膝关节置换中应用骨水泥和止血带对凝血功能的影响

背景：有研究表明膝关节置换中骨水泥固定假体时骨水泥对患者的血液动力学及凝血功能的影响较大。 目的：观察膝关节置换中骨水泥和止血带对患者凝血功能的影响。 方法：采用随机对照研究方法,将骨性关节行单侧膝关节置换患者40例随机分成2组,置换时分别应用止血带和不用止血带。通过比较两组患者血浆凝血酶原时间、活化的部分凝血活酶时间、凝血酶时间、纤维蛋白原及血浆D-二聚体水平的变化,来观察膝关节置换中骨水泥和止血带对置换中凝血功能的影响。 结果与结论：两组患者在骨水泥置入后60,120 min,血浆凝血酶原时间值缩短(P < 0.05),纤维蛋白原和D-二聚体在注入骨水泥后增多(P < 0.05),其中止血带组的变化更为明显,两组患者在180 min时基本恢复正常,活化的部分凝血活酶时间及凝血酶时间在骨水泥注入前后均无明显变化,另外,所监测的凝血功能相关指标(血浆凝血酶原时间、活化部分凝血酶原时间、凝血酶时间、纤维蛋白原及D-二聚体的数值在注入骨水泥前后均在正常范围内。相比非止血带组,止血带组血浆凝血酶原时间缩短、纤维蛋白原及D-二聚体含量增多(P < 0.05)。说明膝关节置换中骨水泥应用后可以使单侧膝关节置换患者的凝血功能处于高凝状态,止血带可加重患者的高凝状态。     

肺结核并呼吸衰竭患者血气分析与凝血检测的相关性研究

<正>目的:探讨肺结核并呼吸衰竭患者凝血六项与血气分析的相关性。方法:选择30例肺结核并呼吸衰竭患者,观察常规治疗前后结核组患者血气分析、凝血六项等指标水平变化。另选30例健康体检者为(对照组)对照。结果:血浆纤维蛋白原、部分活化凝血活酶时间、凝血酶原时间水平均明显升高,治疗后明显下降;相关性分析结果显示,血浆纤维蛋白原与血氧分压呈负相关,与血二氧化碳分压呈正相关。结论:肺结核并呼吸衰竭患者存在高凝状态,临床治疗中适当的抗凝治疗对控制肺结核并呼吸衰竭患者的病情可能有益。     

血液透析器中空纤维体外血液相容性的评价

背景:血液透析器中的中空纤维与肾透析患者的血液有大面积长时间的接触,对其进行血液相容性评价尤为重要。目的:通过对一种透析器中空纤维血液相容性的2次评价,拟初步建立透析器体外血液相容性评价的方法。方法:将样品透析器中的中空纤维截为3cm长,取100根置于硅化玻璃管中,作为一个样品。两次评价试验中,选用不同的已经上市的血液透析器的中空纤维作为对照,对照中空纤维取与样品中空纤维相近表面积的数量,同样处理。每个硅化玻璃管中加入新鲜全血1.2mL,放在置于37℃隔水培养箱的略倾斜的旋转培养器上,以30r/min的速率旋转。30min后取各硅化玻璃管中的全血,用于血细胞分析、凝血分析及血清总补体的检测。结果与结论:与两个对照透析器中空纤维相比,样品透析器中空纤维在不同指标上显示出一定差异,但样品透析器对纤维蛋白原和血小板的巨大消耗作用在2次试验中均有充分体现,且与对照参数差值的绝对值相对于对照参数的百分比远大于15%,可以认为样品透析器中空纤维与对照透析器中空纤维之间血液相容性的差异不被接受,说明实验中所使用的体外血液相容性评价方法具有很好的重现性。     

