腹腔镜阑尾切除术和开腹阑尾切除术对患者凝血功能的对比研究

目的 比较研究腹腔镜阑尾切除术和开腹阑尾切除术后血液凝固状态的改变.检测39例开腹阑尾切除术和16例腹腔镜阑尾切除术患者术后24h血液凝血酶原时间(PT)、部分凝血活酶时间(APTT)、D-二聚体(D-D)、纤维蛋白原(FIB).两组入选标准分别为急性期的阑尾炎,既往无导致血栓形成的高危因素.开腹组手术时间为40～92分钟,平均(65.1±20.3)分钟,腹腔镜组手术时间为45～98分钟,平均(68.3±18.4)分钟,差异无统计学意义(P>0.05).采用SPSS10.0软件包对获得指标进行独立样本t检验.结果 术后24h两组PT 、APTT:A均值在正常范围,组间比较差异无统计学意义(P>0.05);而D-D、FIB均值均高于正常范围,组间比较差异无统计学意义(P＞0.05).结论 腹腔镜阑尾切除术后能引起血液的高凝状态.但与传统的开腹手术比较,风险没有增加.     

直肠癌腹腔镜手术与开腹手术对患者凝血功能的影响

目的探讨腹腔镜与开腹手术对直肠癌患者凝血功能的的影响。方法 2015年6月~2016年6月间我科收治的80例直肠癌手术患者,38例行腹腔镜手术(腹腔镜组),42例行开腹手术(开腹组),检测手术前、后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)及血小板(PLT)的含量,并进行比较。结果两组PT及APTT术后与术前比较差异无统计学意义(P0.05);PLT两组术后1 h及术后24 h较术前降低(P0.05);两组术后1 h,FIB与术前相比差异无统计学意义(P0.05),术后24 h两组均升高(P0.05),组间差异无统计学意义(P0.05)。两组D-D术后较术前均显著升高(P0.05),且两组间差异有统计学意义(P0.05)。结论腹腔镜直肠癌手术及开腹手术均可使患者血液呈高凝状态,易导致术后发生深静脉血栓的危险,且腹腔镜手术对凝血功能的影响更大,因此,应在围术期积极采取预防措施。     

慢性乙型肝炎与肝硬化患者凝血功能及血小板参数指标的变化及临床意义

目的:探讨慢性乙型肝炎与肝硬化患者凝血功能及血小板参数指标的变化及临床意义。方法:选取2017年1月-2019年1月本院收治的肝病患者140例,依据是否进展至肝硬化,分为慢性乙型肝炎组72例和肝硬化组68例;另选择同期健康体检者80例为对照组。比较三组及肝硬化不同肝功能分级患者的凝血功能指标(PT、APTT、TT、FIB、DD)和血小板参数指标(PLT、PCT、MPV、PDW)。结果:慢性乙型肝炎组和肝硬化组的PT、APTT、TT、DD、MPV、PDW均显著高于对照组,且肝硬化组均高于慢性乙型肝炎组,差异均有统计学意义(P0.05);慢性乙型肝炎组和肝硬化组的FIB、PLT、PCT均显著低于对照组,且肝硬化组均低于慢性乙型肝炎组,差异均有统计学意义(P0.05)。随着肝功能分级的增加,PT、APTT、TT、DD、MPV、PDW均显著升高,FIB、PLT、PCT均显著下降,差异均有统计学意义(P0.05)。结论:慢性乙型肝炎和肝硬化患者均有明显的凝血功能障碍和血小板参数异常,对疾病的诊断、预后具有十分重要的临床意义和参考价值。     

