尿激酶溶栓疗法对脑梗死患者血液流变学的影响

目的探讨尿激酶溶栓疗法治疗急性脑梗死时血液流变学的变化.方法对42例急性脑梗死患者进行尿激酶7日溶栓疗法,于溶栓前、溶栓后第3～4d及第7～8d分别检测血液流变学指标.结果急性脑梗死患者血液流变学指标明显高于正常人.除HCT外,溶栓后第3～4d及第7～8d血液流变学其他指标均明显低于溶栓前,两者相比有显著性差异(p<0.05或p<0.01).结论尿激酶7日溶栓疗法能有效地改善急性脑梗死患者血液流变学指标的异常现象.     

急性心肌梗死重组链激酶早期溶栓的血液流变性研究

目的 :观察急性心肌梗死重组链激酶早期静脉溶栓前后的血液流变性变化。方法 :对 36例患者分别于溶栓开始前、溶栓治疗后 3h采血进行血液流变学检查。结果 :急性心肌梗死患者溶栓前各项血液流变学指标均明显异常。溶栓 3h后各项血液流变指标明显改善 ,尤以纤维蛋白原、血小板聚集率、凝血酶原时间、红细胞刚性指数为著。结论 :重组链激酶能明显改善急性心肌梗死血液流变学各项异常指标 ,对缩小梗死面积 ,恢复心肌灌注 ,减少并发症 ,防止梗死后心绞痛及再梗死的发生 ,改善预后具有十分重要的作用。     

急性心肌梗死血液流变学障碍及尿激酶的溶栓治疗作用

目的观察尿激酶溶栓治疗急性心肌梗死（ＡＭＩ）的疗效及血液流变学中的纤维蛋白原、红细胞压积、血沉的变化、方法 按ＷＨＯ诊断ＡＭＩ的标准选择病例,采用１９９２年全国统一的溶栓方案治疗,同时检测溶栓前后血液流变学中的红细胞压积、纤维蛋白原、血沉等指标,并与溶栓结果对比分析。结果溶栓后ＡＭＩ患者再通车７８．６％;患者的纤维蛋白原、红细胞压积及血沉等明显低于溶栓前,统计学处理差异非常显著,Ｐ＜０．００１。结论ＡＭＩ患者存在血液流变学障碍,尿激酶可以改善血流变学异常,尿激酶溶栓治疗对ＡＭＩ效果肯定。     

急性缺血性脑梗死的溶栓治疗

目的 评价缺血性脑梗死急性期溶栓治疗的疗效。方法 98例急性缺血性脑梗死患者，病程为2-7h。行脑血管造影明确栓塞血管及部位。尿激酶以1万U／min持续泵入，总量为100万u，辅助其它常规治疗。治疗14d后评价其临床疗效。结果 基本痊愈14例，显著进步30例、进步39例、无变化11例、死亡4例。有效率为84．7％。显效率为44．8％，血管再通率为73．5％，治疗后神经功能缺损评分较前显著降低（P〈0．01）。结论 急性缺血性脑梗死的溶栓治疗是一种安全有效的方法，可明显改善患者的生存质量。     

多模式CT指导下的急性脑梗死rt-PA静脉溶栓初步研究

目的探讨多模式CT指导下rt—PA静脉溶栓治疗急性脑梗死的疗效与安全性。方法选择16例符合美国国立神经疾病与卒中研究院溶栓试验（NINDS）标准的急性脑梗死患者行多模式CT检查,对符合溶栓标准的8例患者给予重组组织型纤溶酶原激活物（rt-PA）0．9mg／kg溶栓治疗,比较治疗前和治疗后24h、7d、30d的美国卫生研究院卒中量表（NIHSS）评分及生活质量评分（Barthel）指数。结果治疗前NIHSS评分为（12.8±5．33）,治疗后24h、7d、30d的NIHSS评分分别为（10．01±6．69）（6．77±3．56）、（4．12±3．09）,治疗前和治疗后7d、30d比较差异有统计学意义（P〈0．05）;治疗前生活质量评分（Barthel）指数为（20．63±8．67）,治疗后24h、7d、30dBarthel指数分别为（22．77±8．96）、（45．78±23．89）、（59．45±31．03）,治疗前和治疗后7d、30d比较差异有统计学意义（P〈0．05）。1例因再梗塞死亡。结论多模式CT指导下的急性脑梗死早期rt—PA静脉溶栓治疗是有效和安全的,有助于减少症状性颅内出血风险,使更多的患者从溶栓治疗中获益。     

