基于DIC评分早期分层抗凝对改善脓毒症预后的有效性和安全性研究

目的探讨基于弥散性血管内凝血(DIC)评分早期分层抗凝对改善脓毒症预后的有效性和安全性。 方法选取脓毒症患者265例,根据DIC和SIC评分分组,将患者分为DIC组84例、脓毒症凝血病(SIC)组92例和对照组84例(正常凝血状态)。其中DIC组给予常规剂量低分子肝素抗凝治疗,SIC组给予半量低分子肝素治疗,对照组不给予抗凝等治疗。 结果DIC组ICU住院时间、呼吸机使用时间和总住院时间较对照组延长(P＜0.05);28天病死率比较,DIC组、SIC组和对照组差异无统计学意义(P＞0.05)。DIC组、SIC组治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和D二聚体(D-Dimer,D-D)低于治疗前,且DIC组高于SIC和对照组(P＜0.05),而血小板和纤维蛋白原(FIB)低于SIC组和对照组(P＜0.05)。DIC组、SIC组和对照组治疗后乳酸、BUN和Scr均较治疗前降低,DIC组仍高于SIC组和对照组(P＜0.05)。治疗后急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)评分均较治疗前降低,SIC组评分低于对照组,DIC组APACHEⅡ评分高于SIC组和对照组(P＜0.05)。DIC组、SIC组和对照组出血事件总发生率差异无显著性(P＞0.05)。 结论基于脓毒症DIC评分早期分层抗凝在脓毒症治疗中有较好的效果,可减轻患者凝血功能和脏器损功能损害。     

颅脑外伤迟发颅内出血与凝血异常的临床分析

目的 分析因颅脑外伤所导致的迟发性颅内出血与患者凝血功能异常之间的相关关系。方法 选择脑外伤患者共234例,发生迟发性颅内出血(出血组)34例,未发生出血(非出血组)200例,从两组凝血功能对比中总结颅内出血的危险因素。结果 出血组患者的凝血功能指标除血小板外均高于未出血组(P＜0.05),凝血异常与颅内出血存在相关性,后者是前者的危险因素。凝血指标异常达两项时,出血率明显增高。结论 凝血异常是颅脑外伤迟发颅内出血的主要影响因素之一,异常指标达两项时易导致迟发颅内出血,在临床护理工作中应对颅脑外伤患者的凝血功能变化密切观察,避免迟发性出血的发生。     

成分输血对产科急性弥散性血管内凝血患者凝血功能及治疗效果的影响

目的探讨成分输血对产科急性弥散性血管内凝血(DIC)患者凝血功能及治疗效果的影响。方法回顾性分析66例采取综合治疗措施救治的产科急性DIC者的临床资料,根据输血方式的不同分为成分输血的观察组(34例)和全血输血的对照组(32例),比较两组凝血功能指标、治疗效果、不良反应。结果观察组PLT、Fbg明显高于对照组,PT、a PTT明显低于对照组(t=2.843~27.343,P0.01,P0.05);观察组抢救成功率明显高于对照组(χ~2=4.128,P0.05),子宫全切率明显低于对照组(χ~2=4.686,P0.05);观察组不良反应(8.82%)明显低于对照组(28.13%)(χ~2=4.128,P0.05)。结论成分输血有助于改善产科急性DIC患者的凝血功能,提高抢救成功率,降低不良反应。     

超声刀联合高频双极电凝对甲状腺癌患者喉返神经及甲状旁腺的影响

目的:探讨超声刀联合高频双极电凝对甲状腺癌患者喉返神经及甲状旁腺的影响。方法:选择94例甲状腺癌患者为研究对象,采用随机数字表法分为观察组和对照组各47例,对照组采用传统手术治疗方法,观察组采用超声刀联合高频双极电凝手术治疗。比较2组手术指标、血清学指标、喉返神经及甲状旁腺损伤情况。结果:观察组患者术中出血量、手术时间、切口大小、术后引流量、住院时间均明显少于对照组（P<0.01）;观察组手术后血磷水平明显低于对照组,而血钙和甲状旁腺素水平均明显高于对照组（P<0.01）;观察组甲状腺功能低下的发生率低于对照组（P<0.05）。结论:超声刀联合高频双极电凝有助于优化手术指标,稳定血清学指标,减少喉返神经及甲状旁腺损伤的发生率。     

Closure of a nonhealing gastrocutaneous fistula using argon plasma coagulation and endoscopic hemoclips

A case in which a gastrocutaneous fistula developed after percutaneous endoscopic gastrostomy tube placement is presented. The fistula was first managed conservatively, then was closed by argon plasma coagulation and hemoclip placement. The patient was observed and was discharged once the gastrocutaneous fistula closed.     

