two groups: group 1 (n = 200)--patients submitted to allogeneic blood transfusion and group 2 (n = 200)--non transfused patients. Both groups were evaluated and compared according to the presence and type of infection and a possible association with age, sex, types of tumors and therapeutics approach. RESULTS: The relation between infection and blood transfusion, as well as age, sex, management and type of presented tumors were not significant. There was no difference in the incidence of infection between the non transfused patients (28) and those submitted to allogeneic blood transfusion (31). CONCLUSIONS: In the present investigation allogeneic blood transfusion was apparently not related to development of infection in patients with malignant gastrointestinal tumors.     

Blood Component Utilization for Disseminated Intravascular Coagulation (DIC) Cases with Respect to Underlying Condition

To understand transfusion requirement in DIC with respect to (wrt) underlying cause. Patients’ details were analyzed using parameters like yearly requirement, hemoglobin (Hb) and blood components utilization wrt age, sex and cause of DIC. Total 1931 DIC cases from 167 hospitals received 21,153 blood units including whole blood, red cell concentrate fresh frozen plasma, random donor platelets, single donor platelets and cryoprecipitate from year 2001 to 2013. Significant risk of DIC was for females compared to males (p < 0.0001). Whole blood utilization was 25.5 % in 2001 which reduced to 1.2 % in 2013. Mean ± SD Hb concentration was 8.6 ± 3.0 in females and 9.8 ± 3.2 g/dL in males. The lowest mean Hb was 7 g/dL in female DIC cases having malignancy. Septicemia was the major cause of DIC followed by obstetric complications. The highest requirement was for trauma associated with septicemia, requiring 35 units/case. Combination of two or more underlying causes for DIC increased the blood component requirement.     

Adverse transfusion reactions associated with a precipitating anti-C4 antibody of anti-Rodgers specificity

A patient suffering from chronic hepatitis exhibited severe transfusion reactions after administration of fresh frozen plasma and a plasma fraction: PPSB (prothrombin complex concentrate). 1 month before these reactions, she received fresh frozen plasma during plasma exchange therapy. The patient's serum obtained 1 week and 6 months after the second reaction gave a precipitation arc against PPSB preparations when examined by double-diffusion technique in agarose gel. An antibody of IgG class present in these sera reacted with a purified preparation of the fourth complement component (C4). This was demonstrated by various experiments (protein A radioimmunoassay and passive hemagglutination) using purified C4 as antigen. The antibody had a limited specificity and reacted only with C4 of Rodgers specificity. Phenotype determination of the patient's C4 group showed that she was Chido positive and Rodgers negative. Her HLA group was A1, Aw30; B8,-; DR3,-. The patient had neither detectable anti-IgA nor other anti-immunoglobulin antibodies. She had not received blood or plasma transfusion before her hepatitis. The coexistence of a precipitating anti-C4 antibody and adverse transfusion reactions to plasma fractions containing large amounts of C4 indicates that in the absence of antibodies of other specificities, this antibody can be considered as the cause of the transfusion reaction.