两种浓度肝素盐水对静脉内留置三腔管抗凝作用的临床观察

本文报告协和医院血液净化中心，中心静脉留置三腔管患者６３例。用两种方法抗凝（低浓度多次肝素封管：肝素２０ｍｇ／４ｍｌ，每１２小时１次；高浓度一次肝素封管：肝素１００ｍｇ（２ｍｌ＋１．６ｍｌ生理盐水，每管１．８ｍｌ，每次血透结束后一次性肝素封管）时的局部情况，导管通畅情况，治疗效果。本文结论认为：高浓度一次肝素封管法方便、安全、疗效可靠，是值得提倡的一种方法。     

合用刺五加注射液与脑组织液治疗脑梗死患者48例疗 …

目的：观察刺五加注射液脑组织液治疗脑梗死的临床疗效。方法：７４例患者随机分为２组,治疗组４８例用刺五加注射液４０～６０ｍｌ加入５％葡萄糖２５０ｍｌ中,脑组织液１０～２０ｍｌ加入生理盐水２５０ｍｌ中,分别静滴,每日１次,１４日为１个疗程,对照例用脑多肽注射液１０ｍｌ加入生理盐水２５０ｍｌ中,低分子右旋糖酐５００ｍｌ,分别静滴,每日１次,１４日为１个疗程。２组进行比较。结果：治疗组总有效率８５．４％明     

应用凝血酶预防剖胸术后渗血的临床研究

目的：观察激血酶在预防剖胸术后渗血的作用。方法：选择手术病人２５例，随机分为实验组（Ａ组）和对照组（Ｂ组），分别于剖胸手术结束关胸前用注射器向术野、胸内粘连创面、肋骨断端及切口缘喷酒药物一遍，Ａ组药物选用２００ｕ／ｍｌ凝血酶２０ｍｌ，Ｂ组药物选用生理盐水加微量脂肪乳剂制成的安慰剂２０ｍｌ，术后第１、２、３天观察两组病人胸腔射流量。结果：术后第１天及第３天胸腔引流量Ａ组较Ｂ组分别减少１５７．１８ｍｌ     

全血粘度测量时间探讨

由于血液流变学检测广泛地应用于脑中风,冠心病、高血压等疾病的防病治病中。其中全血粘度数据是最为重要的诊治指标。为使实验准确可靠,我们对３４例血标本测定时间进行了观察及统计处理,认为全血粘度的测定最好是即采即测,也可将标本放置在室温下２小时内完成测定。１材料与方法１．１抗凝血标本：晨静脉血采,肝素抗凝。１．２试验仪器：旋转式血液流变检用仪。机型;ＬＢＹ－Ｎ５Ａ,生产厂家：北京普利生集团。１．３温度条件;实验温度３７℃,血标本在室温２０℃（±２．０℃）保存。１．４将３４例血标本分批、分别在采血后０、…     

硫酸镁用于慢性阻塞性肺病急性加重

硫酸镁用于慢性阻塞性肺病急性加重共有７２例慢性阻塞性肺病（ＣＯＰＤ）患者被纳入该项随机、双盲对照试验。在先雾化吸入２．５ｍｇ沙丁胺醇后，治疗组于２０分钟内静脉输入１５０ｍｌ生理盐水加１．２ｇ硫酸镁；对照组则静脉输入１５０ｍｌ生理盐水。结果，两组患者的...     

纳洛酮对心肺脑复苏作用的评价

目的：（１）观察研究纳洛酮在心肺脑复苏中的作用机理及实际疗效。（２）研究心搏骤停患者血中β－内啡肽与正常人的差异。方法：（１）随机划分急诊和住院抢救的心搏骤停患者为纳洛酮复苏组与常规复苏组两组。前者以常规复苏为基础,再给予纳洛酮２．０ｇｍ加生理盐水２０ｍｌ静注,并可间隔３０ｍｉｎ多次重复使用。（２）对常规复苏组和对照组２０例健康体检者均抽静脉血５ｍｌ入专用抗凝管离心取血清存放于冰箱,集中一次测定β     

