山莨菪碱抑制E.Coli内毒素激活兔血小板机理的初步研究

细菌内毒素结合到血小板上引起血小板聚集、血小板减少、血栓素A_2(TXA_2)产生增加、5-羟色胺6-HT)释放和PF_3促凝活性增加等。内毒素对血小板的这些效应已在不同种属动物上得到证实,很多证据说明这些变化可以参与感染性休克中弥漫性血管内凝血和呼吸窘迫综合征的发病。20多年来,已从不同角度证实     

血浆血红蛋白在内毒素所致弥散性血管内凝血中意义的探讨

以大肠杆菌内毒素粗制品注入狗与兔静脉内引起DIC,同时出现血浆血红蛋白增高。由于血浆血红蛋白含量异常率仅次于血小板变化,在异常率较高的指标中以血浆血红蛋白含量变化比值最大,并且内毒素所致DIC动物死亡率与血浆血红蛋白含量成正比,因此血浆血红蛋白可能成为内毒素所致DIC的辅助诊断与预后判断的指标之一。     

ANISODAMINE EFFECTS ON FUNCTIONAL AND MORPHOLOGICCHANGES OF PLATELETS IN ENDOTOXINEMIC RABBITS

The effects of anisodamine (654-2) on platelet aggregation rate and release and morphologic changes by scanning electron microscope were observed in endotoxinemic rabbits. After 654-2 intervention the aggregated platelets became partially dispersed and the pseudopods shortened and thickened. From our data, 654-2 protective action may be due to stabiliz. ing the lysosome membrane or other ways of in- hibiting bata-glucuronidase release, which may also be its antishock effect mechanism.     

丹参、654—2抗脂质过氧化及对小鼠缺血心肌的保护作用

本研究观察丹参、654—2抗脂质过氧化及时异丙肾上腺素(ISO)引起小鼠急性心肌缺血的保护作用.给果显示:与对照组相比,缺血组血浆及心肌匀浆MDA含量明显升高(P<0.05,P<0.01);红细胞SOD活力降低(P<0.05);心肌组织损伤性变化很明显.与缺血组相比,缺血加丹参组血浆及心肌匀浆MDA含量显著降低;SOD活力显著升高;心肌损伤有所改善,缺血加654—2组血浆及心肌匀浆MDA含量显著降低;SOD活力显著升高;心肌损伤明显改善.说明丹参和654—2通过抗自由基及脂质过氧化损伤而对缺血心肌胞有保护作用.     

Observations on the Therapeutic Effects of Anisodamine on Respiratory Distress Syndrome

The animal model of dogs was used to study the pathological evolution ofrespiratory distress syndrome (RDS) and the therapeutic effects of anisodaine on the disease.Atotal of 54 dogs were employed and they were divided into control and experimental groups.RDS was inflicted to the dogs by oleic acid injection.Then the clinical manifestations,theblood gas parameters,the pulmonary arterial pressure,the pulmonary wedge pressure,T_3 andT_L,blood cell counts,neutrophil aggregation rate,platelet maximum aggregation rate,TXB_2,6-keto-PGF_(1a) and hemocoagulagrams were obsenved.On the basis of our observations,it is concluded that the complement activities andneutrophil aggregation induced by TXA_2 are likely the initiative factor of RDS,the pathologicalprocess in the lungs is complicated with disseminated intravascular coagulation,and anisodamineexerts certain therapeutic effects on RDS through preventing the cellular membranes andlysosomes from being injured.     

家兔油酸型呼吸窘迫综合征的血液流变学参数变化

本实验对家兔呼吸窘迫综合征模型在注射油酸后5小时、24小时及48小时血液流变学参数的变化进行了观察。结果表明,静脉注入油酸后5小时的血液表观粘度、血浆粘度、红细胞压积及TK值均无明显变化;注入后24小时的血液表观粘度在低、中、高切变率下均明显增高,红细胞压积减小,TK值增大,与实验前相比,均有明显差异(P<0.02,P<0.05),但血浆粘度无明显变化;注入后48小时的血液流变参数与注入油酸前也无明显差异。提示油酸注入后24小时的血液流变学改变最著,红细胞变形能力明显降低,这是肺损伤的重要原因之一。     