老年患者骨水泥型人工髋关节置换前后的凝血功能

背景：由于老年患者自身的高凝倾向,骨水泥型人工髋关节置换后更容易发生深静脉栓塞、弥漫性血管内凝血、肺栓塞、脑栓塞等并发症。 目的：观察老年患者骨水泥型人工髋关节置换前后凝血4项凝血酶原时间、活化部分凝血活酶时间、凝血酶时间和纤维蛋白原的变化。 方法：检测40例人工髋关节置换老年患者骨水泥植入前10 min,植入后30 min、1 h、2 h、3 h 凝血酶原时间、活化部分凝血活酶时间、凝血酶时间和纤维蛋白原各项指标。 结果与结论：与植入前10 min比较,植入后30 min凝血酶原时间明显下降(P < 0.05),纤维蛋白原明显升高(P < 0.05),植入后3 h均恢复到植入前状态(P > 0.05)。活化部分凝血活酶时间、凝血酶时间在骨水泥植入前后变化均不明显(P > 0.05)。结果表明患者在骨水泥植入后短时间内会出现高凝血状态,在植入3 h后基本消除,提示在植入骨水泥后的3 h是监测凝血的重要时间段。     

mPEG表面修饰的PLGA嵌段共聚物的血液相容性评价

本实验室设计合成了三种不同LA／GA比例的mPEG修饰PLGA（PELGA，含15％mPEG），为了评价它们的血液相容性，我们以硅化玻璃试管为阴性对照，未硅化的试管为阳性对照，参照国际标准（ISO10993）和《中华人民共和国国家标准GB／T16886医疗器械生物学评价》方法进行了体外评价实验。试验包括溶血率实验，血小板黏附实验，动态凝血时间实验，凝血时间实验，血浆复钙时间实验和凝血酶原时间实验等综合评价指标。结果表明，合成材料具有优良的血液相容性，材料制成的纳米粒有望应用于静脉注射。     

临产孕妇凝血四项指标的变化及临床意义

为了解临产孕妇的凝血功能情况，本文检测了205例临产孕妇的凝血四项指标：即凝血酶原时间(FT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)，结果报告如下。     

骨折患者凝血指标变化的临床意义

患者骨折后,由于机体的应激反应可导致凝血系统发生一系列变化。本文检测了60例住院治疗的骨折患者及30例健康体检者的血浆凝血酶原时间(PT)、活化部分凝血活酶时间(A PTT)、纤维蛋白原定量(Fib)及国际标准化比值(IN R),并将结果进行相关性分析,以探讨其凝血指标变化的临床意义     

标本采集量不足对凝血检测项目结果的影响

目的 分析标本采集量不足对凝血检测项目结果的影响.方法 收集采集量不足及足量采血的对照组标本共23对,分别检测凝血酶原时间(PT),活化部分凝血活酶时间(APTT),凝血酶时间(TT),纤维蛋白原(FIB),D-二聚体(D-Dimer)和纤维蛋白/纤维蛋白原降解产物(FDP)的含量.结果 采血量不足组与对照组相比PT、APTT、TT显著延长,FIB和D-Dimer含量显著降低,而FDP含量没有明显变化.结论 凝血标本采集量不足会影响检测结果的准确性.     

临产孕妇凝血指标的变化

为 了解临产孕妇产前凝血功能的情况 ,我们对 2 0 0 2年 1月～ 2 0 0 2年 12月在我院产科住院的 36 9例临产妇女进行了凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)、纤维蛋白原 (FIB)、凝血酶时间 (TT)等四项指标的联合检测 ,结果报告如下。1　资料与方法1.1　检测对象实验组 :孕期大于 38周住院待产的妇女 36 9例 ,心、肝、肾功能正常 ,无其它合并症 ,年龄 2 5岁～ 37岁 ,平均年龄 31.8岁。对照组 :118例健康体检者 ,选择心、肝、肾功能正常 ,无凝血机制异常及血液系统疾病 ,未怀孕的健康女性 (口服避孕药及月经期者除外 ) ,年龄…     