腰阳关穴位注射刺激对冠心病患者QT离散度的影响

观察要阳关穴位注射刺激对冠心病患者ＱＴ离散度的影响及经穴传感作用。将４８例ＱＴｄ明显增大的冠心病患者随机分为４组，每组１２例，分别行腰阳关穴位注射。１组直接穴位注射丹参注射液５ｍｌ，Ⅱ组用２％利多卡因３ｍｌ局麻后注射丹参注射液２ｍｌⅢ组注射生理盐水５ｍｌ，Ⅳ组注射２％利多卡因５ｍｌ，注射前，注射后２０分钟和７日各记录心电图１次。结果：穴位注射后，各组最大ＱＴ间期均缩短，最小ＱＴ间期均延长，致ＱＴｄ     

血塞通注射液联合降纤酶治疗急性脑梗死31例效观察

目的：观察联用血塞通注射液和降纤酶治疗急性脑梗死的疗效。方法：６２例急性脑梗列强中专得承机分为２组。西医组（３１例）给予降纤酶（东菱克栓酶）１０Ｕ加入生理盐水１００ｍｏ静滴,每日１次,３日后改为降纤酶５Ｕ加生理盐水１００ｍｌ静滴,每日１次,治疗２日。中西医结合组（３１例）在西医组治疗基础上加用血塞通注射液４００ｍｇ加生理盐水２５０ｍｌ静滴,每日１次,共１０日。此外,２组均给予降压、控制血糖、抗感染     

心血管疾病病人静脉留置针封管液的探讨

将９０例使用静脉留置针的心血管疾病病人随机分成三组,分别采用１０ｍｌ稀释肝素液、１０ｍｌ生理盐水、３ｍｌ稀释肝素液三种液体封管,对堵管和静脉炎的发生率进行对照观察。结果：堵管率：１０ｍｌ稀释肝素液与１０ｍｌ生理盐水封管差异有显著意义（ｘ＾２－４．３２,ｐ〈０．０５）,但１０ｍｌ稀释肝素液与３ｍｌ稀释肝素液封管差异无显著意义（ｘ＾２＝２．３１,ｐ〉０．０５）;静脉炎的发生率：１０ｍｌ稀释肝素液封管与     

心衰病人理想的补钾方法

我科对心衰病人微泵补钾取得满意效果，现将结果报道如下。１　资料与方法１－１　一般情况：观察对象为我科近期收治的心衰病人，共８８例，其中男５１例，女３７例；年龄在３５～８７岁之间。临床表现除心衰症状外，还有倦怠、乏力、腹胀等低钾症状，血电解质报告血清钾在２．１２～３．４９ｍｍｏｌ／Ｌ。１－２　方法：８８例均以静脉途径补钾，一种方法是使用微泵静脉给药，生理盐水或５％ＧＳ３０ｍｌ加１０％ＫＣｌ２０ｍｌ，以２０～２５ｍｌ／ｈ（约１３～１５ｍｇ／ｍｉｎ）速度给药，约２．５ｈ注完（称微泵补钾）。另一种方法是…     

不同封管液对 PICC 置管输注20%甘露醇的影响

目的：探讨不同封管液对经外周留置的中心静脉导管输注20%甘露醇的影响。方法将99例颅内肿瘤患者按入院顺序分为3组,每组33例。A 组用肝素钠盐水10 ml 正压封管;B组用0.9%生理盐水10 ml 脉冲式冲管,肝素钠盐水10 ml 正压封管;C 组用0.9%生理盐水≥20 ml 脉冲式冲管,肝素钠盐水10 ml 正压封管。结果 A 组导管堵管率为51.5%,B 组为24.6%,C 组为6.1%。C 组导管堵管率显著低于 A 组、B 组(P <0.05或0.01),B 组显著低于A 组(P <0.05)。结论对经外周留置的中心静脉导管置管长期输注20%甘露醇完毕后用≥20 ml 生理盐水脉冲式冲管,肝素钠盐水正压封管,可有效降低导管堵管率。     

Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery

The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 (n=25) included patients receiving aspirin pretreatment, Group 2 (n=22) received heparin pretreatment, and Group 3 (n=28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups (p<0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups (p<0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 (p<0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 (p<0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 (p<0.05), 27.3% of patients in Group 2 (p<0.05) and in 35.7% of patients in Group 3 (p<0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 (p<0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.     

Obtaining blood samples for coagulation studies from a normal saline lock.

