失血性休克患者D-二聚体水平的变化及与弥漫性血管内凝血的关系

目的 探讨失血性休克患者D-二聚体水平的变化及与失血性休克后弥漫性血管内凝血(DIC)之间的关系.方法 将58例失血性休克患者分为并发DIC组(12例)和未并发DIC组(46例),另选取20例健康成人为正常对照组.正常对照组采外周静脉血4次,其余组分别于休克后1、3、5、7 d空腹采集外周静脉血,全自动乳胶微粒增强免疫比浊分析方法 测定血浆D-二聚体水平.结果 休克后1、3、5、7 d非DIC组D-二聚体[(1108.42±229.69)、(948.85±216.32)、(836.96±193.82)、(728.92±183.85)μg/L]及DIC组[(1254.49±289.65)、(1477.95±446.79)、(1665.81±652.36)、(1965.21±859.87)μg/L]均明显高于正常对照组[(169.32±45.78)μg/L],差异有统计学意义(均P＜0.01),失血性休克后3、5、7 d非DIC组血浆D-二聚体水平持续降低(P＜0.01),而DIC组D-二聚体水平持续升高(P＜0.01);休克后3、7 d时DIC组D-二聚体水平与正常对照组及非DIC组比较差异均有统计学意义(P＜0.01).结论 休克后急性期D-二聚体的升高程度与休克后DIC的发生密切相关,测定失血性休克患者急性期外周血浆D-二聚体水平变化对预测休克后DIC的发生具有一定价值.     

失血性休克患者D-二聚体水平的变化及与弥漫性血管内凝血的关系

目的 探讨失血性休克患者D-二聚体水平的变化及与失血性休克后弥漫性血管内凝血(DIC)之间的关系.方法 将58例失血性休克患者分为并发DIC组(12例)和未并发DIC组(46例),另选取20例健康成人为正常对照组.正常对照组采外周静脉血4次,其余组分别于休克后1、3、5、7 d空腹采集外周静脉血,全自动乳胶微粒增强免疫比浊分析方法 测定血浆D-二聚体水平.结果 休克后1、3、5、7 d非DIC组D-二聚体[(1108.42±229.69)、(948.85±216.32)、(836.96±193.82)、(728.92±183.85)μg/L]及DIC组[(1254.49±289.65)、(1477.95±446.79)、(1665.81±652.36)、(1965.21±859.87)μg/L]均明显高于正常对照组[(169.32±45.78)μg/L],差异有统计学意义(均P＜0.01),失血性休克后3、5、7 d非DIC组血浆D-二聚体水平持续降低(P＜0.01),而DIC组D-二聚体水平持续升高(P＜0.01);休克后3、7 d时DIC组D-二聚体水平与正常对照组及非DIC组比较差异均有统计学意义(P＜0.01).结论 休克后急性期D-二聚体的升高程度与休克后DIC的发生密切相关,测定失血性休克患者急性期外周血浆D-二聚体水平变化对预测休克后DIC的发生具有一定价值.     

2型糖尿病视网膜病变患者血清D-二聚体与肿瘤坏死因子α和白细胞介素6的检测价值

目的 研究2型糖尿病视网膜病变(DR)患者血清D-二聚体(D-D)、肿瘤坏死因子α(TNF-α和白细胞介素-6(IL-6)水平检测的临床价值.方法 通过眼底血管荧光造影和眼底检查,将80例糖尿病患者分为糖尿病视网膜病变(DR)组(42例)和糖尿病无视网膜病变(NDR)组(38例),另选健康体检者30例作为对照(对照组),对3组D-D、TNF-α和IL-6进行检测.结果 对照组、NDR组及DR组的D-D、TNF-α、IL-6水平分别为(0.34±0.12)mg/L、(4.5±1.7)ng/L、(66.5±19.3)ng/L;(0.59±0.19)mg/L、(15.5±7.9)ng/L、(101.18±30.1)ng/L;(1.08±0.27)ms/L、(42.1±12.6)ng/L、(161.2±48.8)ng/L.糖尿病患者血清D-D、TNF-α和IL-6水平均明显高于对照组(均P<0.05),DR组血清D-D、TNF.仅和IL-6水平均高于NDR组(均P<0.05).结论 DR患者D-D、TNF-α和IL-6水平明显升高,提示此类患者处于高凝状态,且炎症反应可能在糖尿病视网膜DR发展中起重要作用.

