妊娠期妇女血浆纤维蛋白原生成和降解水平变化

目的:分析正常妊娠期妇女凝血以及纤维蛋白原生成和降解指标的变化特征,初步探讨孕妇妊娠期间的出凝血动态变化.方法:正常妊娠并顺利分娩的孕妇96例,序贯观察她们整个孕期和产后4-9周的活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白(Fg)含量、纤维蛋白(原)降解产物(FDP)含量以及F...     

透析对尿毒症患者凝血系统的影响

目的观察尿毒症透析前患者组、血透（HD）组、腹透（CAPD）组凝血、纤溶功能的变化。方法采用ELISA法检测患者血浆TAT、D-二聚体水平,同时检测患者常规凝血项目（PT、APTT、TT、Fbg）。结果尿毒症患者透析前后TAT、D-二聚体水平均升高,以CAPD组升高尤为明显,患者透析前TT、APTT缩短,透析后APTT情况有所好转。结论尿毒症患者体内存在高凝继发高纤的状态,透析尤其是腹膜透析可加剧这种紊乱。TAT、D-二聚体的测定较常规凝血检查能更准确反映患者体内凝血、纤溶状态。     

原位肝移植患者术时止凝血变化的初步临床研究

研究原位肝移植术中的出血与全身止血凝血改变的关系。方法:本文对一例肝豆状核变性患者原位肝移植手术中凝血、抗凝及纤溶系统的功能进行了系统的观察。结果:发现在移植术中凝血抗凝系统的功能逐渐降低,在无肝期及重新灌注早期达最低点,随后逐渐恢复,而纤溶系统的功能随手术的进行而逐步增强,在无肝期及重新灌注期达最高峰。结论:原位肝移植术中的出血是综合因素引起的,手术各阶段的出凝血变化有其本身的特点。     

腹腔镜子宫切除术应用全麻复合硬膜外麻醉对患者应激反应及纤溶功能的影响

目的探讨全麻复合硬膜外麻醉对腹腔镜下子宫切除术患者应激反应及纤溶功能的影响。方法110例择期行腹腔镜下子宫切除术的患者随机分为A、B两组,A组采用全麻复合硬膜外麻醉,B组采用单纯全麻。结果两组麻醉5min的AD、NA及血糖水平较麻醉前下降,术毕则显著升高,术毕及术后24hB组的AD、NA及血糖水平均显著高于A组（P〈0．05）。两组不同时点的各组DD、PAI-1及t—PA水平之间差异有统计学意义（P〈0．05）,麻醉5min、术毕及术后24hB组的DD、PAI-1及t—PA水平均显著高于A组（P〈0．01）。结论全麻复合硬膜外麻醉更有效地抑制腹腔镜下子宫切除术患者的应激反应及纤溶亢进,有利于降低并发症的发生,是较为理想的腹腔镜手术麻醉方法。     

Hypercoagulability in Cushing’s syndrome: the role of specific haemostatic and fibrinolytic markers

Objective Hypercoagulability is a commonly described complication in patients with Cushing’s syndrome. Recent clinical studies have indicated various abnormalities of coagulation and fibrinolysis parameters which may be related to that phenomenon. The aim of this study was to investigate the mechanisms underlying the hypercoagulable state in patients with Cushing’s syndrome. Research methods and procedures A wide range of serum markers involved in the processes of blood coagulation and fibrinolysis was measured in a group of 33 patients with Cushing’s syndrome and 31 healthy controls. No participant was taking medication which could influence the result or had known diseases, except hypertension and diabetes, which could affect blood coagulation or fibrinolysis parameters. Results Patients with Cushing’s syndrome had higher levels of clotting factors II (P = 0.003), V (P < 0.001), VIII (P < 0.001), IX (P < 0.001), XI (P < 0.001) and XII (P = 0.019), protein C (P < 0.001), protein S (P < 0.001), C1-inhibitor (P < 0.001) and plasminogen activator inhibitor-1 (PAI-1) (P = 0.004). The activity of fibrinolytic markers, plasminogen (P < 0.001), antithrombin (P < 0.001) and antithrombin antigen (P = 0.001) was also increased in the patient group. Conclusion The study has demonstrated hypercoagulability in patients with Cushing’s syndrome manifest as increased prothrombotic activity and compensatory activation of the fibrinolytic system. We propose the introduction of thromboprophylaxis in the preoperative and early postoperative periods, combined with a close follow-up in order to prevent possible thromboembolic events in patients with Cushing’s syndrome.     

安宫牛黄丸及类方预处理对兔心肌缺血及再灌注损伤保护的作用研究

目的安宫牛黄丸及类方预处理对兔心肌缺血再灌注损伤的保护作用及机制。方法将新西兰兔24只建成心肌缺血再灌注模型,并随机分为空白对照组(n=8),醒脑静预处理组(n=8),安宫牛黄丸预处理组(n=8)。空白对照组,安宫牛黄丸组,醒脑静组在缺血前1h分别灌服生理盐水10ml/只;灌服安宫牛黄丸150mg/kg。静推1ml/kg醒脑静注射液。实验中检测组织型纤溶酶原激活剂(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1)、肿瘤坏死因子(TNF)、D-二聚体(D-dimer)、肌酸激酶(CK)的变化,再灌注后用伊文蓝和TTC染色法确定缺血损伤范围,及光镜下作心肌组织病理变化积分比较。结果醒脑静组和安宫牛黄丸组与空白对照组相比较缺血损伤后CK、TNF-α及PAI-1的血浆水平显著地降低(p<0.01);t-PA血浆水平和血浆D-二聚体上升副度显著地增加(p<0.05、p<0.01);醒脑静组和安宫牛黄丸组相比无明显差异;两组与空白对照组比较心肌组织病理变化总积分均值比较显著减少(p<0.01),心肌缺血损伤范围著显减少(p<0.05),醒脑静组和安宫牛黄丸组相比无明显差异。结论安宫牛黄丸及类方醒脑静预处理对兔心缺血再灌注损伤有明显的保护作用,其机制之一与安宫牛黄丸及类方醒脑静抑制炎症介质及促进纤溶作用有关。     