中华眼镜蛇毒致局部组织损伤模型血小板参数的变化

目的:探讨中华眼镜蛇毒致局部组织损伤后对凝血系统的影响。方法:用中华眼镜蛇毒制作家兔局部组织损伤模型。于家兔耳缘静脉采血,于血球仪进行血小板计数(BPC)、血小板比积(PCT)、平均血小板体积(MPV)和血小板体积分布宽度(PDW)检测。结果:与注射蛇毒前相比,注毒后家免有DIC及微血栓形成表现,且BPC和PCT显著减少(均为P<0.001),MPV和PDW明显增大(均为P<0.001)。结论:中华眼镜蛇毒在导致家兔局部组织损伤后可产生急性DIC_o血小板参数检测可用来初步判断DIC及血栓形成的发生和发展。     

阿胶复脉汤对内毒素血症时血小板保护作用机理的探讨

目的：探讨阿胶复脉汤对内毒素血症时血小板保护作用的机理。方法：复制大鼠内毒素血症动物模型,用血小板聚集仪、透射和扫描电镜等观察阿胶复脉汤对内毒素血症大鼠血液凝固性、血小板聚集性及血小板超微结构变化的影响。结果：阿胶复脉汤可使内毒素血症时明显延长的ＫＰＴＴ和ＰＴ时间恢复正常,同时有稳定血小板膜的作用。结论：阿胶复脉汤可改善内毒素血症时微循环的变化而防止ＤＩＣ的发生     

蝮蛇抗栓酶治疗流行性出血热40例疗效观察

应用蝮蛇抗栓酶治疗流行性出血热（ＥＨＦ）４０例。结果显示，在退热，恢复肾功能，尿蛋白消失，血小板恢复正常及越期率等方面均较对照组为优，经统计学处理有显著差异（Ｐ＜０．０１～０．００１）。提示蝮蛇抗栓酶具有减轻肾功能损害，预防和治疗播散性血管内凝血（ＤＩＣ）形成，增强病人免疫功能，减少并发症的发生，提高越期率等作用，且临床应用安全、方便、副作用少，为ＥＨＦ病人的治疗提供了新的途径。     

成人急性白血病合并弥散性血管内凝血36例临床分析

目的 探讨急性白血病合并弥散性血管内凝血（DIC）的临床特点及疗效.方法 分析36例急性白血病病人的临床资料,观察常规DIC筛查指标,以及小剂量肝素钠治疗效果.结果 152例初治的急性白血病人中36例（23.68%）合并DIC,8例病人死亡,5/8人死于颅内出血.DIC病人与非DIC病人PT、Fbg、TT、PLT均数比较差异显著（P＜0.01）,D-dimer、PT、Fbg异常阳性率达80%以上.应用小剂量肝素钠联合血小板输注及凝血因子补充治疗,DIC治愈率77.78%,治愈率病人的DIC纠正时间为7～15 d（均值9.32±5.10）.结论 DIC是急性白血病常见及严重并发症,PT、Fbg、TT、D-dimer是白血病合并DIC重要观察指标,小剂量肝素钠可以有效治疗急性白血病合并DIC.     

INCIDENCE AND ETIOLOGY OF RESPIRATORY DISTRESS IN NEWBORN

Screening of 1986 consecutive live births was done for evidence of Respiratory Distress by administering Downe's scoring in a prospective study at level II nursery of a medical college. A detailed antenatal, natal and postnatal history along with detailed examination supported by relevant investigations was carried out to arrive at the etiological diagnosis of Respiratory Distress Syndrome (RDS).Results: 48 newborns developed RDS during the observation period. The incidence of RDS was 2.42%. Out of these 40.4% were <1500g, 16.6% above 2500 g and the rest between 1500–2500 g. Preterm were thirty times more prone to develop RDS than full term neonates. There was no significant difference in incidence of RDS in male and female neonates. The commonest cause of RDS was hyaline membrane disease (HMD) 18.8% followed by transient tachyopnea of the newborn (TTNB) 14.5% and meconium aspiration syndrome (MAS) 12.5%. HMD was predominantly seen in the preterm in the gestational age of 29 to 32 weeks, TTNB was seen equally in term as well as preterm neonates, where as MAS was common in the term than in the preterm neonates.     

