不同栓塞剂对介入治疗咯血短期疗效的影响

目的探讨不同栓塞剂对支气管动脉栓塞治疗咯血短期疗效的影响。方法咯血患者46例,进行支气管动脉栓塞治疗咯血。栓塞前进行造影,根据病灶是否有难以栓塞的非支气管体循环动脉供血进行配对分组,分别以明胶海绵颗粒或PVA颗粒栓塞。结果明胶海绵栓塞组的有效率为78.3%,PVA颗粒组有效率为82.6%。两组有效率无明显差别。所有疗效不佳的病例都发生在非支气管体循环供血动脉不能充分栓塞者。结论充分栓塞支气管和非支气管体循环动脉是介入治疗咯血成功的关键;选择何种栓塞剂对短期疗效无显著影响。     

超声引导微创治疗腹部实质性脏器创伤性出血的护理体会

目的：总结超声引导微创治疗腹部实质性脏器创伤性出血的护理方法。方法：回顾性分析2010-01-2013-11经床旁超声造影介入治疗的腹部实质性脏器创伤性出血患者152例的护理经验,总结治疗前、治疗中和治疗后的护理要点。结果：通过规范、有效的护理措施,取得很好的临床效果。结论：超声造影引导下对腹部实质脏器外伤出血进行局部止血剂注射可有效治疗腹部实质脏器外伤出血,规范、有效的护理工作,是保证治疗效果、促进患者康复的重要手段。     

内镜下注射蛇毒血凝酶联合静脉滴注奥美拉唑治疗溃疡性上消化道出血的疗效

目的  分析内镜下注射蛇毒血凝酶联合静脉滴注奥美拉唑治疗溃疡性上消化道出血的疗效。 方法  选取2019年5月~2022年5月于本院接受治疗的溃疡性上消化道出血患者126例作为研究对象,依据入院先后顺序分为对照组和研究组,63例/组。对照组给予奥美拉唑静脉滴注治疗,40 mg/次,2次/d;研究组在此基础上于出血部位周围或断端血管内注射蛇毒血凝酶,1~2 U/d,两组均连续治疗5 d。比较两组止血时间、再出血率、转手术率、住院时间,比较两组治疗前后凝血功能指标[凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、D-二聚体（D-D）、纤维蛋白原（FIB）]水平、血流动力学指标[收缩压（SBP）、舒张压（DBP）、心率（HR）]变化,并分析临床疗效和安全性。 结果  研究组的止血时间、再出血率、转手术率、住院时间均较对照组降低（P < 0.05）;治疗后,两组的PT、APTT较治疗前均降低,D-D、FIB较治疗前均升高（P < 0.05）,且研究组PT、APTT水平低于对照组,D-D、FIB水平高于对照组（P < 0.05）;治疗后,两组SBP、DBP、HR值较治疗前均降低（P < 0.05）,且研究组SBP、DBP、HR值高于对照组（P < 0.05）。研究组的治疗总有效率为95.24%,高于对照组的79.36%（P < 0.05）;研究组的不良反应总发生率为6.35%,与对照组的（12.70%）差异无统计学意义（P > 0.05）。 结论  应用内镜下注射蛇毒血凝酶联合静脉滴注奥美拉唑治疗溃疡性上消化道出血的止血效果显著,能明显降低患者再出血率、转手术率,有效改善患者凝血功能指标,维持患者血压及心率稳定,安全性高。     

应用TR-Band桡动脉压迫装置止血的护理体会

经桡动脉冠状动脉介入诊疗具有出血和血管并发症少、患者痛苦小、住院时间缩短和住院费用降低等优点,但随着新的高效抗凝、抗血小板药物的广泛应用,介入术后的出血并发症也相应增多。我科对122例经桡动脉途径行冠状动脉介入诊疗患者,利用TR—Band桡动脉压迫装置进行压迫止血效果良好,现将护理体会介绍如下。     

Association of functional thrombin-activatable fibrinolysis inhibitor (TAFI) with conventional cardiovascular risk factors and its correlation with other hemostatic factors in a Spanish population