兔常温体外循环中大剂量乌司他丁对凝血和纤溶系统的影响

目的观察兔常温体外循环（extracorporeal circulation，ECC）前应用大剂量乌司他丁对凝血和纤溶系统的影响。方法20只大耳白兔随机分成2组：乌司他丁组（U组，n=10）和对照组（C组，n=10）。建立兔常温ECC模型，U组在ECC前给予乌司他丁10×10^4U／kg，C组给予等量生理盐水。ECC转机30min，流量为180～300ml／min，肛温维持在36．5℃-37．5℃。分别记录ECC前、停机、停机后1h、2h和3h的血流动力学指标，测定活化部分凝血激酶时间（Am）、凝血酶原时间（PT）、纤维蛋白原（FIB）和D二聚体（D—D）。结果两组PTECC后均较ECC前显著延长（P〈0．05），两组间胛在停机后3h时有统计学差别，C组长于U组（P〈0．05）。两组APTT ECC后也均较ECC前显著延长（P〈0．01），同时间点U组APTT较C组延长更为明显（P〈0．05）。两组血浆FIB含量ECC后均较ECC前显著降低（P〈0．01），同时间点C组较U组下降更明显（P〈0．05）。ECC后两组血浆D—D浓度较ECC前显著升高（P〈0．05），同时间点C组D—D浓度升高较U组更为显著（P〈0．05）。结论ECC后凝血因子消耗使APTr和Prr延长，纤溶亢进使血浆FIB含量下降，DD浓度升高。ECC前应用大剂量乌司他丁可减少ECC中凝血因子的消耗，抑制纤溶系统的过度激活，改善ECC术后凝血功能。提示ECC前应用大剂量乌司他丁具有血液保护功能。     

恶性疾病患者凝血纤溶分子标志物的研究

目的：测定恶性疾病患者凝血纤溶分子标志物,观察急性白血病、淋巴瘤、实体瘤三种恶性疾病凝血、纤溶系统改变的临床意义。方法：选择同期恶性肿瘤47例,其中急性白血病患者27例（其中初治21例和复发组6例）,淋巴瘤患者10例;实体瘤患者10例;对照组为30例健康人。取空腹外周静脉血,3.8%枸橼酸钠抗凝,采用酶联免疫双抗体夹心法测定血浆组织因子（TF）、血浆凝血酶-抗凝血酶复合物（TAT）、血浆组织型纤溶酶原激活物（t-PA）、血浆纤溶酶原激活物抑制物（PAI-1）。结果：急性白血病、淋巴瘤、实体瘤三组的TF值均高于对照组,有统计学意义,淋巴瘤组的TF值高于急性白血病组,差异有显著性统计学意义;急性白血病组、淋巴瘤组、实体瘤组的TAT高于对照组,并达到统计学意义;急性白血病、淋巴瘤、实体瘤三组的t-PA值均高于对照组,有显著统计学意义;实体瘤组t-PA值高于急性白血病组;急性白血病组及实体瘤PAI-1均高于对照组,有统计学意义。结论：急性白血病、淋巴瘤、实体瘤存在相似的凝血和纤溶异常。     

Preserved endothelial vasomotion and fibrinolytic function in patients with acute stent thrombosis or in-stent restenosis

Introduction: Acute stent thrombosis and in-stent restenosis are serious complications of percutaneous coronary intervention (PCI) and may be associated with vascular or platelet abnormalities. We aimed to assess endothelium-dependent vasomotion, endogenous fibrinolysis and platelet function in patients with acute stent thrombosis or in-stent restenosis. Materials and methods: Thirty-six subjects were enrolled into four groups: acute stent thrombosis, in-stent restenosis, uncomplicated PCI with stent implantation and healthy matched controls. Forearm blood flow was measured using bilateral venous occlusion plethysmography during intra-brachial acetylcholine, substance P and sodium nitroprusside infusion. Venous blood samples were withdrawn for estimation of plasma fibrinolytic variables and platelet aggregometry. Results: Acetylcholine, substance P and sodium nitroprusside caused dose-dependent increases in blood flow (P<0.001) and substance P caused a dose-dependent increase in tissue-type plasminogen activator (t-PA) release (P<0.001) in all groups. Thrombin, collagen, adenosine diphosphate (ADP) and the thromboxane A2 analogue, U46619, caused dose-dependent platelet aggregation (P<0.001) in all groups. There were no significant between group differences in these responses except that, in keeping with aspirin therapy, collagen-induced platelet aggregation was impaired in patient groups compared with healthy controls (P<0.01). Post-hoc analysis demonstrated a significant impairment of acute t-PA release in current smokers compared to non-smokers (P<0.05). Conclusions: Despite previous reports suggesting impaired vascular function, endothelium-dependent vasomotion, endogenous fibrinolysis and platelet aggregation do not appear to play a major role in the pathogenesis of acute stent thrombosis or in-stent restenosis.