静脉输液加药后的微粒变化

本文对我院急诊病人常用的供静脉给药的22种药物、42组配伍情况,制成静脉加药输液,在超净工作台条件下,用KF—4型微粒计数器,测定了168次微粒数,结果显示输液加药后微粒虽有增加,但均在药典规定范围内。输液中加1种、2种、3种药物后所产生的微粒数分别为x_1=5.52(n_1=16);x_2=8.17(n_2=18)、x_3=10.25(n_3=8),经统计处理,三组间无显著差异(P<0.05)。本文对产生微粒的药物、注射器、操作环境等因素进行了分析。     

Utilization of recombinant activated factor VII in southern Ontario in 85 patients with and without haemophilia

Recombinant activated factor VII (rFVIIa) is licensed for the treatment of bleeding in individuals with haemophilia and inhibitors. The use of rFVIIa appears to be increasing, and an increase in unlicensed use is suspected. There are currently few data about the specific indications for its use. The aim of this study was to describe the patterns of utilization of rFVIIa. We performed a retrospective cohort study using rFVIIa infusion data collected prospectively and clinical data collected retrospectively. Patients were identified using a tracking system designed to account for use of all coagulation factor concentrates issued in southern Ontario. Between 1 January 2001 and 31 December 2005, 85 patients received rFVIIa. 1164 infusions were given (8246.4 mg). Haemophilia patients with inhibitors accounted for 82.9% of rFVIIa infused and represented 8.2% of patients. The total amount of rFVIIa used increased each year from 2001 to 2004 and then decreased in 2005. The total number of infusions of rFVIIa administered annually increased. Both on-label and off-label use of rFVIIa increased. The number of patients with haemophilia receiving rFVIIa remained small and constant. The number of patients receiving rFVIIa for off-label indications increased markedly. Most rFVIIa infusions were given for licensed indications; however, these infusions represented <10% of patients treated. Overall, the utilization of rFVIIa is increasing, mostly for approved indications; however, the number of patients being prescribed rFVIIa for off-label indications has increased. The tracking system used in this study is a valuable tool to describe ongoing utilization patterns of rFVIIa.     

去除白细胞输血的临床意义

目的:评估去除白细胞输血的临床应用价值。方法:251例患者接受了去除白细胞红细胞悬液761U,(每人1￣8U不等),对其中200U红细胞悬液滤除白细胞前、后分别进行白细胞计数和血红蛋白测定,并对其输血反应进行了观察。结果:发现应用白细胞滤器后,其白细胞数比过滤前显著减低,过滤前、后白细胞数分别为(6.16±1.44)×109/L与(0.12±0.10)×109/L(P<0.01),血红蛋白过滤前、后无显著性差异,分别为:(161.58±23.31)g/L与(157.84±22.35)g/L,P>0.05。251例接受去白细胞受血者均未出现输血反应。结论:白细胞滤器能有效去除白细胞,去除白细胞能减少非溶血性输血反应。     

The current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery

Objective: We assessed the current role of preoperative and intraoperative autologous blood donation in pediatric open-heart surgery. Methods: Group 1 consisted of 51 patients between 5 and 10 years old who underwent preoperative autologous blood donation. Group 2 consisted of 50 age-matched patients without preoperative donation as controls. Intraoperative donation was conducted in both groups prior to cardiopulmonary bypass. We evaluated perioperative blood cell count, blood loss, and the need for homologous blood products. Results: No serious complications occurred in preoperative or intraoperative donation. Total preoperative donation storage was 17.5±3.4 mL/kg. Intraoperative donation was 21.7 ±6.1 mL/kg in Group 1 and 12.8±4.0 mL/kg in Group 2 (p<0.001). On admission, serum hemoglobin was lower in Group 1 (12.2±1.0 g/dL versus 13.6±1.6 g/dL, p<0.001) but returned postoperatively to the preoperative value. It hovered at a depressed level in Group 2 (12.2±1.4 versus 10.2±1.1 g/dL, p<0.001). The homologous blood requirement was significantly less in Group 1 than in Group 2 (0% versus 10%, p<0.05). Postoperative platelet counts showed similar curves, and blood loss was not statistically significantly different between groups. Conclusion: Preoperative and intraoperative donations are safe and continue to contribute uniquely to blood conservation, providing important options in comprehensive blood conservation programs in current pediatric open-heart surgery.     

