全髋关节置换后血清炎性因子表达及深静脉血栓形成57例分析

为观察全髋关节置换后早期肿瘤坏死因子α、白细胞介素1、白细胞介素6水平的变化,及其与深静脉血栓形成的关系,选择2005-01/2007-12行全髋关节置换的57例患者,应用彩色多普勒超声检查下肢深静脉血流通畅情况,采用放射免疫法测定血清肿瘤坏死因子α、白细胞介素1,6的浓度。结果全髋关节置换中超声检查发现25例形成深静脉血栓,32例未发现静脉血栓;置换后1,3 d,形成血栓的25例患者血清肿瘤坏死因子α、白细胞介素1,6的表达均明显高于未发现静脉血栓患者(P < 0.05或0.01)。提示全髋关节置换后,深静脉血栓形成患者早期相关血浆炎症细胞因子的表达增强,可能与深静脉血栓形成有关。     

老年单侧全髋关节置换与下肢深静脉血栓形成

背景：下肢深静脉血栓形成是全髋关节置换患者围手术期严重的并发症,其发生率较高。目前尚不清楚原发病对老年全髋关节置换后下肢深静脉血栓形成的影响。 目的：观察不同原发病对老年全髋关节置换后下肢深静脉血栓形成的影响。 方法：选择单侧全髋关节置换患者147例,年龄64~93岁,根据原发病不同分为2组：骨折组68例,置换前经历了创伤,均为股骨颈骨折患者;骨病组79例,术前未经历过创伤。根据患者生理年龄、置换前社会活动能力、骨质情况、预期寿命等选择全髋假体,其中采用生物学假体5例,混合型假体12例,其他全部采用骨水泥型假体。对术后出现患肢肿胀和/或疼痛,下肢伴有或不伴有Homans征/ Neuhofs征阳性的患者常规应用加压超声技术进行超声多谱勒检查。 结果与结论：骨折组置换后32例出现患侧肢体肿胀,伴有疼痛者20例,出现Homans征/ Neuhofs征15例,经超声多普勒检查证实29例下肢下肢深静脉血栓形成阳性;股骨颈骨折后行全髋关节置换1例,无下肢深静脉血栓形成临床症状,于置换后17 d猝死,尸检证实为伤侧下肢混合型下肢深静脉血栓形成合并肺栓塞;骨病组置换后20例出现患侧肢体肿胀,伴有疼痛者11例,出现Homans征/ Neuhofs征9例,经超声多普勒检查证实20例下肢深静脉血栓形成阳性。股骨颈骨折患者比骨病组患者具有更高的血液凝固状态,下肢深静脉血栓形成发生率更高(P < 0.05)。提示股骨颈骨折是老年全髋关节置换后下肢深静脉血栓形成发生的高危因素。     

大鼠骨髓间充质干细胞血管细胞黏附分子1及细胞间黏附分子1的表达

背景：骨髓间充质干细胞系统性输注后,何种因素促使其迁移到正确部位尤为关键,目前认为黏附分子在介导骨髓间充质干细胞向缺血或损伤组织迁移过程中起重要作用。 目的：观察血管细胞黏附分子1与细胞间黏附分子1在大鼠骨髓间充质干细胞中的表达。 方法：采用直接贴壁法体外分离培养大鼠骨髓间充质干细胞,免疫细胞化学染色检测血管细胞黏附分子1及细胞间黏附分子1蛋白的表达,应用免疫荧光直标法在流式细胞仪上检测血管细胞黏附分子1及细胞间黏附分子1抗原的表达率,RT-PCR半定量分析血管细胞黏附分子1及细胞间黏附分子1 mRNA的表达。 结果与结论：免疫细胞化学染色结果显示,骨髓间充质干细胞血管细胞黏附分子1呈弱阳性表达,细胞间黏附分子1呈强阳性表达。流式细胞仪检测结果显示,血管细胞黏附分子1表达率为6%,细胞间黏附分子1表达率为100%。RT-PCR检测结果显示,血管细胞黏附分子1 mRNA呈微弱表达,细胞间黏附分子1 mRNA呈高度表达。提示在生理状态下,体外培养的大鼠骨髓间充质干细胞低表达血管细胞黏附分子1,高表达细胞间黏附分子1。     