Abstract：

Objective To investigate the clinical value of D-dimer (D-D),tumor necrosis factor-a (TNF-a) and interleukin-6 (IL-6) levels in type 2 diabetic patients with diabetic retinopathy. Methods All the patients had routine FFA and examination of fundus and were divided into two groups based on the results: normal fundus( NDR group n = 38 ) , diabetic retinopathy( DR group n = 42 ). Thirty healthy subjects were used as control group. The serum levels of D-D, IL-6 and TNF-a was detected. Results The serum levels of D-D, IL-6 and TNF-a of type 2 diabetic patients were higher than those of control group statistically (P < 0.05). The serum levels of D-D, IL-6 and TNF-a of DR group were higher than those of NDR group(P <0.05). Conclusions The levels of D-D, IL-6 and TNF-a in type 2 diabetic patients with diabetic retinopathy are higher than those of normal fundus group. The inflammatory reaction may play an important role in the initiation and sustainment of DR.     

急性淋巴细胞白血病患者血清瘦素表达水平的研究

目的 研究急性淋巴细胞白血病(ALL)患者血清瘦素水平变化的临床意义.方法 选取ALL患者及健康成人各20例,分别以放射免疫法测定其血清瘦素水平,并在化疗2个周期后再次测定ALL患者血清瘦素水平.结果 ALL组化疗前血清瘦素水平明显低于健康对照组[(19.2±4.5)μg/L比(33.9±6.2)μg/L,P<0.05].ALL组化疗后血清瘦素水平[(28.9±5.5)μg/L]明显高于化疗前(P<0.05).结论 ALL患者血清瘦素水平较健康成人低,经化疗缓解后,其血清瘦素水平明显增高.血清瘦素水平可作为判断ALL治疗效果的有效指标之一.

Abstract：

Objective To investigate the level of plasma leptin in patients with acute lymphoblastic leukemia (ALL) , and to compare the difference of plasma leptin levels in patients with ALL respectively before and after chemotherapy in order to discuss the relationship between ALL and plasma leptin level. Methods There were 20 cases in ALL group and 20 normal persons in control group. We examined the expression of the levels of leptin in plasma with ALL patients respectively before (group A) and after 2 circles chemotherapy (group C) and normal persons (group B) using radioimmunoassay method. Results The leptin levels of group A and B were( 19. 2 ± 4.5) n,g/L and (33.9 ±6. 2) p,g/L respectively with significant statistical difference. The leptin levels of group A and C were(19.2 ±4.5)μg/L and (28.9 ±5.5)μg/L respectively. Conclusions The plasma leptin level in patients with ALL is lower than that in normal persons. After chemotherapy the plasma leptin level is markedly higher than before. The leptin level of plasma can be used as a helpful indicator to evaluate the therapeutic effect of patients with ALL.     

不同剂量甲泼尼龙静脉治疗风湿性疾病对血糖影响的前瞻性对照研究

目的 分析静脉应用不同剂量甲泼尼龙对患者治疗最初3 d空腹、早餐后、午餐后及晚餐后血糖的影响.方法 选择2008年5月至2010年9月80例因风湿性疾病需要应用甲泼尼龙静脉点滴治疗的住院患者.所有患者既往均无糖尿病或糖耐量异常史,无口服或静脉应用糖皮质激素病史.甲泼尼龙用量≤80 mg为常规剂量组,共40例;用量≥200 mg为冲击剂量组,共40例.分别检测每例患者入院时空腹、应用甲泼尼龙第1、2、3天的快速血糖值(包括空腹、早餐后、午餐后、晚餐后),以及应用激素1个月后的空腹血糖值.结果 2组同一时间点的血糖值比较差异无统计学意义(P＞0.05).80例患者不同时间血糖值的比较结果显示,第1、2、3天的早餐后血糖[分别为(7.99±2.61)、(8.15±3.14)、(7.53±2.59)mmol/L]与这3天的中餐后血糖[分别为(11.80±3.43)、(11.73±3.52)、(10.88±3.63)mmol/L]及晚餐后糖[分别为(10.84±3.59)、(10.86±3.47)、(10.16±3.60)mmol/L]比较,差异均有统计学意义(P＜0.05);中餐后和晚餐后血糖比较,差异无统计学意义(P＞0.05).应用甲泼尼龙前和应用1月时的空腹血糖值比较,差异无统计学意义(P＞0.05).结论 静脉输注甲泼尼龙主要影响中餐及晚餐后血糖.血糖变化未显示出与甲泼尼龙剂量正相关,血糖增高呈一过性.

