Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

目的 评价Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性.方法 拟行剖宫产术的Rh(D)阴性血型病人30例,年龄20～35岁,体重50～80 kg,ASA分级Ⅰ或Ⅱ级.静脉输注乳酸钠林格氏液7 ml/kg后经桡动脉采血,采血速率60～80 ml/min,采血同时静脉输注与采血等速率的6%羟乙基淀粉130/0.4.采集的自体血经2个循环的直接法分离为富含血小板血浆、贫血小板血浆和浓缩红细胞,每个循环以分离出红细胞后15 s时停止采血.出血量≥全身血容量的20%时立即回输自体血;出血量<全身血容量20%者,在缝合子宫后回输,依次回输富含血小板血浆、输贫血小板血浆和输浓缩红细胞.监测母体生命体征指标和胎儿心率.记录自体血采集过程中低血压和心动过速的发生情况.分别于采血前(基础状态)、采血结束时、自体血回输前和术后24 h时采集外周静脉血样,测定Hb、Hct、Plt、PT、APTT、INR和Fib.胎儿娩出后采集脐动脉血样,进行血气分析.于胎儿娩出后1、5min时行Apgar评分.记录术中出血量和异体输血情况.结果 自体血采集过程中未见低血压和心动过速的发生,胎儿HR维持在正常范围.与基础状态比较,其他时点SpO2、Hb、Hct、Plt、PT、APTT、INR和Fib差异无统计学意义(P>0.05).脐动脉血pH值、BE和乳酸浓度均在正常范围内.胎儿娩出后1、5 min时Apgar评分分别为(9.0±0.8)、(9.2±0.8)分;术中出血量(405±28)ml,所有病人未输注异体血.结论 Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性良好.

Abstract：

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.     

右美托咪定不同时机给药对学龄前儿童七氟醚麻醉苏醒期躁动的影响

目的观察右美托咪定不同时机给药对学龄前儿童七氟醚麻醉苏醒期躁动（EA）的影响。方法将120例接受七氟醚麻醉行扁桃体或腺样体切除术的学龄前（2~7岁）患儿,按随机数字表法分为术前用药组[麻醉诱导前10min开始泵注右美托咪定1滋g/（kg·h）,持续15min]、术中用药组[诱导插管后5min开始泵注右美托咪定1滋g/（kg·h）,持续15min]、全程用药组[麻醉诱导前10min至诱导插管后20min持续泵注右美托咪定0.5滋g/（kg·h）]、对照组（全程持续泵注等量0.9%氯化钠注射液）,每组30例。记录各组患儿麻醉诱导前10min（T0）、诱导插管后20min（T1）、入麻醉恢复室（PACU）后10min（T2）的平均动脉压（MAP）和心率（HR）,观察各组手术时间、拔管时间、PACU滞留时间,比较各组术后心动过缓、恶心呕吐、躁动（采用Aono镇静躁动评分）等不良反应发生情况。结果4组患儿围术期各时点（包括T0、T1、T2）MAP、HR、手术时间、PACU滞留时间以及心动过缓、恶心呕吐发生率比较,差异均无统计学意义（均P＞0.05）;拔管时间、Aono镇静评分和躁动发生率比较,差异均有统计学意义（均P＜0.05）,其中术中给药组拔管时间较对照组明显延长（P＜0.05）,而术前、术中、全程用药组间两两比较,差异均无统计学意义（均P＞0.05）;术前、术中、全程用药组Aono镇静评分及躁动发生率均较对照组明显降低（均P＜0.05）,全程用药组Aono镇静评分较术中用药组明显降低（P＜0.05）,而躁动发生率比较差异无统计学意义（P＞0.05）。结论右美托咪定不同时机给药均能有效改善学龄前儿童七氟醚麻醉EA,其中全程给药的效果最优,术中给药可延长术后拔管时间。     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.     

Rh(D)阴性血型病人剖宫产术中成分式自体输血的安全性

Objective To investigate the safety of autologous blood component transfusion during cesarean section in patients with Rh (D)-negative blood group.Methods Thirty ASA Ⅰ or Ⅱ patients of Rh (D)-negative blood group, aged 20-35 yr, weighing 50-80 kg, undergoing elective cesarean section, were enrolled in this study.After lactated Ringer' s solution 7 ml/kg was infused, blood was obtained from radial artery at a rate of 60-80ml/min, and blood volume was maintained by simultaneous infusion of 6% hydroxyethyl starch 130/0.4 at the same rate. The collected blood was subjected to two cycles of autologous blood component separation. Blood collecting during each cycle was stopped 15 s after red blood cells were separated. The autologous blood was infused when the blood loss≥20% of blood volume. The autologous blood was infused after suture of the uterus when the blood loss < 20% of blood volume. The parameters of maternal vital signs and fetal heart rate were monitored. Hypotension and tachycardia were recorded during autologous blood collecting. SpO2 was monitored routinely. Venous blood samples were taken before blood collecting (baseline), at the end of blood collecting, before autologous blood transfusion, 24 h after operation for determination of Hb, Hct, Plt, PT, APTT, INR and Fib. Umbilical arterial blood samples were obtained after delivery for blood gas analysis. Apgar score was recorded at 1 and 5 min after birth. Blood loss and allogeneic blood transfusion were also recorded. Results No hypotension and tachycardia occurred during the process of blood collecting and the fetal heart rate was within the normal range. Compared with the baseline value, there were no significant differences in SpO2 , Hb, Hct, Plt, PT, APTT, INR and FIB value at the other time points. The pH value and concentrations of base excess and lactate were within the normal range.The Apgar score was (9.0 ±0.8) and (9.2 ± 0.8) at 1 and 5 min after birth respectively. The blood loss during operation was (405 ± 28) ml and no patients received homologous blood transfusion. Conclusion The safety of autologous blood component transfusion is good during cesarean section in Rh (D)-negative blood group patients.     

基于网络药理学与分子对接技术探讨大黄肝毒性的作用机制

目的 利用网络药理学和分子对接技术探讨大黄肝毒性的分子作用机制。方法 在TCMSP检索大黄活性成分及文献获取潜在肝毒性成分，利用Swiss Target Prediction数据库获取成分靶点，通过GeneCards和OMIM数据库获取人类肝毒性相关靶点。利用STRING数据库将Venn图获得成分与疾病共同靶标进行（PPI）网络分析，用Cytoscape软件构建“大黄成分–肝毒性作用靶点”网络，并且利用DAVID数据库进行基因本体（GO）功能富集和京都基因与基因组百科全书（KEGG）（KEGG）通路富集。将部分肝毒性核心成分和关键靶点进行分子对接。结果 共获取大黄潜在肝毒性成分21种，对应靶点724个，人类肝毒性相关靶点957个，大黄与肝毒性的共同靶点151个，核心成分可能是大黄酸、大黄酚、β-谷甾醇、大黄素-1-O-β-D-葡萄糖硫苷、大黄素甲醚二葡萄糖苷、芦荟大黄素等，关键靶点可能是白蛋白（ALB）、蛋白激酶B1（Akt1）、肿瘤蛋白p53（TP53）等。KEGG通路显示癌症通路、前列腺癌通路等可能在大黄肝毒性中起关键作用。分子对接结果表明，大黄肝毒性核心成分与关键靶点对接良好。结论 大黄通过多成分、多靶点、多通路机制导致肝毒性作用。