风心病患者围体外循环期及术后血液流变学动态观察

目的 研究风心病患者围体外循环手术前后血液流变学指标的变化。方法 检测在体外循环下进行心脏手术的风心病患者术前、术中30min、以及术后1、3、5、7d的血液流变学指标，并以术前检测指标为对照进行配对t检验，观察血液流变学指标在围体外手术前后的动态变化。结果 血液流变学指标在手术中及术后7d内有不同程度的变化，各项指标基本均在术后第3d变化最为显著，至第7d基本恢复。结论 体外循环手术对患者血液流变性有一定的伤害，这种伤害在术后第3d表现最为显著，至术后第7d基本上恢复。体外循环术中的血液流变学检测有利于了解手术患者的血流动力学情况。     

断指再植患者血液流变性的变化

目的探讨断指再植患者血液流变学变化的特点及规律.方法对42例患者分别于手术前、术后0.5、2、6、24、48、72 h,7、14 d检测血液流变学指标,另外取30名健康成人作为对照组进行对比分析.结果手术前至术后72 h断指患者血液流变学等各项指标均明显高于正常(P＜0.01,P＜0.05),第72 h各项指标基本恢复正常(P＞0.05).结论血液流变学指标检测对防治血管危象的发生,提高断指再植成活率有一定指导意义.     

中药三联治疗对急性脑梗死患者血液流变性的影响

目的:观察中药三联疗法对急性脑梗死患者血液流变性的影响。方法:140例急性脑梗死患者随机分为中药三联治疗组(80例)和西药对照治疗组(60例)。三联治疗组采用中药内服,中药直肠灌注和静脉滴注香丹注射液治疗。对照组用低分子右旋精酐+香丹注射液及胞磷胆碱静滴。于治疗前后抽血检查血流变指标,比较各组治疗前后及两组间治疗前后的差异。结果:治疗21天后,治疗组各项血液流变学指标与治疗前比较均有改善,差异有极显著性统计学意义(P<0.01);对照组仅纤维蛋白原和血浆粘度有显著改善(P<0.05)。治疗后两组各项血液流变学指标均呈下降趋势,治疗组下降程度较对照组更显著,治疗后治疗组全血低切粘度比对照组降低更明显(P<0.05)。结论:中药三联疗法能明显改善急性脑梗死患者的血液流变性。     

不同剂量尿激酶静脉溶栓治疗急性心肌梗塞及对血液流变的影响

目的评价不同剂量尿激酶静脉溶栓治疗急性心肌梗塞（ＡＭＩ）的疗效和安全性,了解不同剂量尿激酶对血液流变学指标的影响。方法５８例ＡＭＩ病人,随机分为两组：大、中剂量组分别静脉滴注尿激酶（ＵＫ）１００～１２０万Ｕ、２５～４５万Ｕ。用药后根据临床血管再通指标判断冠脉再通率,进行疗效评价并对比观察治疗前后血液流变学指标的变化。结果冠脉再通率;大剂量组６４．３％（１８／２８）;中等剂量组为２０.０％（６／３０）。两组均未发生严重出血症状。溶栓后全血比粘度、血浆比粘度明显下降,而血小板聚集率及红细胞压积（％）没有明显变化。结论大剂量尿激酶可显著改变血液流变学状态,而这种改变将有利于治疗ＡＭＩ。ＡＭＩ早期采用大剂量尿激酶静脉溶栓是安全有效的。     