肝素涂层插管生物相容性评价

对肝素涂层插管和未涂层插管设计了抗凝血、血栓形成观察以及溶血、细胞毒性、炎性和免疫反应等多种试验，从多角度综合对肝素涂层插管材料进行生物相容性评价。通过活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原降解产物(FIB)、凝血酶时间(TT)、血小板活化因子、纤维蛋白吸附等试验，测定样品的体外抗凝血性，然后通过半体内血栓形成试验，模拟插管在动物体内的使用环境和过程，观察样品引起血栓形成的状况。同时，通过溶血试验和细胞毒性试验以及炎症反应、补体激活、免疫球蛋白等检测，进一步对样品进行血液相容性评价。结果显示，肝素涂层实验组APTT和TT得到有效延长，而其他体外抗凝指标未见显著变化；在动物半体内模型试验和检测中，肝素涂层实验组6 h血栓形成的各项指标均低于未涂层对照组，表明肝素涂层通过抑制内源性凝血途径达到了预期的抗凝效果；而溶血率、细胞毒性、炎症反应、补体激活、免疫球蛋白等方面的试验结果与未涂层对照组无差异，表明肝素涂层对材料的血液相容性无不良影响。结果表明，肝素涂层显著提高了动静脉插管的体内外抗凝血性，具有良好的生物相容性，可提高临床应用的安全性。     

乌司他丁联合血必净对烧伤后脓毒症患者凝血功能及全身炎性反应的影响研究

目的 研究乌司他丁、血必净联合治疗对烧伤后脓毒症凝血功能及全身炎性反应影响。方法 回顾分析2016年6月~2018年6月在我院诊治的146例烧伤后脓毒症患者临床资料,随机分为对照组和观察组,各73例。对照组采用常规综合治疗,观察组在对照组基础上采用乌司他丁联合血必净治疗,观察两组治疗患者治疗前后凝血功能及全身炎性反应情况。结果 治疗后,观察组凝血酶原时间（PT）、纤维蛋白原（FIB）、血纤维蛋白原降解产物（FDP）、部分凝血活酶时间（APTT）、凝血酶时间（TT）均优于对照组,差异均有统计学意义（P＜0.05）;观察组TNF-α、IL-6、IL-10、CRP水平改善优于对照组,差异有统计学意义（P＜0.05）。结论 乌司他丁、血必净联合治疗对烧伤后脓毒症可以改善凝血功能,减轻炎性反应,促进患者的康复。     

下肢骨折围手术期凝血-抗凝及纤溶指标动态变化的意义

目的：探讨下肢骨折患者围手术期凝血一抗凝及纤溶指标动态变化规律,指导临床有针对性预防下肢深静脉血栓形成。方法：选择下肢骨折需卧床治疗患者35例为实验组,选择上肢骨折患者30例为对照组。分别于术前、术后1d、术后3d及术后14d采集静脉血,检测血浆凝血酶原时间（PT）、活化部分凝血活酶时间（AFIT）、纤维蛋白原（FIB）、纤维蛋白（原）降解产物（FDP）、D．二聚体（D-D）、抗凝血酶活性（AT）。结果：FIB、FDP和D-D：实验组术后1d和术后14d与术前比较差异有非常显著性意义（P〈0．01）,对照组术后1d与术前比较差异有非常显著性意义（P〈0．01）;AT：实验组术后14d与术前比较差异有非常显著性意义（P〈0．01）。结论：下肢骨折患者术后局部血流减慢,FIB、FDP和D-D增高,AT降低,提示机体可能处于血栓前状态或有血栓形成。     

Rapid centrifugation for routine coagulation testing

Routine coagulation assays are performed with platelet-poor plasma obtained after centrifugation of whole citrated blood. Usually clinical laboratories centrifuge blood from 2,000 to 2,500 g for 15-30 minutes. Thirty two blood samples routinely submitted to coagulation tests, were assayed for the prothrombin time, activated partial thromboplastin time, and fibrinogen level, in order to compare results obtained using 2 types of centrifugation : centrifugation at 2,500 g for 15 minutes and rapid centrifugation on StatSpin Express 2 at 4,440 g for 2 minutes. A good correlation was observed for the prothrombin time, activated partial thromboplastin time, and fibrinogen levels being respectively 1,009, 0,908 and 1. We concluded that rapid centrifugation at 4,440 g for 2 minutes does not modify results and contributes, by decreasing duration of the pre-analytical variable to reduce the completion time of these tests.     