常规凝血指标和血小板计数与血栓弹力图判断危重型蝮蛇咬伤患者严重程度的临床价值

目的 探讨危重型蝮蛇咬伤患者常规凝血指标、血小板计数（PLT）和血栓弹力图（TEG）对病情严重程度的评估价值。方法 选取2010年1月-2014年1月中国人民解放军总医院第一附属医院急救部治疗的危重型蝮蛇咬伤患者68例为研究对象。按局部伤口、神经毒症状、血循毒症状的第2高分,将患者依次分为非危重组（20例）、危重组（27例）和极危重组（21例）。检测常规凝血功能指标〔活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、D-二聚体（DD）〕和PLT,描绘TEG,记录血凝时间（R）、血块成型时间（K）、α角和血块强度（MA）。结果 3组APTT、TT比较,差异无统计学意义（P＞0.05）。3组PT、FIB、DD和PLT比较,差异有统计学意义（P＜0.05）;其中,极危重组PT、DD高于非危重组和危重组,极危重组FIB、PLT低于非危重组和危重组,差异有统计学意义（P＜0.05）。3组R、K、α角和MA比较,差异均有统计学意义（P＜0.05）;其中,极危重组R、K较非危重组和危重组延长,极危重组α角、MA小于非危重组和危重组,差异有统计学意义（P＜0.05）。APTT、TT、PT和PLT与R呈正相关（r=0.379、0.571、0.061、0.645,P＜0.05）;TT、PT、DD与K呈正相关（r=0.637、0.611、0.521,P＜0.05）,FIB、PLT与K呈负相关（r=-0.371、-0.723,P＜0.05）;TT、PT与α角呈负相关（r=-0.687、-0.702,P＜0.05）,FIB、PLT与α角呈正相关（r=0.335、0.728,P＜0.05）;APTT、TT、PT与MA呈负相关（r=-0.567、-0.787、-0.679,P＜0.05）,FIB、PLT与MA呈正相关（r=0.329、0.639,P＜0.05）。结论 常规凝血功能指标、PLT及TEG对判断危重型蝮蛇咬伤患者病情严重程度有重要参考价值,其可以较好地评估患者凝血功能状态,有助于提供精确治疗。     

新生儿凝血功能检查及临床意义初探

目的：探讨新生儿早期的凝血状态及临床意义。方法以贵州省人民医院出生的新生儿为研究对象,其中早产组为153例早产儿（27～36＋6周）,肺炎组为63例新生儿肺炎,窒息组为65例轻度窒息新生儿,吸入组为61例新生儿胎粪吸入综合征,呼吸组为31例呼吸窘迫综合征,对照组为健康足月新生儿28例。使用sysmexCA7000自动血凝分析仪检测受检者血液样本凝血四项（APTT、PT、FIB、TT）,分析各组指标显著差异性。结果新生儿早产组APTT、PT、TT均明显高于对照组, FIB、PLT低于对照组,结果差异均有显著性（P＜0.05）;肺炎组APTT、PT均明显高于对照组,FIB低于对照组,具有显著差异（P＜0.05）,PLT、TT差异无统计学意义（P＞0.05）;窒息组FIB、PLT低于对照组,PT、TT高于对照组,差异均有显著性（P＜0.05）, APTT无统计学差异（P＞0.05）;吸入组FIB低于对照组,TT、PT高于对照组,差异有统计学意义（P＜0.05）,APTT、PLT无统计学差异（P＞0.05）;呼吸组APTT、PT、TT高于对照组,FIB低于对照组,差异有显著性（P＜0.05）,PLT结果无统计学差异（P＞0.05）。结论新生儿在不同情况下,凝血四项均表现出差异性,及时检测凝血指标,对新生儿凝血功能紊乱作出诊断并预防具有重要的意义。     

腹腔镜手术对胃肠道间质瘤患者血小板相关指标的影响

目的观察腹腔镜手术对胃肠道间质瘤患者血小板相关指标的影响。方法将108例胃肠道间质瘤患者采用抽签法均分为观察组和对照组各54例,对照组行开腹手术治疗,观察组行腹腔镜手术治疗,记录两组手术时间、手术切口、术中出血量、住院时间等围术期指标,同时观察两组术前、后血小板相关指标[血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数(PLT)]变化情况。结果观察组手术时间(78.62±11.01)min、手术切口(31.26±7.12)mm、出血量(24.10±5.68)m L、住院时间(5.16±3.12)d,均显著小于对照组(P0.05)。术后两组PT、APTT均较术前降低,D-D、FIB、PLT均较术前升高,两组比较,差异具有统计学意义(P0.05);术后观察组PT(10.79±0.31)s、APTT(28.86±0.61)s,均较对照组降低,D-D(为999.0±551.99)μg/L、FIB为(3.98±0.19)g/L、PLT为(198.09±27.01)×109/L,均较对照组升高,两组比较,差异具有统计学意义(P0.05)。结论腹腔镜手术治疗胃肠道间质瘤具有手术时间短、手术切口小、出血量少、住院时间短等显著优势,但术后患者的D-D、FIB水平进一步升高,PT时间显著缩短,易引起术后血栓性疾病的发生。     