尿激酶溶栓治疗急性心肌梗死65例临床观察

目的 观察尿激酶溶栓治疗急性心肌梗死的临床疗效.方法 确诊后立即给予尿激酶150万U溶于100mL的生理盐水中,在30min内静脉滴入.溶栓治疗开始前口服阿司匹林300mg,以后150 mg/d,连服2周,再改75 mg/d维持.滴入尿激酶后每隔12h皮下注射低分子肝素5000U一次,2次/d,共3d.结果 65例患者治疗120min内血管再通47例,再通率72.3%.出现心源性休克4例,心力衰竭8例,皮肤粘膜散在出血点及注射部位皮下瘀斑3例,牙龈出血2例,鼻衄1例,无过敏反应和危及生命的大出血,死亡2例.结论 尿激酶溶栓治疗急性心肌梗死疗效果显著,操作方便、价格便宜、值得在基层医院临床推广.     

Comparison of hprt variant frequencies and chromosome aberration frequencies in lymphocytes from radiotherapy and chemotherapy patients: a prospective study

The autoradiographic 6-thioguanine-resistant mutant lymphocyte assay and a chromosome aberration assay were used to determine the time-course of appearance and persistence of elevated frequencies of hprt variants and dicentric chromosomes in patients receiving x-irradiation therapy. Twelve cancer patients, treated with 180-200 cGy/day, 5 days/wk, for 3-7 wk, were studied before treatment, at various weekly intervals during treatment, and after treatment. The hprt mutation assays were done with frozen/thawed lymphocytes isolated from aliquots of the same blood samples used for the chromosome aberration assays. The hprt variant frequencies (Vfs) of only 4 of the 7 patients assayed at 2 wk of treatment were elevated over pre-treatment Vfs, but during the 3rd and 4th weeks of treatment there were significant (P less than 0.01) 5- to 15-fold increases in all Vfs. By 6-32 wk after treatment Vfs had fallen to levels only slightly higher than the mean pre-treatment Vf. The frequencies of cells with dicentric chromosomes were significantly increased (P less than 0.01) after 1 wk of radiotherapy, continued to increase during therapy, and remained elevated after treatment. Five multiple sclerosis patients were also studied before and at 2 and 4 wk intervals after treatment with monthly i.v. doses of 750 mg/m2 of cyclophosphamide (CP). There were no significant elevations in chromosome aberrations at these post-treatment sample times. Previous assays for hprt mutants, done with aloquots of the same blood samples (Ammenheuser et al.: Mutat Res 204:509-520, 1988), had shown 8- to 20-fold increases in Vfs 2 wk after the 1st CP treatment. Our results demonstrate the complementary nature of these two human monitoring assays and emphasize the importance of careful selection of optimal sampling times.     

Thymosin Alpha 1 is Associated with Improved Cellular Immunity and Reduced Infection Rate in Severe Acute Pancreatitis Patients in a Double-Blind Randomized Control Study

The aim of this prospective, double-blinded pilot trial study was to evaluate the effects of Thymosin alpha 1 use in the early phase on immunomodulation and clinical outcomes in patients with severe acute pancreatitis (SAP). A total of 24 patients with SAP were randomized to receive either conventional therapy for SAP or immunomodulatory therapy (TA1 group). The patients in the thymosin group were injected with Talpha1 3.2 mg twice per day for 7 days. The serum level of HLA-DR and CD4/CD8 ratio and other immune parameters were measured on admission, the 8th day and the 28th day. There was a low expression of monocyte HLA-DR in both groups on admission, and more rapid alterations in the HLA-DR were found in the TA1 group. The positive rates of blood and abdominal drainage culture were statistically significant during the 28th follow-up period. The duration of ICU stay was shorter after TA1 treatment. Improves cell-induced immunity and reduces infection rate in severe acute pancreatitis patients.     

