1例血浆置换联合连续血液净化抢救输血性溶血病人的护理

血浆置换（TPE）是通过血浆分离装置,利用体外循环的方法将血浆分离并滤除,弃去病人的异常血浆,然后将血液的有形成分及所补充的置换液回输到体内。连续性血液净化（CBP）是所有连续、缓慢清除机体过多水分和溶质,对脏器功能起支持作用的各种血液净化技术的总称。现将TPE联合CBP抢救输血性溶血病人的护理介绍如下。     

治疗性血浆成分去除的研究进展与临床应用

治疗性血浆置换术(therapeutic plasma exchange,TPE)是分离置换血浆,清除血浆中的致病因子达到治疗疾病的目的,是血液净化(plasmapurification)的一种方法。血浆置换的历史可追溯到上世纪初。1914年首次采用抽出血液静置沉降后弃去血浆,将血液有形成分输回体内,并补充相应的电解质溶液,首创了TPE。但由于操作方法原始、费时,并发症多且严重(如溶血、败血症)等诸多限制,很快被人们淡忘。直至1950年代,随着医疗技术的发展,工艺的改进,尤其是1960年用TPE治疗原发性巨球蛋白血症获得成功后,对TPE的研究和应用再次兴起,先后研制了血细胞分…     

治疗性血浆置换在神经系统疾病中的应用

血浆置换的概念始于1914年,随着新的高选择性血浆分离技术的推广,血浆置换应用得日益广泛。1980年代中期我国开始应用治疗性血浆置换(theraputic plasma ex-change,TPE)治疗各种重症疾病。传统的TPE是将患者血浆非选择性地分离,再将去除血浆后的血液有形成分以及所需补充的白蛋白(或血浆)、平衡盐液等回输到患者体内,以达到治疗目的。随着血浆体外处理技术的发展,特别是各种新型特异性材料的应用,TPE的安全性和选择去除特异性得到了极大的提高,促进了TPE在各种疾病中的应用。笔者对TPE在神经系统疾病中的应用进展做一简要介绍。1 TP…     

血浆置换治疗中血浆分离器破膜的原因分析及对策

血浆置换(plasma exchange,PE)是一种用来清除血液中大分子物质的血液净化疗法。其基本过程是将患者血液经血泵引出,经过血浆分离器分离血浆和细胞成分,去除致病血浆或选择性地去除血浆中的某些致病因子,然后将细胞成分、净化后血浆及所需补充的置换液输回体内[1]。血浆置换是一项特殊的血液净化技术,临床采用血浆置换治疗的疾病有神经系统疾病、自身免疫疾病、风湿病、肾脏疾病、     

治疗性血浆置换急性并发症的观察与护理

治疗性血浆置换(TPE)是将正常血浆或血浆代用品与患者的血浆进行置换,以去除血浆中的致病因子.目前已用于治疗多种疾病,并取得了满意效果[1].但TPE过程中存在并发症或不良反应影响TPE的顺利进行.本文通过对江苏省苏北人民医院开展的76例TPE进行分析,就TPE急性并发症发生的原因,提出护理对策.……     

308例血浆置换治疗中凝血的观察与护理

血浆置换(plasma exchange,PE)是通过血浆分离装置,利用体外循环的方法,将血浆分离并滤出,弃去含有致病因子的异常血浆,再将血液的有形成分以及补充的置换液回输体内的方法.有效防治凝血是决定血浆置换能否顺利完成的关键.我科自1998年9月在国内率先开展膜式血浆置换机治疗,共治疗病人308例.现将护理报告如下.     

血浆置换在肾移植前后的临床应用及护理

血浆置换(plasma Exchange，PE)是血液净化技术的一部分，是利用分离技术在体外清除掉患血液中异常血液的血细胞和血浆成分，然后将血液细胞与新补充的血浆置换液一起回输体内，在短时间内大量除去血浆中大分子致病物质，达到治疗疾病的目的。近几年临床应用非常广泛，几乎涉及到临床各科的疾病，其中治疗肾脏疾病占首位(26％)。现就PE应用与肾移植术前后的机制，疗效，并发症及护理措施作一综述。     