脑出血患者血清细胞间黏附分子-1与血管细胞黏附分子-1含量变化

目的观察脑出血患者1d、3d、7d、14d血清中可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sV-CAM-1)含量变化,探讨临床意义。方法采用双抗夹心酶联免疫吸附法(ELISA)测定血清中sICAM-1、sVCAM-1含量。结果脑出血患者sICAM-1、sVCAM-1含量第1d开始升高,与对照组比较差异无统计学意义(P>0.05);第3d、7d含量显著升高,与对照组相比差异有统计学意义(P<0.01);第14d含量开始下降,与对照组相比差异有统计学意义(P<0.01);重型脑出血组与轻型脑出血组比较,第3d、7d差异均有统计学意义(P<0.05,P<0.01)。结论ICAM-1、VCAM-1参与脑血肿周围脑组织炎症反应及继发性脑组织损伤。     

细胞黏附分子血浆E-选择素水平与下肢深静脉血栓形成

背景：研究表明，深静脉内白细胞参与的炎症反应在深静脉血栓形成中起了很重要的作用，而E-选择素的主要作用是介导炎症过程中白细胞与血管内皮细胞黏附的起始过程。 目的：拟观察细胞黏附分子E-选择素水平与下肢深静脉血栓形成的关系。 设计、时间及地点：配对设计，直线相关分析，于2007-09/12在重庆医科大学附属第一医院血管外科及重庆医科大学临床检验诊断学实验室完成。 对象：选择发病在3 d 内或病情加重的27例下肢深静脉血栓形成患者，男16例，女11例，平均年龄(57±15)岁。 方法：入院时采集第1次血液标本，经过溶栓，抗凝治疗72 h 后采集第2次血液标本。用ELISA法测定血浆中E-选择素的质量浓度，同时测定第1次采血样本的血小板计数及其凝血功能，包括部分激活凝血活酶时间、凝血酶原时间、血浆纤维蛋白原。 主要观察指标：治疗前后患者E-选择素的水平，治疗前凝血功能、血小板计数及与E-选择素相关性分析。 结果：27例下肢深静脉血栓形成患者在治疗期间均未发生急性肺栓塞，1例行Forgart导管取栓术，其余26例患者72 h 后，15例患者临床症状明显好转，11例临床症状未见好转。①下肢深静脉血栓形成患者经过溶栓、抗凝治疗临床缓解者血浆E-选择素水平明显下降(P=0.001)，而临床未缓解者血浆E-选择素水平则呈上升表现(P=0.003)。②下肢深静脉血栓形成患者治疗前E-选择素水平与血小板计数无相关性(r=-0.113，P=0.576)，与纤维蛋白原含量无相关性(r=-0.050，P=0.802)，与部分激活凝血活酶时间无相关性(r=-0.046，P=0.822)，与凝血酶原时间亦无相关性(r=-0.080，P=0.690)。 结论：血浆E-选择素水平与深静脉血栓形成症状严重程度呈正相关性。     

全髋关节置换后早期并发深静脉血栓的多因素Logistic回归分析

背景：随着对全髋关节置换后并发深静脉血栓的认识加深,减少和避免其发生已成为临床面临的重要课题。以往对影响深静脉血栓形成的相关因素报道虽多,但着眼点片面、样本量过少、统计学意义差、基础试验与临床研究的结果相混淆、研究方法及设计缺乏科学性,造成报道不一致,各抒己见。 目的：探讨全髋关节置换术早期并发深静脉血栓的原因及其相关因素,并提出预防与处理对策,从而降低发生率。 方法：回顾分析1 780例首次全髋关节置换术病例,选择性别、年龄、体质量、病种、合并症、患髋既往手术、麻醉、手术时间、假体固定方式、输血、术后患肢训练、防血栓药物、并发症指标进行统计,采用SPSS建立标准化数据库,行Logistic多因素回归分析。 结果与结论：1 780例全髋关节置换患者中有深静脉血栓136例。年龄、合并症、麻醉、假体固定方式、输血、患肢术后主被动训练、防血栓药物因素与深静脉血栓有相关性(P < 0.05)。高龄、高血压或糖尿病、全麻、骨水泥固定、输全血是全髋关节置换术早期并发深静脉血栓的危险因素,患肢术后主被动训练、防血栓药物应用是保护因素。认真做好围手术期处理,积极控制慢性合并症、术前做好评估、术中操作精细、术后积极预防治疗及护理可以降低深静脉血栓的发生。     