Our aim was to determine the associations of functional thrombin-activatable fibrinolysis inhibitor (TAFI) levels in plasma with conventional cardiovascular risk factors, sex and age, and possible correlations with other hemostatic factors in a Spanish population. We included 303 individuals from a Spanish population. Hemostatic factors such as von Willebrand Factor, VII ag, VIIIc, XIc, XIIc, APCR, protein S, protein C, antithrombin, fibrinogen, and t-PA antigen were assayed. The functional TAFI assay was based on the activation of plasma TAFI with thrombin-thrombomodulin, and the measure of TAFIa activity on the hippuryl-Arg substrate. There were no statistical differences in mean values of functional TAFI among the various female age groups or among the different male age groups, with or without cardiovascular risk factors. Only women younger than 30 years of age showed lower levels of functional TAFI compared to older women. No differences were found among men of different ages. Adjusted for sex and age, hemostatic factors did not show a correlation with functional TAFI levels in plasma. Women with hypercholesterolemia showed higher levels of TAFI; other conventional cardiovascular risk factors did not modify functional TAFI levels either in men or in women. We also found no correlation of functional TAFI levels related to any other hemostatic factors.     

Prevention of Radial Artery Occlusion of 3 Hemostatic Methods in Transradial Intervention for Coronary Angiography

ObjectivesThe main objective of this study was to compare the efficacy of 3 hemostatic methods for the prevention of early radial artery occlusion (RAO): standard patent hemostasis, patent hemostasis with ulnar compression or the ulnar artery transient compression facilitating radial artery patent hemostasis (ULTRA) method, and facilitated hemostasis with a hemostatic disc.BackgroundThere are no prospective randomized studies that compare early RAO rates with the 3 most used nonocclusive hemostatic methods.MethodsThis was a prospective, longitudinal, comparative, and randomized study. The final population analyzed was 1,469, and they were randomized into 3 groups: 491 patients in group 1 with standard patent hemostasis, 490 patients in group 2 with the ULTRA method, and 488 patients in group 3 with facilitated hemostasis with a hemostatic disc.ResultsThe RAO rate at 24 hours of the total population analyzed was 4.6%. By hemostasis groups, it was 3.6% for patent hemostasis, 5.5% for the ULTRA method, and 4.7% for facilitated hemostasis with a hemostatic disc, with no statistical difference among the 3 groups (P = 0.387). At 30 days, the overall rate of RAO was 1.8%, and by groups, it was 1.4% for the patent hemostasis group, 1.8% for the ULTRA method group, and 2.2% for the facilitated hemostasis with a hemostatic disc group, respectively (P = 0.185).ConclusionsThe rates of RAO at 24 hours evaluated by plethysmography oximetry and confirmed by ultrasound among 3 current radial hemostasis methods (ie, patent hemostasis, the ULTRA method, and facilitated hemostasis with a hemostatic disc) are not different.     

海绵肾的超声表现及特点

目的分析海绵肾的声像图表现特点,提高对该病的认识。方法收集经静脉肾盂造影或CT证实的海绵肾12例,对其进行回顾性分析。所有病例均行双肾的超声检查。结果11例表现为双侧肾脏髓质的病变,1例表现为单侧肾脏髓质的病变,病变的髓质均显示其回声有明显的增强。有10例肾髓质表现为边缘较毛糙的强回声团。有2例在增强的部分髓质中可见到细小的筛状结构。结论海绵肾声像图具有其表现特征,超声是诊断海绵肾的一种有价值的检查方法。     