应用MB——病毒灭活血浆提高血液净化治疗的安全性

血液净化（CBP）技术和（CBP）治疗管理的规范化建设，在近年中取得了令人瞩目的进展。除常规的．肾病血液透析外，在非肾病领域和炎性疾病的治疗中（CBP）技术也显示了良好的应用前景。作为净化血液重要手段之一的血浆置换（PE）及其联合治疗，已成为急性中毒和人工肝支持的重要手段。今年4月北京某院在救治河北一起突发多人砷化氢中毒事件中，对批量病人进行紧急血浆置换，成功地挽救了十余名中毒者生命。     

妊娠期治疗性血浆置换的临床实践进展CSCD

治疗性血浆置换(therapeutic plasma exchange,TPE)通过分离并清除血浆中可溶的治病物质,并以置换液补充体液、电解质和血浆成分,从而达到治疗的目的。妊娠期出现红细胞同种免疫(red cell alloimmunization,RCA)、血栓性微血管病(thrombotic microangiopathy,TMA)、自身免疫性疾病、脂代谢疾病时,需要考虑应用TPE治疗,本文对妊娠期进行TPE治疗的指征、并发症等进行文献综述,供临床实践参考。     

血浆置换临床实践中的技术要点

血浆置换(plasma exchange,PE)是一种用于清除循环中致病性蛋白分子或蛋白结合物质的血液净化手段,已广泛用于临床一些疾病,如自身免疫性疾病的救治中.其技术形式包括膜分离及离心分离2种类型.PE的技术要点包括治疗剂量及频次确定,滤器选择,治疗参数如血流量、血浆分离速度设定,置换液选择,体外循环的抗凝,治疗相...     

The risks associated with blood and blood product transfusion

Although transfusion of blood and blood products is often of life-saving benefit for the many patients who receive transfusions every year, it is not without considerable risk. Nurses need to be aware of these risks so that they can respond to patient anxiety about transfusion. This article outlines risks associated with transfusion and the measures taken to minimize them. Attention will be focused principally on the two most significant risks: transmission of serious blood-borne infection and the potentially fatal acute immune haemolytic reaction that can occur if patients receive incompatible red cells. Other significant adverse effects will be discussed briefly. Recent initiative aimed at monitoring the incidence of these adverse effects and increasing the safety of blood transfusion will be discussed, with special emphasis on the nurse's role in the transfusion process.     

Extended blood grouping of blood donors with automatable PCR-ELISA genotyping

BACKGROUND: In the past 10 years, PCR-based methods have been described to allow the detection of gene polymorphisms responsible for many blood group antigens. These methods are routinely used to test samples of fetal origin and to resolve serologic discrepancies. Another interesting application of blood group genotyping could be the extended typing of blood donors for minor antigens to facilitate the procurement of compatible blood for alloimmunized patients. STUDY DESIGN AND METHODS: PCR-based tests have been modified to allow multiplex amplification of specific fragments of blood group genes and the convenient detection of hybridized amplicons by ELISA in a microplate format. RESULTS: The results obtained show that fragments of the Rh (D, c, C, e, E), Kell (K, k), Duffy (Fya, Fyb), and Kidd (Jka, Jkb) genes could be amplified along with controls in multiplex PCR reactions. Labeling of amplicons with digoxigenin allowed their solid-phase detection in microplate wells previously coated with individual blood group-specific oligonucleotides. A comparative study performed with 100 individuals showed a 99.7 percent concordance between genotypes and phenotypes for the 11 antigens assayed, with only three discrepant Fyb genotypes. CONCLUSION: Extended genotyping could be performed once on regular donors and confirmed when needed by standard serologic RBC assays. The format of these tests will allow easy automation of the procedure including the interpretation and downloading of the results with existing ELISA software.     

中老年人高尿酸血症与血糖血脂的关系

目的 探讨中老年人高尿酸血症与血糖、血脂的关系.方法 选取在中老年高尿酸血症患者45例和血尿酸正常者50例,分别检测空腹血糖、血清总胆固醇、三酰甘油、血尿酸等指标.结果 高尿酸血症组总胆固醇及三酰甘油均明显高于血尿酸正常组,差异有统计学意义(P<0.05);两组间血糖比较差异无统计学意义(P>0.05).高尿酸血症组尿酸与总胆固醇及三酰甘油之间存在显著的正相关.结论 中老年高尿酸血症与高血糖、高血脂密切相关,且呈正相关.应早发现、早干预、早治疗,以减少心血管疾病的发生.     