髋关节置换术后下肢深静脉血栓形成的预防性护理

目的探讨髋关节置换术后预防下肢深静脉血栓形成的护理对策。方法对70例髋关节置换术患者给予术前宣教、术后早期积极主动和被动活动、对高危人群辅以预防性抗凝治疗,预防下肢深静脉血栓的发生。结果 70例髋关节置换术患者经护理干预后,无1例发生下肢深静脉血栓,住院时间15～24d,平均住院(18.3±2.4)d。结论指导髋关节置换患者术后早期功能锻炼,并进行预防性抗凝治疗,能有效预防髋关节置换术后下肢深静脉血栓的形成。     

髋关节置换术后下肢深静脉血栓形成的预防性护理

目的探讨髋关节置换术后预防下肢深静脉血栓形成的护理对策。方法对70例髋关节置换术患者给予术前宣教、术后早期积极主动和被动活动、对高危人群辅以预防性抗凝治疗,预防下肢深静脉血栓的发生。结果70例髋关节置换术患者经护理干预后,无1例发生下肢深静脉血栓,住院时间15～24d,平均住院（18．3±2．4）d。结论指导髋关节置换患者术后早期功能锻炼,并进行预防性抗凝治疗,能有效预防髋关节置换术后下肢深静脉血栓的形成。     

可溶性细胞间黏附分子-1、血管细胞黏附分子-1与急性脑梗死关系的研究

急性脑梗死(acute cerebral infarction,ACI)后会引发颅内炎性反应。研究显示,缺血区内大量白细胞(WBC)黏附于血管内皮细胞表面并外渗。炎性介质细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)与这一过程密切相关,而外周血可溶性ICAM-1(sICAM-1)、VCAM-1(sVCAM-1)主要来源于细胞表面模型ICAM-1、VCAM-1,其血浆水平的增高是内皮细胞和WBC损害或激活的标志。作者观察了38例ACI、33例恢复期脑梗死(remissonstages cerebral infarction,RSCI)患者血浆sICAM-1、     

22例髋关节术后下肢深静脉血栓形成患者的护理

目的 探讨髋关节术后下肢深静脉血栓形成的护理措施. 方法 自2004-01～2009-01我科共收治22例髋关节术后下肢深静脉血栓形成患者,针对发病因素给予抗凝、溶栓治疗及有效护理措施. 结果 本组患者临床症状体征完全缓解,无严重并发症.结论 对形成静脉血栓患者,应采取促进静脉血液回流、抬高患肢、监测凝血指标、观察出血倾向,在置管溶栓期间做好导管护理,并采取措施预防肺栓塞.     

Changes in the levels of soluble adhesion molecules and coagulation factors in patients with deep vein thrombosis

Current biochemical markers of thrombosis, such as d-dimer, are of little value in demonstrating the presence of thrombus postoperatively, as their levels are elevated by surgery. Thrombosis involves adhesive interactions between the endothelium, platelets and leukocytes. The aim of the study was to determine which of a panel of haemostatic and adhesion factors are altered by the presence of thrombus, but not by surgery. These factors were measured in 20 patients with established spontaneous DVTs, 13 patients having hip replacement surgery and 28 control patients. Circulating levels of P-selectin, VCAM-1 and tissue factor were found to be increased when thrombus was present (p <0.018, p <0.0001, p <0.0028 respectively), but were not altered by surgery. The significance of these circulating factors in venous thrombosis remains to be established, but it is conceivable that they are the product of increased leukocyte trafficking and activity. Assay of VCAM-1, in particular, may be of use in the early detection of venous thrombi in postoperative patients.     

Prevention of deep vein thrombosis by low-molecular-weight heparin and dihydroergotamine in patients undergoing total hip replacement.