In vivo effects of stroma-free hemoglobin and polyhemoglobin on coagulation factors in rats

We studied the effects of rat stroma-free hemoglobin (rSFH), human stroma-free hemoglobin (hSFH), rat polyhemoglobin (rPoly), and human polyhemoglobin (hPoly) on coagulation factors in rats. Albumin and saline infused rats were controls. The infusion volume was 10% of the rat's blood volume. The concentrations of hemoglobin in this study were 7 g/dl. Measurements for prothrombin time (PT) and activated partial thromboplastin time (PTT) were at 5 minutes, 2, 6, 24 and 72 hours after infusion. Factor X, fibrinogen, plasminogen, antithrombin III, and antiplasmin were followed at 24 and 72 hours after infusion. Compared with saline infused rats PT and PTT did not change significantly in those rats infused with Hb preparations. There was a transient increase of PTT from 2 to 24 hours after infusion in albumin infused rats. Factor X, fibrinogen, antithrombin III and antiplasmin showed no significant differences between Hb infused groups and saline infused group. Twenty-four hours and 72 hours after infusion plasminogen decreased in all groups except the albumin infused rats at 24 hours after infusion when compared with normal rat plasma pool. However, there were no significant differences in plasminogen levels between the hemoglobin infused groups and the control saline group. Stroma-free and polyHb solutions (rSFH, hSFH, rPoly and hPoly) did not cause significant changes in prothrombin time and activated partial thromboplastin time in rats. The rats infused with hemoglobin solutions (rSFH, hSFH, rPoly, and hPoly) did not show significant differences in Factor X, fibrinogen, antithrombin III and antiplasmin levels compared with the control group.     

Low density lipoprotein adsorption on sol-gel derived alumina for blood purification therapy

Among the clinical treatments of Familial Hyper cholesterolemia patients to reduce the concentration of low density lipoprotein (LDL), blood purification therapy is most suitable in which a blood-compatible adsorbent is employed. In the present study, alumina powders were prepared via a sol-gel route to develop a LDL-adsorbent Aluminum tri2-propoxide was hydrolyzed and subsequently calcined up to 1200 degrees C. Surface charge density and pore size distribution were measured, and the phases were identified. The alumina calcined above 400 degrees C had excellent blood compatibility in terms of endogenous clotting parameters, i.e., partial thromboplastin time: (PTT), prothrombin time: (PT), and the amount of fibrinogen: (Fib). The amount of LDL-adsorption (DeltaW(LDL)) increased with the calcining temperature, showing a good linear correlation to surface charge density. The 1200 degrees C sample consisted only of alpha-alumina, and was greatest in DeltaW(LDL). All samples involved pores smaller than 20 nm but not the pores large enough to accommodate LDL molecules (20-25 nm). From those results, it was concluded for the present alumina particles that the surface charge density was the primary factor and that the chemical activity of alpha-alumina also contributed to the excellent LDL-adsorption for the 1200 degrees C sample, while entrapping LDL in the pores was not an active mechanism.     

Laboratory findings in hypertensive disorders of pregnancy.

This study sought to determine whether a normal platelet count is a reliable predictor of the absence of other coagulation abnormalities in patients with a hypertensive disorder of pregnancy. A retrospective review of laboratory data obtained from 80 patients with hypertensive disorders of pregnancy was carried out. Results of complete blood cell count, prothrombin time (PT), partial thromboplastin time (PTT), D-dimer, fibrin split products, and fibrinogen, bilirubin, and liver enzyme levels were reviewed. Minor abnormalities of PT, PTT, and fibrinogen level were frequent, even in the presence of a normal platelet count. These were found mostly in patients with severe pre-eclampsia. A baseline complete blood cell count including platelet count is probably sufficient in patients with a hypertensive disorder of pregnancy. Fibrinogen level and PT and PTT determinations are recommended in patients who have severe preeclampsia and for whom operative delivery or regional anesthesia is planned. This will detect minor abnormalities in a few patients despite a normal platelet count. This information may help prevent bleeding complications.     