Abstract：

Objective To investigate the effects of Plasma glucose of different dose methylprednisolone therapies in the treatment of Rheumatoid diseases, including fasting plasma glucose examined and the levels of 2h postprandial glucose. Methods Eighty cases of patients of Rheumatoid diseases who had no Diabetes mellitus and no history of prednisone taking were selected during year 2008 to 2010. All the patients were divided into two groups. The normal dose group were forty patients who received the methylprednisolone ( ≤ 80 mg/day) and the large dose group were also forty patients who received the methylprednisolone( ≥200 mg/day). Compared the levels of fasting plasma glucose and the 2 h postprandial glucose in the first three days and the fasting plasma glucose after 1 month. Results The levels of the plasma glucose were not significantly changed in the two groups at the same point. The levels of the plasma glucose after breakfast were significantly different with the levels after lunch and dinner. There was no difference of the plasma glucose between the time before using methylprednisolone and one month. Conclusions The methylprednisolone infusion was mainly effect the plasma glucose levels after lunch and dinner. There was no dose-dependent phenomenon when using the methylprednisolone.     

Effects of valsartan with or without benazepril on blood pressure,angiotensin Ⅱ,and endoxin in patients with essential hypertension

AIM：To eveluate the effects of valsartan(Val)with or without benazepril(Ben)on blood pressure and plasma levels of angiotensin(Ang Ⅱ)and digoxin-immunoreactive factors(endoxin)in patients with essential hypertension. METHODS:Ninety patients with essential hypertension were randomly divided into 3 groups(n=30 per group):Ben group(Ben 10 mg/d,po);Val group(Val 80mg/d,po);combination drug therapy group(Val 80mg/d Ben 10mg/d,po);all patients were treated for 12 weeks.Age and sex-matched 20 normal subjects were served as control group.RESULTS:The levels of plasma endoxin and ang Ⅱ in patients with essential hypertension were remarkably higher than those in normal subjects.The levels of plasma ang Ⅱ and endoxin were all obvious positive correlation with systolic blood pressure(SBP)and diastolic blood pressure(DBP)(Ang Ⅱ:r=0.5151,0.7978;endoxin:r= 0.4706,0.7274,respectively),within 6 weeks of drug intervene,SBP and DBP were remarkably decreased in 3 groups.After 6 weeks,SBP and DBP were continuously decreased in Ben group and Val Ben group,but not in Val group.Level of plasma AngⅡ was remarkably decreased as SBP and DBP decreased in Ben group and Val Ben group;level of plasma AngⅡ was remarkably increased in Val group.CONCLUSION:Val with or without Ben remarkably decreased SBP and DBP in patients with essential hypertension within 6 weeks.Antihypertensive efficacy was weakened after long-term use of Val alone.The antihypertensive effect of Val Ben group was the most remarkable among 3 groups and could avoid the side effects of high plasma AngⅡ.     