In 110 high-risk patients undergoing total hip replacement the antithrombotic efficacy and safety of a single daily injection of 1500 aPTT-U low-molecular-weight heparin plus 0.5 mg dihydroergotamine (Embolex) was, in a double-blind study, compared with a twice daily administration of 5000 IU of the heparin-dihydroergotamine combination Heparin-Dihydergot. Deep vein thrombosis diagnosed with phlebography occurred in 9.6% in the Embolex-group and in 25% in the Heparin-Dihydergot-group. Intra- and postoperative blood loss and blood replacement were similar in both groups. Therefore, and on account of the single daily administration, Embolex offers at least the advantage of improved compliance of the patients and reduced workload of the nursing staff.     

Thrombin-antithrombin III complexes in the prediction of deep vein thrombosis following total hip replacement

In 196 consecutive patients who underwent elective total hip surgery we investigated the diagnostic accuracy of the thrombin-antithrombin III complex immunoassay, as assessed on the first, fourth and tenth postoperative day, for the development of deep vein thrombosis (DVT). Patients received either LMW-heparinoid (n = 97) or placebo (n = 99) and underwent contrast venography on the tenth postoperative day. Thrombin-antithrombin III (T-AT) plasma levels were raised in all patients on the first postoperative day and gradually decreased during the study period. T-AT plasma levels were significantly higher in patients developing DVT when compared to patients without DVT and remained so until day 10. This difference was apparent both in the LMW-heparinoid group as well as in the placebo-treated patients. ROC-curve analysis revealed no satisfactory discriminative power for the diagnosis of developing DVT at any of the studied cut-off values for T-AT. We conclude that the postoperative determination of T-AT complex plasma concentrations in hip surgery patients has no clinical utility in the prediction of postoperative DVT.     

An attempt at predicting postoperative deep vein thrombosis by preoperative coagulation studies in patients undergoing total hip replacement

Preoperative levels of fibrinogen, factors V, VII, VIII and antithrombin III were measured in 25 consecutive patients undergoing total hip replacement. Deep vein thrombosis (D.V.T.) was detected by fibrinogen-uptake test in 60% of the patients. The preoperative fibrinogen level was significantly higher (p < 0.05), and serum antithrombin III was markedly lower (p less than or equal to 0.1) in patients with postoperative D.V.T. The quotient of fibrinogen to serum antithrombin III was significantly higher (p < 0.01) in patients with D.V.T. This quotient may serve as an additional parameter to other clinical and laboratory tests in prediction of postoperative D.V.T. following hip surgery.     

Prevention of deep vein thrombosis following total hip replacement by low molecular weight heparinoid.

We assessed the safety and efficacy of the novel low molecular weight heparinoid Lomoparan (Org 10172) for the prevention of deep-vein thrombosis in patients undergoing elective total hip replacement in a randomized, placebo-controlled, double-blind trial in 197 consecutive patients. The heparinoid (750 anti-factor Xa-units, s.c., b.i.d.) was administered to 97 patients and 99 patients received placebo. Study medication was started preoperatively and continued for 10 days. Efficacy was assessed by bilateral phlebography at day 10, postoperatively. The incidence of deep-vein thrombosis was 56.6% and 15.5% respectively in the placebo and heparinoid treated patients (incidence reduction: 74%; P less than 0.001). This reduction was observed both for proximal-vein thrombosis (25% to 8%; P less than 0.005) and isolated calf-vein thrombosis (31% to 7%; P less than 0.001). No major hemorrhage was observed. The number of red-cell units transfused and drain-fluid loss were comparable for the two study groups. Six patients in the heparinoid group and none in the control group developed minor wound hematomas (P less than 0.05). During an 8-week post-discharge follow-up period three patients with a normal venogram at day 10 developed clinically apparent venous thromboembolism, which was confirmed by objective testing. All three patients belonged to the heparinoid-treated group. We conclude that 750 anti-factor Xa units Org 10172 s.c. twice daily starting preoperatively is safe and effectively reduces early deep-vein thrombosis following elective total hip replacement. Further studies on the incidence of post-discharge thromboembolism are required.