Inhibitors in congenital coagulation disorders

The development of inhibitory 'allo' antibodies to a deficient coagulation factor is arguably now the most severe and important complication of clotting factor concentrate exposure in haemophilia and other congenital coagulation disorders. Furthermore, development of an inhibitor to the factor VIII or factor IX transgene product remains a significant concern in gene therapy protocols for haemophilia. Although the development of an inhibitor does not usually change the rate, initial severity or pattern of bleeding, it does compromise the ability to manage haemorrhage in affected individuals, resulting in a greater rate of complications, cost and disability. The purpose of this review is to summarize current understanding of the epidemiology, immunobiology, laboratory evaluation and management of inhibitors arising in patients with congenital coagulation disorders. An attempt has been made to focus on recent advances in the immunology of inhibitors, and to speculate on their potential clinical application.     

Hemostasis Laboratory: Assays for Platelet Function and Von Willebrand Disease

Journal of Thrombosis and Thrombolysis -     

血管内超声在冠状动脉支架置入术中的使用和护理体会

目的：分析血管内超声在冠状动脉支架置入术中的使用和护理体会。方法：选择本院2013年3月-2014年3月80例拟在血管内超声下行冠状动脉支架置入术的患者作为研究组,同时选择80例同一时间在本院使用传统方法进行冠状动脉支架置入术的患者作为对照组,对比两组患者的治疗效果以及术后冠状动脉再狭窄情况,分析血管内超声在冠状动脉支架植入术的使用效果。结果：研究组的治疗效果明显高于对照组,差异具有统计学意义（P<0.05）。研究组出现冠状再狭窄5例,对照组出现冠状再狭窄8例,差异具有统计学意义（P<0.05）。结论：血管内超声在冠状动脉支架置入术的应用中治疗效果明显,推荐使用。     

Occult Diffuse Neoplasm in the Lungs: Intravascular Large B-Cell Lymphoma

BackgroundIntrathoracic involvement with lymphomas is common and manifests lymphadenopathy as well as a wide spectrum of imaging abnormalities in the lungs. Intravascular large B-cell lymphoma (IVLBCL) is a rare extranodal subtype of large B-cell lymphoma that typically involves small blood vessels and is difficult to detect.MethodsUsing a computer-assisted search, we identified patients with histopathologically proven IVLBCL in the lungs at Mayo Clinic from 2001 through 2018. Medical records, imaging studies, and pathologic specimens were reviewed.ResultsA total of 5 patients were diagnosed with a median age at diagnosis of 68 years (range, 44-73); 4 patients were male. The diagnosis of IVLBCL was achieved by surgical lung biopsy in 3 and at autopsy in 2. At presentation, all 5 patients had dyspnea and systemic symptoms including fever, fatigue, night sweats, and/or weight loss. Chest radiography and computed tomography (CT) failed to demonstrate the diffuse infiltrative process; positron emission tomography (PET) scan performed in 2 patients did not show fluorodeoxyglucose (FDG) uptake in the lungs. Pulmonary function tests obtained in 3 patients showed reduced diffusing capacity in all; transthoracic echocardiography yielded evidence of pulmonary hypertension in 2 of 4 patients. All 3 patients diagnosed antemortem underwent chemotherapy with 1 patient remaining alive at 4 years after diagnosis.ConclusionsIVLBCL is difficult to diagnose given variable and nonspecific clinical presentations. Microvascular disease processes such as IVLBCL should be kept in mind in cases of undiagnosed progressive dyspnea accompanied by systemic symptoms even when imaging studies are unrevealing.