肝纤维化血清学指标水平与肝癌的相关性研究

Objective To investigate the significance of serum fibrosis markers in liver fibrosis in liver neoplasms. Methods Radioimmunoassay was used to measure the level of serum procollagen (PC) Ⅲ, collagen type Ⅳ(Ⅳ-C), laminin LN and hyaluronic acid(HA) in 120 patients with liver neoplasms and 100 healthy people.Results Before therapy, the level of Ⅳ-C in the hepatocellular carcinoma group showed significant difference compared with those in control group (P＜0. 01 ). The levels of PCⅢ and LN in the hepatocellular carcinoma group were higher than those in control group ( P ＜ 0.05 ). Before therapy the levels of HA in metastatic cancer of liver group and extrahepatic malignant tumor group were higher than those in control group ( P ＜ 0. 05 ). Before and after the therapy the levels of hepatocellular carcinoma group serum PC Ⅲ, Ⅳ-C, LN and HA were significantly higher than those in the metastatic cancer of liver group ( P ＜ 0. 05). Before and after the therapy the levels of hepatocellula carcinoma group serum PC Ⅲ, Ⅳ-C, LN and HA were significantly difference ( P ＜ 0.05 ). Conclusions The levels of serum PC Ⅲ, Ⅳ-C, LN and HA are significantly related with the hepatocellular carcinoma. These markers can reflect the fibrosis degree of chronic hepatocellular carcinoma and will be an indicator of prognosis.     

肝纤维化血清学指标水平与肝癌的相关性研究

Objective To investigate the significance of serum fibrosis markers in liver fibrosis in liver neoplasms. Methods Radioimmunoassay was used to measure the level of serum procollagen (PC) Ⅲ, collagen type Ⅳ(Ⅳ-C), laminin LN and hyaluronic acid(HA) in 120 patients with liver neoplasms and 100 healthy people.Results Before therapy, the level of Ⅳ-C in the hepatocellular carcinoma group showed significant difference compared with those in control group (P＜0. 01 ). The levels of PCⅢ and LN in the hepatocellular carcinoma group were higher than those in control group ( P ＜ 0.05 ). Before therapy the levels of HA in metastatic cancer of liver group and extrahepatic malignant tumor group were higher than those in control group ( P ＜ 0. 05 ). Before and after the therapy the levels of hepatocellular carcinoma group serum PC Ⅲ, Ⅳ-C, LN and HA were significantly higher than those in the metastatic cancer of liver group ( P ＜ 0. 05). Before and after the therapy the levels of hepatocellula carcinoma group serum PC Ⅲ, Ⅳ-C, LN and HA were significantly difference ( P ＜ 0.05 ). Conclusions The levels of serum PC Ⅲ, Ⅳ-C, LN and HA are significantly related with the hepatocellular carcinoma. These markers can reflect the fibrosis degree of chronic hepatocellular carcinoma and will be an indicator of prognosis.     

孕妇血清一氧化氮水平与胎膜早破和绒毛膜羊膜炎的关系

目的 探讨血清NO水平与胎膜早破(PROM)及绒毛膜羊膜炎的关系.方法 将78例胎膜早破孕妇按照实际情况分为早产合并胎膜早破(pPROM)组33例和足月胎膜早破(tPROM)组45例,50例临产前剖宫产的胎膜完好孕妇为正常对照组,分析比较3组血清NO水平,观察3组发生绒毛膜羊膜炎的情况及绒毛膜羊膜炎患者血清NO水平.结果 pPROM组和tPROM组血清NO水平相近,均高于正常对照组,差异有统计学意义[(85±26)μmol/L、(83±21)μmoL/L比(60±16)μmoL/L,P＜0.05];pPROM组和tPROM组绒毛膜羊膜炎发生率高于正常对照组,差异有统计学意义[33.3%(11/33)、31.1%(14/45)比4.0%(2/50)];绒毛膜羊膜炎患者血清NO水平明显高于非绒毛膜羊膜炎患者,差异有统计学意义[(109±39)μmol/L比(73±33)μmol/L,P＜0.05].结论 血清NO水平的增高可能预示绒毛膜羊膜炎及胎膜早破的存在.