急性重症感染并发弥漫性血管内凝血的实验诊断

对５０例急性重症感染病人（２４例合并ＤＩＣ，２６例未合并ＤＩＣ）做了凝血酶原时间（ＰＴ）、活化的部分凝血活酶时间（ＡＰＴＴ）、纤维蛋白原含量（Ｆｇ）、血小板数量（Ｐｌｔ）、抗凝血Ⅲ（ＡＴ－Ⅲ）、纤溶酶原活性（ＰＬＧ）、α＿２纤溶酶活性（α＿２ＡＰ）和Ｄ－二聚体含量（Ｄ－Ｄｉｍｅｒ）８种凝血纤溶指标的测定观察。结果表明：ＤＩＣ在感染性多系统脏器衰竭（ＭＳＯＦ）的发生发展过程中具有重要作用。单次Ｆｇ含量测定对感染性ＤＩＣ的诊断价值不大。ＰＴ、ＡＰＴＴ、ＡＴ－Ⅲ、ＰＬＧ、Ｐｌｔ、Ｄ－Ｄｉｍｅｒ和α＿２ＡＰ可做为感染性ＤＩＣ的实验诊断指标，但单项测定对ＤＩＣ的诊断率均未超过８０％，而多项指标的联合检测可提高诊断率至９０％以上。     

山莨菪碱对内毒素狗全血乳酸、肝糖原含量的影响

在观察山莨菪碱(654-2)对内毒素狗血流动力学指标影响的同时,观察了654-2对其动脉全血乳酸、血浆葡萄糖及肝细胞糖原含量的影响。实验结果;实验组(内毒素加654-2)动物高乳酸血症下降速度较对照组(内毒素加生理盐水)显著增快;注内毒素后第6h,肝糖原含量较对照组显著增高,而两组动物血流动力学指标变化无明显差异。提示654-2有改善内毒素狗肝脏对乳酸的糖异生作用,而这一作用似与血流动力学指标的改善关系不大。654-2对肝细胞的保护作用可能是其作用环节之一。     

血小板和D-二聚体联检在DIC诊断中的应用

目的探讨血小板数量和D-二聚体（D—D）含量在弥漫性血管内凝血（D1C）发生过程中的变化。方法胶体金法检测DIC患者及正常对照组血浆中D-D的含量,同时采集全血检测血小板数量。并对12例重型DIC患者血浆中D．D和全血血小板数量进行了为期10d的动态监测。结果血浆中D—D的含量在DIC组显著增高,与对照组比较差异均有统计学意义（P〈0．01）。血小板呈短暂上升后明显降低或与发病初期相比明显降低（P〈0．01）。动态观测中,D-D变化不大,而血小板计数短暂上升后明显降低,且随着治疗过程有一定的回升。结论二者联检可以明显提高DIC的诊断效率,且血小板因出现较早且随着治疗的过程能同步变化,可作为一较理想的动态监测指标。     

用等位基因特异性PCR筛查海南省黎族人β-地中海贫血IVSII654(C→T)突变

目的:研究海南省黎族人群β-地中海贫血IVSII654(C→T)突变的发病率。方法:应用等位基因特异性聚合酶链反应(PCR)技术筛查海南省白沙、昌江、陵水、琼中、保亭等县黎族人群中β-地中海贫血IVSII654(C→T)突变。结果:共筛查了788例黎族人DNA标本,未发现β-地中海贫血IVSII654(C→T)突变。结论:IVSII654(C→T)突变不是海南省黎族人群中主要的β-地中海贫血的基因类型。     

海水型呼吸窘迫综合征犬模型的实验研究

目的构建海水型呼吸窘迫综合征(SW-RDS)的犬模型,为研究海水淹溺后的呼吸窘迫综合征的病理表现和治疗提供平台。方法选择12只健康犬随机分为2组,即对照组(n=4)和模型组(n=8)。对比两组血流动力学、血气分析、电解质等指标和肺组织细胞学变化,并检测支气管肺泡液和血液乳酸脱氢酶(LDH-L)、碱性磷酸酶(ALP)浓度。结果与对照组相比,模型组出现明显的血流动力学、血气和乳酸的变化,病理结果显示肺组织损伤明显,LDH-L和ALP持续显著升高。上述变化符合SW-RDS的诊断标准。结论SW-RDS犬模型能够反映海水淹溺后的病理生理变化规律和SW-RDS的病理特征。     