Erratum to: Thymosin Alpha 1 is Associated with Improved Cellular Immunity and Reduced Infection Rate in Severe Acute Pancreatitis Patients in a Double-Blind Randomized Control Study

The aim of this prospective, double-blinded pilot trial study was to evaluate the effects of Thymosin alpha 1 use in the early phase on immunomodulation and clinical outcomes in patients with severe acute pancreatitis (SAP). A total of 24 patients with SAP were randomized to receive either conventional therapy for SAP or immunomodulatory therapy (TA1 group). The patients in the thymosin group were injected with Talpha1 3.2 mg twice per day for 7 days. The serum level of HLA-DR and CD4/CD8 ratio and other immune parameters were measured on admission, the 8th day and the 28th day. There was a low expression of monocyte HLA-DR in both groups on admission, and more rapid alterations in the HLA-DR were found in the TA1 group. The positive rates of blood and abdominal drainage culture were statistically significant during the 28th follow-up period. The duration of ICU stay was shorter after TA1 treatment. Improves cell-induced immunity and reduces infection rate in severe acute pancreatitis patients.     

Modification of aerobic digestive flora in patients in intensive care during and after treatment with cefmenoxime

To evaluate the resistant strains selection during treatment with cefmenoxime, a 3rd generation cephalosporin, 10 adult inpatients of an intensive-care unit had quantitative stool cultures, before the treatment, on the 7-10th day of therapy, and 7-10 days after the end of the antibiotic course. The results show that the selecting effect of cefmenoxime is not different from the effect previously observed for cefotaxime.     

D-二聚体定量测定在AMI溶栓治疗监测中的应用

目的:观察急性心肌梗死(AMI)患者溶栓治疗前后D-二聚体含量的变化,探讨在AMI患者溶栓治治疗监测中的应用.方法:对46例AMI患者,测定在溶栓治疗前及治疗后1h、2h、4h、6h、8h、12h、24h、48h、72h、168h血浆D-二聚体的含量及正常对照组30例D-二聚体含量.结果:再通组与未通和未溶栓组比较,溶栓治疗前无显著差异(P＞0.05),溶栓治疗后再通组与其它两组有非常显著的差异(P＜0.01),于溶栓后6h达高峰.结论:D-二聚体定量测定在AMI溶栓治疗监测中,是一项非常有价值的指标,与溶栓治疗效果有密切相关性.     

心脏瓣膜病患者瓣膜置换术前后BNP浓度的变化

目的:观察心瓣膜置换术患者围手术期血浆B型钠尿肽(BNP)浓度的变化规律。方法:56例心瓣膜置换术患者按NYHA心功能标准分级,术前进行超声心动图检查,测量左室射血分数(LVEF),同时于术前、术后1天、3天、5天、7天、14天,分别测量血浆BNP浓度,分析术前BNP浓度与心功能的关系,以及围手术期BNP浓度变化趋势。结果:心瓣膜疾病患者术前心功能NYHA分级与BNP水平呈正相关(r=0.59,P<0.05)。术后BNP浓度急剧上升,24h达峰值(P<0.01)。术后3～7天明显下降,但仍略高于术前水平,术后14天明显下降且低于术前水平。结论:术前血浆BNP浓度与心功能状况明显相关,BNP浓度越高,心功能越差。术后早期BNP浓度快速升高,后期呈下降趋势。     