凝血功能紊乱与危重症患者病情及预后的相关性研究

目的：探讨危重症患者凝血功能的改变与病情严重程度和预后的关系。方法：将68例危重症患者按急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）评分分为A（〈12分）、B（12—25分）、C（〉25分）三组,D组为健康对照组,分析不同评分患者血浆凝血酶原时间（IT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）和血小板（PLT）的水平变化与APACHEⅡ的关系。并根据患者预后分为存活组和死亡组,比较两组上述指标的差异。结果：危重症患者AFFT、PT、TT明显长于D组,PLT和FIB明显低于D组,差异有统计学意义（P〈0．05）;死亡组与存活组相比,AFFT、PT、TT明显延长,PLT和FIB明显降低,差异有统计学意义（P〈0．05）;C组的IT、APTT、TT显著高于A组和B组,PLT和FIB显著低于A组和B组,差异有统计学意义（P〈0．05）,B组的PT、APTT、TT显著高于A组,PLT和FIB显著低于A组,差异有统计学意义（P〈o．05）,A组的PT高于D组,差异有统计学意义（P〈0．05）,APTT略高于D组,但差异无统计学意义（P〉0．05）,TT、PLT和FIB与D组比较差异无统计学意义（P〉0．05）。结论：危重症患者普遍存在凝血系统功能紊乱,PT、APTT、TT、FIB和PLT对患者的预后及病情轻重的判断具有重要价值。     

腹部手术患者凝血指标的观察

目的探讨腹部手术患者凝血指标的变化及其临床意义。方法检测45例腹部手术患者手术前后血浆血小板计数（PLT）、凝血酶原时间（PT）、凝血酶时间（TT）、部分凝血酶时间（APTT）、纤维蛋白原（FIB）,并与50名对照组的凝血指标比较。结果腹部手术患者术前血浆FIB高于正常对照组,PLT、PT、TT、APTT与对照组比较无显著性差异;术后血浆PLT数量和FIB均显著降低,PT、TT、APTT延长,但FIB与对照组比较无显著性差异;术后死亡组PLT水平低于生存组,PT、TT、APTT、FIB无明显变化。结论腹部手术患者术前常呈高凝状态,术后则可呈现高凝、相对纤溶抑制和低凝,术后PLT降低,PT、TT、APTT延长可作为预测患者死亡的危险指标。     

降钙素原抗凝血酶Ⅲ和D-二聚体在新生儿重症肺炎诊治中的价值

目的：探讨降钙素原、抗凝血酶Ⅲ和 D-二聚体在新生儿重症肺炎诊治中的价值。方法选取新生儿普通肺炎97例、重症肺炎43例及健康新生儿70例为研究对象。重症肺炎组患儿,按照外周血 PCT 水平分为 PCT ＜2.00 ng／ mL 组和 PCT≥2.00 ng／ mL组。对全部新生儿采集静脉血分别测定血小板（PLT）、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（DD）和抗凝血酶Ⅲ（AT-Ⅲ）。结果与健康新生儿组比较,普通肺炎组、重症肺炎组 TT 、PT、APTT延长（P ＜0.05）,PCT、DD、FIB水平升高（P ＜0.05）,AT-Ⅲ和 PLT 水平降低（P ＜0.05）。与普通肺炎组比较,重症肺炎组PCT、AT-Ⅲ和 PLT水平降低（P ＜0.05）,DD、FIB 水平升高（P ＜0.05）,两组 PT、APTT、TT 比较差异无统计学意义（P ＞0.05）。与PCT ＜2.00 ng／ mL组比较,PCT≥2.00 ng／ mL组的患儿 DIC的发生率高（32.0％ vs 11.1％）,ATⅢ活性降低,PLT水平降低,而 DD的水平升高,差异均有统计学意义（P＜0.05）。结论降钙素原、抗凝血酶Ⅲ和D-二聚体在新生儿重症肺炎诊治中具有重要的价值。     

不同比例浓缩红细胞与血浆输注对产后大出血患者凝血功能的影响

目的分析不同比例浓缩红细胞与血浆输注对产后大出血患者凝血功能的影响。方法选取安阳市妇幼保健院2013年11月至2016年3月收治的66例产后大出血患者,采用随机数字表法分为A组(n=22)、B组(n=22)和C组(n=22)。A组采用浓缩红细胞与血浆比例(1∶8),B组(1∶3),C组(1∶1)。观察3组凝血功能指标[血小板计数(PLT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)]。结果输血后,A组PLT、FIB均明显低于产前,APTT、TT、PT均明显高于产前,差异均有统计学意义(P<0.05);输血后,B组PLT、FIB均略低于产前,APTT、TT、PT均略高于产前,差异均有统计学意义(P<0.05);C组PLT、FIB、APTT、TT、PT与产前相比均无明显变化,差异无统计学意义(P>0.05)。结论不同比例浓缩红细胞与血浆输注对产后大出血患者凝血功能影响程度不同,其中浓缩红细胞与血浆1∶1比例对凝血功能影响最小,适合用于对产后大出血患者进行输血。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.