Peripheral blood stem cell collection with a blood cell separator

Forty-three patients with malignant nonmyeloid diseases underwent peripheral blood stem cell collections on an apheresis system (Spectra, COBE BCT, Lakewood, CO). Collections took place during the white cell (WBC) recovery phase following conditioning chemotherapy. One hundred two procedures were done after chemotherapy alone, and 72 procedures after chemotherapy plus granulocyte-colony-stimulating factor (G-CSF). Four centrifugal separation factors were tested. One and one-half patient blood volumes were processed in each procedure. The mean volume of the collected component was 158 +/− 16 mL. After chemotherapy alone, the procedures provided a mean of 0.8 × 10(8) WBCs per kg and 2.3 × 10(4) colony-forming units-granulocyte macrophage (CFU-GM) per kg of recipient body weight. The mononuclear cell percentage in the components increased with the centrifugal separation factor from 85 to 96 percent. In parallel, platelet contamination increased from 2.1 to 3.8 × 10(11). The collect hematocrit ranged from 1.0 to 2.5 percent (0.01-0.025). The collection efficiency for mononuclear cells and CFU- GM also increased with the centrifugal separation factors from 52 to 70 percent for mononuclear cells and from 55 to 68 percent for CFU-GM. Collections performed after G-CSF-stimulated mobilization were characterized by a higher neutrophil contamination independent of centrifugal separation factor, which gave a mean mononuclear cell percentage of 64 percent in the collected component. The average yield for these procedures was 2 × 10(8) WBCs per kg and 28 × 10(4) CFU-GM per kg.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increased peak blood velocity in association with elevated blood pressure

To test the hypothesis that peak blood velocity in the common carotid artery is increased in association with elevated blood pressure, the authors measured peak common carotid blood velocity in 458 subjects by color Doppler ultrasonography. Blood pressure was measured at the time of ultrasound examination by automated sphygmomanometer. Peak blood velocity was increased in subjects with elevated blood pressure (right common carotid: 72.5 ± 2.0 cm/s vs. 62.7 ± 2.5 cm/s, left common carotid: 72.0 ± 1.8 cm/s vs. 63.9 ± 2.0 cm/s, p < 0.001). Peak blood velocity was significantly correlated with systolic blood pressures between 135 and 160 mmHg (r = 0.47 in right common carotid, 0.45 in left common carotid, n = 123, p < 0.001). No correlation was found between peak blood velocity and blood pressures less than 135 mmHg or greater than 160 mmHg. By increasing erythrocyte momentum, increased peak blood velocity may play a role in the pathogenesis of arterial diseases associated with hypertension.     

腰围与血压、血糖、血脂的相关性研究

目的探讨腰围与血压、血糖、血脂的相关性。方法选取2009-12—2010-10来我院体检的11888名成年人的体检资料进行统计学分析。结果男性SBP、DBP、Glu、TG、HDL-C均与腰围呈显著相关（〈0.01）,TC、LDL-C与腰围有相关性（〈0.05）;而女性则所有指标均与腰围呈显著相关（〈0.01）。结论腰围的测定对慢性非传染性生活方式疾病的风险性评估有一定意义,同时可作为对健康管理过程中效果评价的重要指标,值得推广。     

脑出血患者预后与血脂血糖及凝血等指标变化的相关性

目的:检测脑出血时多种指标的变化,探讨对脑出血患者预后的影响。方法:测定50例脑出血患者的凝血、纤溶指标,血糖、血脂水平,白细胞含量及血小板和相关指标的改变。结果:脑出血组血糖、三酰甘油、载脂蛋白B、低密度脂蛋白胆固醇水平显著高于对照组(P<0.05),血清低密度脂蛋白胆固醇水平低于正常值(P<0.05)。脑出血组D二聚体含量为(2.35±1.70)mg/L,大于对照组(0.31±0.25)mg/L,差异有显著性意义(P<0.05),而凝血指标与对照组差异无显著性意义。脑出血组白细胞含量显著增加,血小板及相关指标未受影响。急性期血糖增高者较血糖正常组预后差,病死率高。结论:血脂异常与脑出血的发生关系密切,脑出血对血糖水平、白细胞数量及纤溶状态均有一定程度的影响,但对血小板和相关指标影响不大。提示急性期血糖增高预示预后不良。