Abstract：

Objective To study the relationship between the level of nitric oxide(NO) in blood and premature rupture of membranes (PROM) and chorioamnionitis. Methods The 78 cases of premature rupture of membranes were divided into two groups according to the actual situation. The group of preterm premature rupture of membranes (pPROM) included 33 patients and the full-term premature rupture of membranes (tPROM) group had 45 patients. Fifty intact membranes' pregnant women who chose cesarean section before labor were selected as the normal control group. The levels of serum NO and the occurrence of chorioamnionitis were analyzed and compared among the three groups. Results The blood serum NO level was similar in PROM group and tPROM group but higher than that of the normal control group[(85 ±26)μmol/L, (83±21)μmol/L vs (60 ±16)μmol/L, P＜0.05]. The incidence of chorioamnionitis in PROM group and tPROM group was higher than that of the normal control group. The blood serum NO level of chorioamnionitis group was higher than that of the non-chorioamnionitis group [(109 ± 39)μmol/L vs (73 ± 33) μmol/L, P＜0. 05]. Couclusion The level of blood serum NO may predict PROM and chorioamnionitis.     

危重患者血浆中性粒细胞明胶蛋白酶相关载脂蛋白浓度的测定及其临床意义

Objective To detect the concentration of plasma neutrophil gelatinase-associated lipocalin (NGAL) and the clinical significance in critically ill patients. Methods Fifty-four critically ill patients in ICU were enrolled in the present study with 23 health persons as controls. Plasma NGAL concentration was measured by enzyme-linked immunosorbent assay (ELISA) on the 1 st and 7th day from 54 adult patients in ICU and the controls (control group). Results The plasma NGAL concentrations of ICU patients were significantly higher than those of the controls (P ＜0.001 ). NGAL concentrations were no significant difference between the Death group and the Survival group on the 1 st day(P = 0. 259). But there was a markedly significant difference in Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores (P ＜0. 001 ). The APACHE Ⅱ scores on the 7th day significantly decreased in the improved patients (P =0.019) and showed a subtle tendency of increase in the deteriorated patients ( P =0.403) in comparison to the first day. The plasma NGAL levels followed the same trends, but showing a significant increase even in deteriorated patients ( P = 0. 016 and P= 0. 034, respectively). Conclusions The plasma NGAL concentrations of critically ill patients is significantly increased. Combined with APACHE Ⅱ scores,it can provide useful and available data of the disease state of critically ill patients.     

腹主动脉球囊置入术与宫腔球囊填塞术治疗凶险性前置胎盘的效果分析

目的探讨腹主动脉球囊置入术与宫腔球囊填塞术治疗凶险性前置胎盘的效果。方法选取2019年1月~2020年1月105例凶险性前置胎盘患者为观察对象,按照随机数表法分为对照组52例和观察组53例。对照组采用宫腔球囊填塞术治疗,观察组采用腹主动脉球囊置入术+宫腔球囊填塞术治疗。比较两组出血量、输红细胞量、输血浆量、术后24 h出血量、术中胎盘植入、失血性休克、DIC率、子宫次全切除或全切除率、新生儿体重、Apgar 1 min评分、Apgar 5 min评分、新生儿窒息率。结果观察组出血量、输红细胞量、输血浆量、术后24 h出血量少于对照组(P<0.05);两组术中胎盘植入差异无统计学意义(P>0.05),观察组失血性休克、DIC率、子宫次全切除或全切除率低于对照组(P<0.05);两组新生儿体重、Apgar 1 min评分、Apgar 5 min评分、新生儿窒息率差异无统计学意义(P>0.05)。结论腹主动脉球囊置入术联合宫腔球囊填塞术治疗凶险性前置胎盘能够减少出血量、输血量、术后24 h出血量,降低失血性休克、DIC率、子宫次全切除或全切除率,改善孕产妇的预后。     