Changes in fibrinogen levels,platelet counts,clotting times and fibrinolytic activity in relation to thrombosis in contagious bovine pleuropneumonia

Changes in the packed cell volume, haemoglobin, fibrinogen and total protein levels, in the prothrombin, thrombin clotting and kaolin partial thromboplastin times, platelet numbers and fibrin degradation products were investigated in 7 cattle in which contagious bovine pleuropneumonia (CBPP) was induced by inoculating Mycoplasma mycoides by the endobronchial intubation method. Thrombosis of lung vessels was confirmed in all animals at necropsy.The results of the complement fixation and slide agglutination blood tests indicated that typical lesions of CBPP were present at 7 days. There was a rise in fibrinogen levels soon after inoculation and the difference between the means of the levels of the infected and control animals was significant from the 7th day. Platelet counts in the infected animals were reduced on the 2nd to the 5th day and, although a significant difference between these and the controls could not be demonstrated, this was confirmed by a compensatory rise in the severely affected animals that survived. The kaolin partial thromboplastin time test showed a significant rise in the infected animals from the 8th day, but there was no increase in the prothrombin time nor the thrombin clotting time indicating that depletion of factors in the intrinsic clotting system had commenced by the 8th day and that factors, VIII, IX, XI and XII could have been involved. Fibrin degradation products increased significantly in the infected animals from the 9th day.We conclude that thrombosis is an early event in the pathogenesis of CBPP, it contributes to the subsequent pathology of the lung lesions and platelets are involved to a substantial degree in the formation of the thrombi.     

Enhanced biocompatibility and antibacterial property of polyurethane materials modified with citric acid and chitosan

Citric acid (CA) and chitosan (CS) were covalently immobilized on polyurethane (PU) materials to improve the biocompatibility and antibacterial property. The polyurethane pre-polymer with isocyanate group was synthesized by one pot method, and then grafted with citric acid, followed by blending with polyethersulfone (PES) to prepare the blend membrane by phase-inversion method so that chitosan can be grafted from the membrane via esterification and acylation reactions eventually. The native and modified membranes were characterized by attenuated total reflectance-Fourier transform infrared spectroscope, X-ray photoelectron spectroscopy, scanning electron microscopy, water contact angle measurement, and tensile strength test. Protein adsorption, platelet adhesion, hemolysis assay, activated partial thromboplastin time, prothrombin time, thrombin time, and adsorption of Ca²⁺ were executed to evaluate the blood compatibility of the membranes decorated by CA and CS. Particularly, the antibacterial activities on the modified membranes were evaluated based on a vitro antibacterial test. It could be concluded that the modified membrane had good anticoagulant property and antibacterial property.     

Effects of hormone replacement on hemostasis in spontaneous menopause

OBJECTIVE: To examine the effects of continuous combined estrogen-progesterone replacement therapy on coagulation and natural anticoagulant systems in spontaneous menopause. DESIGN: A randomized, double-blind, placebo-controlled study was conducted during a 6-month period to examine the effect of hormone replacement therapy (HRT) on blood coagulation parameters. One hundred-ten healthy postmenopausal women were randomized into two groups. Those in group 1 were given conjugated estrogen (0.625 mg/d, Premarin) and medroxyprogesterone acetate (5 mg/d, Farlutal), and those in group 2 were given identical tablets of placebo for 6 months. Serum levels of modified activated protein C resistance, antithrombin III, fibrinogen, factor VIIIa, factor VIII, factor IX, activated partial thromboplastin time, prothrombin time, thrombin time, and lipoprotein (a) were measured before and 6 months after the treatment and analyzed for changes in extrinsic and intrinsic coagulation parameters. RESULTS: At the end of the 6-month period, fibrinogen, lipoprotein (a), and activated protein C resistance levels were decreased significantly in the HRT group compared with the control group. Antithrombin III levels were increased, indicating antithrombin activity. Activated partial thromboplastin time, as a measure for intrinsic coagulation cascade, was prolonged in concert with decreased intrinsic coagulation factors, factor VIII, and factor IX (p < 0.05). In the extrinsic coagulation system, prothrombin time was significantly increased, although factor VIIa level was not changed (p > 0.05). CONCLUSION: Significant changes were observed in the coagulation parameters, which may further explain the cardioprotective effect of HRT.