不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

颅内静脉窦血栓形成的CT诊断

颅内静脉窦血栓形成是一种特殊的脑血管疾病,常发生于感染后,分娩期和消耗疾病中,临床表现复杂多样而无特异性,常病情危重,病死率高,早期对病人局部溶栓等治疗效果明显。本文收集14例颅内静脉窦血栓形成的CT表现作回顾性分析,用以提高对颅内静脉窦血栓形成的CT影像特征的认识。1 临床资料 女性11例,男性3例,年龄19～52岁,平均32岁。其中10例为上矢状窦血栓,4例为乙状窦血栓。临床表现轻重不一,单纯头痛1例,其它所有患者起病时均表现头疼、呕吐,视乳头水肿的颅内高压症状,同时伴意识不清4例,单侧肢瘫5例,癫痫4例,14例中,1例经手术证实,5例DSA血管造影证实,8例经影像和临床随访证实。     

关于举办暴发性肝衰竭诊断治疗及肝移植新进展新技术学术班的通知

针对乙型肝炎病毒携带者病情突然恶化导致的重型肝炎以及因药物所致的暴发性肝衰竭增加的趋势，为提高广大医务工作者对于重型肝炎的早期诊断和合理治疗水平，首都医科大学附属北京佑安医院、医药世界杂志社、华西医学继续教育中心联合主办，中华医学会北京分会协办，于2005年8月在四川省成都市举办“暴发性肝衰竭诊断治疗及肝移植新进展新技术学术班”。学术班具体事项通知如下：     

静脉血栓栓塞的基础与临床实践(3)--诊断策略与程序

急性静脉血栓栓塞(VTE)为一常见且潜在高度死亡危险的疾病.     

汤坤标治疗下肢深静脉血栓形成经验

汤坤标主任中医师,业医30余载,学验俱丰,临床擅长外科.笔者现将其治疗下肢深静脉血栓形成的经验介绍如下.     

血小板功能与心脑血管病

血小板作为血液的一种有形成分，在生理的止血和病理的血栓形成过程中，扮演了一个非常重要的角色。现代科学研究表明，除了通常的血液疾病外，血小板在动脉血栓栓塞、冠心病、脑血管病、高血压和糖尿病等疾病的发病和防治中起重要作用。     

下肢深静脉血栓形成25例临床分析

目的 探讨下肢深静脉血栓形成的溶栓治疗效果。方法 用尿激酶溶栓。低分子量肝素抗凝，低分子右旋糖酐祛聚疗法。治疗下肢深静脉血栓形成25例。结果 随访6个月，临床治愈18例，治愈率72%；显效5例，显效率20%，有效2例，有效率8%。结论 非手术溶栓治疗下肢溶静脉血栓形成，早发现早溶栓治疗效果较好。     

急性心肌梗死并发脑梗死10例报告

心脑血管疾病已成为目前威胁人类生命与健康的主要疾病。近年来 ,急性心肌梗死 (AMI)并发脑梗死患者增多 ,已引起人们的高度重视 ,1996年 4月～ 2 0 0 0年 4月 ,我院收治AMI并发脑梗死 10例 ,报告如下。1　临床资料　　本组 AMI患者 2 6 6例 ,其中并发脑梗死 10例 (3.76 % )。AMI均按 WHO标准确诊 ,脑梗死的诊断均根据 1986年第二届全国脑血管学术会议制定的标准。所有患者均以颅脑CT诊断为依据。10例中 ,男 7例 ,女 3例 ,男女比为 2 .3:1。年龄 45～ 78岁 ,平均 6 1.5岁。发病时呈典型心肌梗死表现者 6例 ;以头晕 ,意识丧失 ,一过性…