严重下肢创伤患者血浆纤溶酶原激活物抑制物1和抗凝血酶Ⅲ水平变化及弥散性血管内凝血相关性研究

目的探讨严重下肢创伤患者纤溶酶原激活物抑制物1(PAI-1)、抗凝血酶III(ATⅢ)的变化及其与伤后前弥散性血管内凝血(DIC)、DIC等并发症的关系。方法将26例下肢创伤患者分为重伤组(简明损伤定级评分不低于3分,20例)和轻伤组(6例);26例患者又分为前DIC组7例、DIC组3例、其他组16例;26例患者于伤后第1,3,6天空腹采外周静脉血,检测血液PAI-1及ATⅢ水平变化,并与对照组10例健康人比较。结果重伤组和轻伤组PAI-1在伤后第1天明显高于对照组(P<0.01),且重伤组明显高于轻伤组(P<0.05),ATⅢ在伤后第1,3,6天明显低于对照组(P<0.01),且重伤组明显低于轻伤组(P<0.05)。DIC组PAI-1在伤后第1天明显高于前DIC组(P<0.05),而ATⅢ在伤后第1,3天明显低于非前DIC组(P<0.05)。伤后ATⅢ水平与DIC、前DIC的发生呈明显负相关。结论下肢创伤后急性期ATⅢ和PAI-1水平变化与创伤严重程度有关,检测这两项指标对于预测下肢伤患者病情进展及并发症发生情况能提供可靠的实验诊断依据。     

糖尿病肾病患者血浆血栓调节蛋白和D-二聚体的变化及意义

目的：观察2型糖尿病患者不同程度肾病血浆血栓调节蛋白（TM）和D-二聚体（D—D）的变化，了解其在糖尿病肾病发病中的意义。方法：用ELISA法测定58例2型糖尿病和21例正常对照者血浆TM和D—D浓度。结果：2型糖尿病患者血浆TM和D—D水平明显高于正常对照组：糖尿病肾病患者血浆TM和D—D水平明显高于糖尿病非肾病患者；慢性肾衰组血浆TM水平高于微量白蛋白尿组和临床蛋白尿组；临床蛋白尿组血浆TM水平高于微量白蛋白尿组；TM与空腹血糖（FPG）、血尿素氮（BUN）、肌酐（Cr）、纤维蛋白原（FIB）、尿微量白蛋白（UMA）、糖尿病视网膜病变（DR）呈正相关：D—D与患者年龄、FPG、BUN、Cr,FIB、UMA、DR呈正相关。结论：血浆TM受肾功能的影响．可以作为糖尿病肾病的早期预测因素。肾功能受损、年老、高血糖均会导致体内高凝状态。     

新鲜冰冻血浆与浓缩红细胞不同比例输注对失血性休克患者凝血功能的影响

目的探讨输注不同比例的新鲜冰冻血浆(FFP)和浓缩红细胞(CRBC)对失血性休克患者凝血功能的影响。方法根据患者第一个24h内被输注的FFP量和CRBC量的不同比例(100ml∶1U),65例患者分为三组:低比例(L)组,22例,FFP∶CRBC=1∶6.5;中比例(M)组,20例,FFP∶CRBC=1∶3;高比例(H)组,23例,FFP∶CRBC=1∶1.1。行相关凝血指标实验室结果分析。结果输血6h后,三组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)均明显异常。输血12h后,H组的PT、APTT、TT和FIB均达到正常或基本正常,且明显优于L组(P<0.01),M组的4项指标略好于L组。结论大量输血容易造成稀释性低凝状态,建议对失血性休克患者使用FFP和CRBC比例为1:1进行输血治疗有利于维持凝血功能。     

凝血与纤溶系统水平对产妇弥漫性血管内凝血的早期诊断价值

目的通过观察DIC产妇中凝血与纤溶系统水平的变化,探讨其是否可以作为产妇DIC的早期诊断指标,评价其诊断价值。方法选取2009年1月～2011年6月在笔者所在医院进行治疗的32例DIC产妇和进行体检的30例健康产妇,对两组受试者的凝血与纤溶系统多种指标进行检查。结果与对照组产妇比较,DIC组的PLT计数和FIB水平显著降低,而PT、TT及APTT显著增加,D-D升高,两组受试者比较,差异有统计学意义(P<0.05)。结论凝血与纤溶系统水平对于产妇DIC的早期诊断具有重要的意义,其中PT、TT及APTT显著性增加表明凝血功能亢进,而D-D升高表明继发性纤溶的发生,上述指标的变化可以作为产妇DIC早期诊断的指标。     

血浆D-D、FIB及FDP在肺栓塞治疗中的表达及意义

目的 观察血浆D-二聚体(D-D)、纤维蛋白原(FIB)、纤维蛋白原降解产物(FDP)在肺栓塞治疗中的表达及意义.方法 选取50例肺栓塞患者作为实验组,根据病情不同分为低危组(15例)、中危组(23例)、高危组(12例);根据最终疗效分为有效组(29例)和无效组(21例).另选健康者50例为对照组.比较实验组与对照组D...     