DIAGNOSING DISSEMINATED INTRAVASCULAR COAGULATION IN ACUTE INFECTION : CAN WE DO WITHOUT FDP & D-DIMER

Alterations in coagulation profile viz. platelet count, prothrombin time (PT), partial thromboplastin time with kaolin (PTTK), thrombin time (TT) and fibrinogen were studied in 96 patients (73 males and 23 females) of acute infections. Fibrin/fibrinogen degradation products (FDP) level >25µg fibrinogen equivalent unit (FEU)/ml along-with D-dimer >1.0µg FEU/ml was considered criteria for diagnosis of disseminated intravascular coagulation (DIC). Normal values were established using plasma from 12 healthy voluntary blood donors. Out of these 96 patients, 15 had infection with Gram positive bacteria, 23 with Gram negative bacteria and 38 with Dengue. In 20 patients, nature of infection was not defined. Mean platelet count per cubic millimetre was 2.14 lac in Gram positive infection and 1.74 lac in Gram negative infection (p=0.07). There was no significant difference in other coagulation parameters in Gram positive and Gram negative infection. Platelet counts were low in 71% of Dengue patients but there was no significant alteration in PT, PTTK and TT. None of the Dengue patients had hypofibrinogenemia or DIC though hyperfibrinogenemia was present in 21% of Dengue patients. 20 patients had features of septicemia (Gram +ve 7, Gram -ve 8, undefined 5); 10 had concomitant DIC. DIC was present in additional 4 patients of acute infection without septicemia. PTTK was raised in 60% of the septicemia patients. 20 out of 82 non-DIC acute infection patients had subnormal PTTK. Commonest alteration in 14 DIC patients was raised PTTK with a sensitivity of 78.6% and specificity of 81.7%. Low fibrinogen levels though specific for DIC, were present in only 21.4% of the DIC patients. Combinations of PTTK >38 sec with PT >15 sec or platelet count < 1.5 lac/mmm³ were good screening tests for DIC and detected 11 and 10 patients out of 14 with three and two false positives respectively.KEY WORDS: D-dimer, Disseminated Intravascular Coagulation, Fibrinogen degradation products, Partial thromboplastin time, Prothrombin time, Thrombin time     

临产孕妇凝血功能指标的检测与分析

目的探讨临产孕妇凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（Fbg）、血小板计数（PLT）、血小板平均体积（MPV）、血小板分布宽度（PDW）指标与弥散性血管内凝血（DIC）之间的相互关联及其影响。方法采用日本SysmexCA-50自动血凝仪及日本Kx-21血液分析仪对我院500例临产孕妇和50例正常婚检妇女进行以上指标的检测和分析。结果临产孕妇的Fbg、MPV、PDW明显高于对照组,有显著性差异（P〈O．01）;PLT与对照组相比,无显著性差异（P〉O．05）;临产孕妇的PT、APTT和TT明显低于对照组,有显著性差异（P〈O．01）。结论临产孕妇血液呈高凝状态,产前凝血功能指标的检测,对预防临产孕妇在分娩过程及产后可能出现的大出血、对于预防弥散性血管内凝血的发生及诊断,都有着极其重要的意义．     

弥散性血管内凝血中敏感实验室检测指标的观察

目的：对反映弥散性血管内凝血（DIC）敏感的实验室检测指标进行比较分析，方法：检测120例Pre-DIC患者，30例DIC患者及30例健康志愿者血浆中PT，TT，KPTT，Fbg,D-Dimer,sP-选择素，凝血酶调节蛋白及BPC的变化，结果：Pre-DIC组及DIC患者组BPC，Fbg,D-Dimer,sP-选择素及TM与正常对照组比较有统计差异（P＜0．05或P＜0．01），对Pre-DIC组患者进行回顾性分析发现，对于诊断早期DIC的敏感实验室检测指标依次为；sP-选择素，TM、D－Dimer,BPC,Fbg,KTPP,TP,TT.敏感度依次为：96．7％，90．8％，81．7％，80．8％，76．6％，63．3％，56．7％，50．8％，而其特异性分别为60．5％，55．3％，73．6％，47．4％，26．3％，44．7％，42．1％，36．8％，虽然Pre-DIC组患者sP-选择素，TM较正常对照组有不同程度的升高，但其升高程度不及DIC组，随后发生DIC的76例患者sP-选择素，TM较非DIC患者升高明显，结论：sP-选择素，TM为DIC时出现异常最早的实验室指标之一。它们反映了患者体内高凝状态及内皮损伤程度，可作为诊断DIC得首选指标。     

烧伤合并DIC

本文就近十年来我们在67例特重烧伤病人治疗过程中血液凝固系统变化及DIC的发生诊治方面进行了初步分析及总结。体会到:(1)对大面积烧伤病人的处理中要高度警惕DIC的发生,防患于未然。(2)休克、败血症与DIC及多脏器功能衰竭互为因果。(3)抗休克、抗感染及烧伤原发病的治疗以及烧伤后即开始应用小剂量肝素(10mg/日皮下注射)是预防DIC发生的关键环节,一旦DIC诊断成立后,根据凝血系统异常及三P试验阳性的表规,积极采取抗凝、抗纤溶药及凝血物质的应用,防止DIC的继续发展。