OBJECTIVES: To determine the amount of blood that should be discarded from a peripheral normal saline lock, a capped-off intravenous port, before a blood sample is obtained for determination of activated partial thromboplastin time from patients being treated with heparin. METHODS: A prospective, quasi-experimental design was used with 32 patients. A blood sample was obtained via venipuncture from each patient to serve as the control for that patient. The normal saline lock was flushed with 2 mL of normal saline. Four consecutive 3-mL blood samples were obtained directly from the normal saline lock, representing samples obtained after discard volumes of 0, 2, 4, and 6 times the dead space of the catheter and extension set (1.5 mL). Activated partial thromboplastin times for the venipuncture blood sample were compared with the times for the blood samples obtained from the normal saline lock. RESULTS: The only significant difference (P = .02) was that activated partial thromboplastin time was 15% higher in the blood sample obtained from the normal saline lock with no blood discarded than in the venipuncture blood sample. CONCLUSIONS: Nurses can obtain accurate measurements of activated partial thromboplastin time with blood samples obtained from normal saline locks by first discarding a volume of blood equal to 2 times the dead space of the catheter and extension set. Obtaining blood samples in this manner reduces patients' discomfort due to repeated venipuncture and diminishes blood loss.     

血液透析联合血液灌流治疗中两种不同卸灌方式对治疗效果的影响

目的探讨血液透析联合血液灌流治疗中2种不同卸灌方式对治疗效果的影响。方法肝素生理盐水冲洗浸泡灌流器,使灌流器中吸附剂充分膨胀肝素化,灌流器串联于透析器前端,联合治疗2.5h,卸下灌流器,再继续透析1.5h。20例患者每人3次血液透析联合血液灌流,其中10例30次生理盐水卸灌法,10例30次部分空气卸灌法。结果生理盐水卸灌法和部分空气卸灌法对中大分子毒素清除无影响（P〉0.05）,部分空气卸灌法的残血量大于生理盐水卸灌法（P〈0.01）,生理盐水卸灌法延续透析结束后透析器的凝血程度大于部分空气卸灌法（P〈0.05）。结论 2种回血卸灌方式对中大分子毒素清除无影响;在减少失血量、杜绝空气栓塞、避免感染等方面,生理盐水卸灌法优于部分空气卸灌法。     

Measurement of Type B natriuretic peptide in heparin and K2 EDTA plasma

BackgroundEthylene diamine tetraacetic acid (EDTA) plasma is the only suitable specimen recommended by the manufacturers to be used in the determination of BNP. It appears crucial to evaluate if more conventional heparin plasma samples could be reliably used for BNP determination. Aim of this study was to evaluate the use of heparin plasma sample for BNP determination.MethodsVenous blood from 42 consecutive patients admitted at the division of cardiology was collected in two test tubes, with K₂-EDTA (Group 1) and lithium heparin with gel separator (Group 2) and analysed within 20 min of blood collection.ResultsStatistical analysis showed a significant difference between Group 1 and Group 2 (p < 0.0001). Sample collected in K₂-EDTA showed a significant underestimation when compared to lithium–heparin.ConclusionsOur data showed that BNP could not be dosed on different collection tubes without altering the results. In our experimental conditions, interestingly we found that BNP levels are significantly lower if measured in EDTA plasma.     

经尿道前列腺汽化术或电切术中血糖与低钠血症的关系

【目的】探讨经尿道前列腺汽化术或电切术中血糖与低钠血症的关系。【方法】择期行尿道前列腺汽化术或电切术患者84例,在手术进行30～60min开始抽血化验血糖和血钠,以后每隔15min测一次。血糖>20mmol/L为明显升高组,血糖10.2～19.2mmol/L为中度升高组,血糖<10.2mmol/L为轻度或正常组,对比三组相应的血钠值。血糖>20mmol/L给速尿20mg并酌情给胰岛素。【结果】血糖明显升高组8例(占10%),其血钠为116～129mmol/L,血糖中度升高组16例(占18%),血钠有6例为130～134mmol/L,余10例正常,血糖正常或轻度升高组60例(占71%),血钠全部在正常范围内。血糖>20mmol/L时使用速尿20mg5～10min后测血糖及血钠均比用药前有明显改变(P<0.05)。【结论】经尿道前列腺汽化术或电切术中血糖与血钠成明显的负相关性,术中血糖测定可以间接预测稀释性低钠血症。     