静脉药物配置中心的建立在临床中的应用

静脉输液药物集中配置、管理是我国医院管理的一项新举措.长期以来,临床静脉输液中的加药工作一直是由护士在治疗室独立完成,这种方式存在着很多不足之处.在这种环境污染下,职业健康安全管理越来越受到各国政府的重视.为了提高服务质量,预防和控制可能存在的环境污染及职业健康安全风险,国家颁布 GB/T24001～ 1996<环境管理体系规范和使用指南>, GB/T28001-2001<职业健康安全管理体系规范>标准,引进国外的先进管理模式,此项工作由药师和护士共同完成,以期达到合理用药减少药物的流失和浪费,科学配置、降低输液反应.静脉药物配置中心把静脉药物配置从普通环境的治疗室转为在具有洁净条件的配置中心进行集中管理配置,保证配置出来的药品安全无菌、有效.需要输液的患者在舒适、整洁和安静的环境下进行输液,减少临床护理工作量的目的,把更多的时间还给病人.这为顺利实施静脉配置中心的项目提供了保障,确保了输液中心正常运行.     

Pretransplant Exposure to Donor HLA-DR Antigen in Random Transfusion Units and the Development of Donor Antigen-Specific Hyporeactivity

Our previous studies have shown that the in vitro assay of donor antigen-specific hyporeactivity is a useful marker for identifying solid organ transplant recipients (kidney, lung and heart) at low risk for immunologic complications (i.e., late acute rejection episodes and chronic rejection). Donor antigen-specific hyporeactivity is defined as a significantly decreased post- vs. pretransplant proliferative response to donor antigens while response to third-party controls remains unchanged. We analyzed whether exposure to the same HLA-DR antigen pretransplant via random blood transfusion and posttransplant via the transplanted organ influenced the development of hyporeactivity. Thirty previously nontransfused recipients, each receiving two 150 ml pretransplant random blood transfusions, were assessed for hyporeactivity at 1 year posttransplant. Of the 12 recipients with pretransplant exposure to kidney HLA-DR via transfusions, 6 (50%) developed hyporesponsiveness; in contrast, of the 18 recipients who were not preexposed, only 3 (15%) exhibited this form of immunomodulation. Of interest, 2 of the 3 hyporesponsive recipients who were not preexposed, received units containing HLA-DR antigens previously shown to share crossreactive epitopes with the kidney HLA-DR. In conclusion, these results suggest a increased incidence in the development of hyporeactivity in patients receiving pretransplant transfusions which share an HLA-DR antigen with the transplanted kidney.     

ACARDIAC TWIN FETUS WITH SEVERE HYDROPS FETALIS AND BILATERAL TALIPES VARUS DEFORMITY

Twin reversed-arterial-perfusion syndrome (TRAPS) is a rare complication of monochorionic twin pregnancies. TRAPS is characterized by the hemodynamic dependence of a “recipient” twin from a “pump” twin. The “recipient” twin exhibits lethal abnormalities, such as acardia and acephaly. Circulatory failure of the normal twin derives from the existence of arterio-arterial and veno-venous anastomoses within the placenta that allow retrograde perfusion of the acardiac twin by blood coming from the normal twin. Acardiac twinning is the most extreme manifestation of the twin-twin transfusion syndrome. This occurs in 1 in 100 monozygotic twin pregnancies and 1 in 35,000 births. We report a case of diamnionic monochorionic female twins in which the acardiac twin demonstrated severe hydrops fetalis and bilateral talipes varus deformity. Cesarean section was performed on a 27-year-old hypertensive gravida 2, para 1 mother for fetal indications at 32 6/7 weeks gestation. The acardiac fetus had a two-vessel umbilical cord measuring 43.5 cm in length and 0.8 cm in diameter. The proximal end inserted into the root of the normal twin's umbilical cord in an acute angle forming a “v” close to the placental disc. Structures rostral to the thorax were absent except for a round mass of flesh with three small buds in place of the head and neck, and bilateral upper extremities. Only the kidneys, right adrenal, small and large intestine, and rudimentary urinary bladder were present. Both feet demonstrated talipes varus deformity. The fetus was severely hydropic. The subcutaneous fat measured 4.5 cm in maximum thickness. The normal twin had a protracted course complicated with respiratory distress syndrome, moderate secundum atrial septal defect with left to right shunt, and thrombocytopenia of prematurity. The baby was eventually discharged after approximately 1 month. At the time of this report, 5 months postpartum, the neonate is growing and developing normally. To our knowledge, this is the first report of severe hydrops fetalis and talipes varus deformity in an acardiac twin.     

Legionnaires' Disease in Leukaemic Reticuloendotheliosis

At our hospital 15 cases of leukaemic reticuloendotheliosis and 4 cases of Legionnaires' disease have been diagnosed. 3 patients had both diseases. The clinical findings are reported. It is probable that patients with leukaemic reticuloendotheliosis have an increased susceptibility to Legionnaires' disease. Possible reasons for the decreased resistance are discussed.