不同复苏液对失血性休克大鼠血中粘附分子表达的影响

目的：观察不同复苏液对失血性休克大鼠血浆血小板α颗粒膜糖蛋白-140（GMP-140）、血清可溶性血管细胞粘附分子-1（sVCAM-1）及可溶性细胞间粘附分子-1（sICAM-1）表达的影响,并探讨其可能机制。方法：50只SD大鼠随机分为5组（对照组、假手术组、休克组、林格组和万汶组）,每组10只。建立失血性休克大鼠模型后,复苏各组在失血性休克1h后给予不同复苏液（林格氏液、6%中分子羟乙基淀粉130/0.4）,复苏2h后采血,检测血浆GMP-140、血清sVCAM-1及sICAM-1的变化。结果：与对照组比较,休克组和林格组GMP-140、sVCAM-1、sICAM-1均明显升高（P〈0.01）,而万汶组改变不明显;与假手术组相比,休克组的GMP-140、sVCAM-1、sICAM-1明显升高（P〈0.01）;林格组的GMP-140亦明显升高,余两项指标未见明显变化;万汶组的GMP-140、sVCAM-1、sICAM-1改变不明显;相对于休克组,林格组的sVCAM-1下降明显（P〈0.01）,sICAM-1虽有下降,但差异无统计学意义;而万汶组的GMP-140、sI-CAM-1、sVCAM-1均明显低于休克组和林格组（P〈0.01）。结论：大鼠失血性休克可使纤溶功能亢进,血小板和凝血系统被活化;采用万汶＋林格液复苏在调节凝血功能方面优于单用林格液复苏;休克早期经充分的液体复苏后,不管是万汶还是林格液都可能会改善微循环。其可能的原因是血液稀释具有抗缺血再灌注损伤的作用,应用万汶可能减少内皮细胞损伤并改善微循环。     

盐酸戊乙奎醚对急性失血性休克患者围术期血乳酸盐水平及氧代谢的影响

目的观察盐酸戊乙奎醚对急性失血性休克患者围术期血乳酸盐水平和氧代谢的影响,探讨其对失血性休克患者的治疗作用。方法将96例急性失血性休克行剖腹探查术患者采用McLeod改良的Wichmann-Hill伪随机数发生器生成的随机序列分成2组,各48例。治疗组在手术开始时静脉注射盐酸戊乙奎醚0．05mg／kg,对照组静脉注射等量容积的0．9％NaCl溶液。分别记录输注前、注药后30、60、120min4个时点的动脉血乳酸盐浓度（BL）及氧代谢指标。同时监测平均动脉压、中心静脉压、心输出量、心率及排尿量的变化。结果2组患者注药后30、60min的中心静脉压、平均动脉压与输注前比较有所回升,且治疗组较对照组回升明显,差异有统计学意义（均P〈0．05）;心率在注药后30、60min与输注前比较下降,且治疗组较对照组下降明显,差异有统计学意义（均P〈0．05）;尿量在注药后60、120min与输注前比较增多（P〈0．05）,且治疗组较对照组增多更明显（P〈0．05）。2组患者在注药后氧输送量、氧耗量与输注前比较均上升,且治疗组高于对照组（P〈0．05）;治疗组心输出量在注药后60、120min时点上升（P〈0．05）,对照组注药后120min时点上升;BL浓度进行性下降（P〈0．05）;治疗组氧摄取率在注药后30、60min时点下降（P〈0．05）,对照组氧摄取率各时点与输注前比较无明显变化。结论围术期盐酸戊乙奎醚用于抢救急性失血性休克患者可有效地改善氧供及氧利用率,减轻乳酸酸中毒,恢复正常的组织代谢。