胰岛素泵与传统注射胰岛素治疗2型糖尿病的临床比较

糖尿病(DM)是一组以慢性高血糖为特征的代谢性疾病,长期的高血糖与DM晚期并发症显著相关,采取胰岛素泵强化治疗可以更好地控制血糖,防治各种并发症的发生、发展。胰岛素泵是目前对DM患者进行强化治疗的有效手段之一,为观察其疗效和安全性,我们应用胰岛素泵治疗2型DM患者38例,并     

冲管液肝素浓度与肿瘤患者PICC穿刺点延时渗血关系的研究

目的探讨在不同凝血状态的恶性肿瘤患者中不同外周静脉置入中心静脉导管(PICC)冲管液肝素浓度对穿刺点延时渗血发生率的影响。方法共340例患者,其中242例在PICC置管术前根据血小板计数和凝血酶原时间、凝血酶时间测定、活化部分凝血活酶时间、纤维蛋白原凝血4项检测结果分为低凝血(A组)、正常凝血(B组)和高凝血(C组)3组,每组分别随机采用3种不同肝素浓度导管封管液(A组为生理盐水1、2.5 U/mL、25 U/mL,B组为12.5 U/mL、25 U/mL、50 U/mL,C组为25 U/mL、50 U/mL、75 U/mL)。98例为不分凝血状态采用同一肝素浓度封管液(50 U/mL)的对照组(D组)。结果所有患者总渗血发生率为30.9%(105/340)。A组、B组、C组渗血发生率分别为25.4%(16/63)、25.8%(23/89)、23.3%(21/90)(P>0.05),D组渗血发生率45.9%(45/98)显著高于A、B、C 3组(P<0.01)。在A、B、C组中,采用不同肝素浓度封管液患者的渗血发生率差异均无统计学意义(P>0.05)。在D组中,低凝血状态患者的渗血发生率88.2%(15/17)显著高于正常凝血的38.9%(28/72)和高凝血状态的22.2%(2/9)(P<0.01)。结论本研究结果提示,根据PICC置管术前检测患者的血小板计数及凝血状态选择合适的封管液肝素浓度,对降低穿刺点延迟性渗血发生率具有一定的临床价值。     

脂微球前列腺素E_1对控制性降压患者动脉氧分压及肺内分流影响

目的观察脂微球前列腺素E1对硝普钠控制性降压患者手术期间动脉氧分压及肺内分流影响。方法择期行鼻内窥镜手术患者40例,分为脂微球前列腺素E1组（P组）和对照组（C组）,每组20例。P组持续静脉泵注脂微球前列腺素E12 ng/（kg.min）,C组以同样容积速率泵入生理盐水。分别于输注硝普钠前,降压30、60 min,停止硝普钠输注复压后20 min时分别取动脉血和右心房血做血气分析并记录监测数据。结果两组患者在不同采样点组间MAP、HR、pH值无显著性差异（P〉0.05）;与降压前比较,两组降压30、60 min时Qs/Qt升高,PaO2降低（P〈0.05）;组间比较降压30、60 min、复压后3点,P组PaO2高于C组（P〈0.05）,Qs/Qt仅在复压后P组高于C组（P〈0.05）;组内比较,C组复压后PaO2低于降压前（P〈0.05）。结论脂微球前列腺素E1可以改善硝普钠控制性降压所引起动脉氧合变化,对降压期间肺内分流和血流动力学无明显影响,复压后可改善肺内分流。     

两种不同抗凝方法在连续性静脉静脉血液透析滤过中应用的对比研究

目的观察连续性静脉静脉血液透析滤过（CVVHDF）治疗中常规肝素抗凝与体外枸橼酸钠抗凝两种方法的效果与特点。方法多器官功能不全病人70例,按照随机原则分为两组：A组（体外枸橼酸钠抗凝组）（n=37）,B组（常规肝素抗凝组）（n=33）行连续性静脉静脉血液透析滤过治疗,记录治疗前、后的血电解质,酸碱度,凝血指标的变化。管路及血滤器的凝血情况和使用时间,并观察治疗中不良反应。结果治疗过程中两组患者生命体征平稳,电解质、血气指标稳定,肌酐、尿素清除效果明显,超滤可达目标值,A组血滤器的凝血情况和使用时间优于B组,A组体内凝血时间不受影响,A组葡萄糖酸钙用量明显大于B组。结论在CVVHDF体外枸橼酸钠抗凝对比常规肝素抗凝更有效和更安全。