脊椎植骨术中人工骨对软组织的反应**☆

背景:脊椎后路植骨融合是常见的脊椎术式,人工骨可以很好地辅助植骨融合,但是由于软组织可能对人工骨存在一定的反应,人工骨目前很少应用于脊椎后路植骨中. 目的:拟通过兔的脊椎后路植骨实验,探讨如何降低脊椎手术中软组织对人工骨反应. 方法:36只成年公兔随机分为可吸收止血纱布组和对照组,于 L2-3去皮质的椎板表面上,植入β-磷酸三钙人工骨,以可吸收止血纱布隔离背侧软组织为可吸收止血纱布组,无隔离物为对照组.检测植骨后不同时间点,兔血液中的 C-反应蛋白表达,记录植骨后1周和12周皮肤愈合和皮下组织愈合情况以及局部炎症反应,CT 检查记录植骨后不同时间点的人工骨爬行替代情况. 结果与结论:1周时,可吸收止血纱布组所有兔的背侧筋膜愈合完整;对照组9只中7只筋膜愈合完整,2只背侧筋膜愈合欠佳.12周时,可吸收止血纱布组9只中8只背侧筋膜愈合良好,1只愈合欠佳;对照组9只中6只愈合良好,2只愈合欠佳,1只轻度感染.1周时两组肌肉组织都存在一定充血,部分炎性细胞浸润,可吸收止血纱布组炎性细胞浸润较少,局部充血相对较少.12周时两组肌肉组织都存在一定的肉芽组织增生,可吸收止血纱布组炎性细胞浸润略少,对照组部分动物可见较明显的坏死组织.植骨后即刻,植骨后1周,4周时血液中的 C-反应蛋白表达在两组间差异无显著性意义.植骨后12周时,CT 检查显示靠近骨面的人工骨吸收明显,靠近软组织的人工骨无明显吸收,人工骨吸收情况在两组间无明显区别.结果提示,人工骨放置应尽量与植骨面多接触,这可促进人工骨尽早吸收,并降低软组织反应.减少人工骨和软组织接触,可以降低软组织对人工骨的反应.可吸收止血纱布的早期生物隔离和组织修复作用能一定程度减少组织对人工骨的反应.     

两种吸收性止血材料应用于腹腔镜肾上腺手术后的护理观察

目的探讨两种吸收性止血材料生物蛋白胶（Fibrin Sealant）及止血纱布（速即纱）在后腹腔镜肾上腺手术中的止血效果及术后护理观察。方法对手术中利用生物蛋白胶注入术区（47例）或止血纱布填塞术区（25例）创面止血的患者进行回顾性分析。结果速即纱组在肾上腺全切及部分切除术后的引流量、引流时间、住院天数及并发症发生率均明显低于对照组,而生物蛋白胶组肾上腺全切术后只有住院时间明显低于对照组,肾上腺部分切除术后引流量及引流时间均明显低于对照组。结论止血纱布（速即纱）组织相容性好,使用方便、止血快速、吸收完全、止血效果可靠,是后腹腔镜肾上腺创面止血的理想材料,且便于术后护理。     

Comparative efficacy and safety of topical hemostatic agents in primary total knee arthroplasty: A network meta-analysis of randomized controlled trials

Background:Topical hemostatic agents are commonly used for reducing perioperative blood loss and transfusion requirement in primary total knee arthroplasty (TKA), although the optimal option has yet to be defined. This study aimed to evaluate the efficacy and safety of topical hemostatic agents and rank the best intervention using the network meta-analysis (NMA) method.Methods:We searched Web of science, PubMed, and Cochrane Library database up to April 2020, for randomized controlled trials (RCTs) on topical hemostatic agents in primary TKA. The quality of included studies was assessed using the Cochrane “risk of bias” tool. Direct and indirect comparisons were performed for the result of network meta-analysis followed by consistency test.Results:Thirty seven RCTs with 3792 patients were included in this NMA and the pooled results indicated that tranexamic acid plus diluted epinephrine (TXA+DEP) displayed the highest efficacy in reducing total blood loss, hemoglobin drop and transfusion requirement. None of the included treatments was found to increase risk of thromboembolic events compared to placebo. According to the results of ranking probabilities, TXA+DEP had the highest possibility to be the best topical hemostatic agent with regard to the greatest comparative efficacy and a relatively high safety level.Conclusion:Current evidence supports that administration of TXA+DEP may be the optimal topical hemostatic agent to decrease blood loss and transfusion requirement in primary TKA. More direct studies that focused on the topical application of TXA+DEP versus other treatments are needed in the future.