利培酮口服液合并氯硝西泮与氟哌啶醇肌注后换用利培酮口服液临床对照研究

目的比较利培酮口服液合并氯硝西泮片与氟哌啶醇肌注控制精神分裂症兴奋激越症状的疗效和安全性,以及在兴奋激越控制后以利培酮口服液替换氟哌啶醇肌注的疗效及安全性。方法纳入65例兴奋激越的精神分裂症患者:33例随机分入研究组,利培酮口服液(2～6m/d)合并氯硝西泮(2～4mg/d),第8天起氯硝西泮逐渐减量,共观察49d;32例分入对照组,前7天氟哌啶醇肌注(10～20mg/d),第8天起逐渐替换为利培酮口服液(2～6ml/d),共观察49d。以阳性与阴性症状量表(PANSS)及兴奋激越项目(PANSS-EC)和治疗中出现的症状量表(TESS)评定疗效和不良反应,分别在入组时及治疗第7天、第14天、第49天各评定1次。结果两组有效率比较无显著性差异(χ2=0.14,P>0.05)。治疗前后比较,两组PANSS总分从治疗第7天起下降有显著性差异(t=2.27,2.39;P均<0.05),从治疗第14天起下降有非常显著性差异(t=3.40,4.30;P均<0.01);两组PANSS-EC评分从治疗第7天起下降并有非常显著性差异(t=7.01,8.44;P均<0.01);两组治疗同期PANSS总分、PANSS-EC评分比较无显著性差异(t=0.49～1.82;P均>0.05)。研究组肌强直、震颤、静坐不能的发生率均明显低于对照组(χ2=5.63～10.46;P均<0.05)。结论利培酮口服液合并氯硝西泮可有效安全地治疗精神分裂症急性兴奋激越。用氟哌啶醇肌注控制兴奋激越后直接换用利培酮口服液,也能保持疗效。     

创伤性脑损伤后大鼠外周血CD8的变化

目的:探讨外周血CD8在创伤性脑损伤后的变化特点。方法:改良Feeney's自由落体打击法制备创伤性脑损伤模型;ELISA检测大鼠血清中神经元特异性烯醇化酶(NSE)和CD8的含量,双变量分析两者的相关性;Western blot法检测大鼠血液淋巴细胞FasL蛋白的表达。结果:颅脑外伤后大鼠血清CD8升高滞后于NSE。大鼠伤后1 d血清NSE水平即显著升高,伤后3 d达到峰值,随后逐渐下降;大鼠血清CD8在伤后3 d开始升高,峰值出现在伤后7 d,随后逐渐下降。统计分析显示伤后1 d、3 d、7 d的血清的NSE与伤后3 d、7 d、14 d的血清CD8含量变化呈现正相关。但伤后不同时间大鼠血液淋巴细胞FasL蛋白表达的差异均无统计学显著性。结论:创伤性脑损伤后释放入血的NSE刺激机体免疫应答,引起外周血CD8增多,推测其可能与创伤性脑损伤后继发性损伤的免疫应答有关。     

吗啡和电针对术后淋巴细胞增殖反应和T细胞亚群的影响

为了观察硬膜外吗啡和电针对术后病人免疫功能的影响，对１８例单纯胆囊切除术病人分别于术前和术后第１、３、７天检测淋巴细胞增殖反应和Ｔ细胞亚群的变化。结果表明硬膜外注入吗啡１ｍｇ在有效镇痛的同时却抑制了淋巴细胞增殖反应直至术后第７天，出现Ｔ细胞亚群中ＣＤ＾３＋，ＣＤ＾＋４表达下降。     

血清降钙素原测定在指导下呼吸道感染抗生素治疗的价值

目的:评价动态监测血清降钙素原(procalcitonin,PCT)在指导下呼吸道感染抗菌治疗中的临床价值。方法:选取90例医院获得性下呼吸道感染患者,根据应用抗生素的最终临床指标分为对抗生素治疗有效组(A组)和对抗生素治疗无效组(B组),观察确诊感染后第1、3、5、7d两组患者的血清PCT水平变化,并采用ROC曲线下面积观察PCT评估抗菌疗效的价值。结果:两组患者确诊感染后的第1d血清PCT水平比较无明显差异(P>0.05);而第3、5、7d A组患者血清PCT水平逐渐下降,而B组患者PCT水平则明显升高,两组比较有统计学差异(P<0.05)。第1、3、5、7d PCT水平指示抗菌无效的ROC曲线下面积分别为0.447、0.716、0.981、1.000,其中第3、5、7d PCT的ROC曲线下面积与第1d PCT的ROC曲线下面积比较差异均有显著性(P<0.05);抗生素治疗第5d,以PCT水平3.095μg/L为截点,判断抗生素治疗无效的灵敏度和特异性分别为97.4%和91.0%。结论:在医院获得性下呼吸道感染抗菌治疗过程中,动态监测PCT水平可作为优化抗生素治疗的有效指标。