肝素涂层支架对冠心病患者纤溶、前列腺素及内皮素水平的影响及临床意义

目的研究冠心病患者肝素涂层支架植入术后纤溶、前列腺素、内皮素(ET)和丙二醛(MDA)水平的变化及临床意义。方法30例患者随机分为普通无涂层支架组(NCS)16例和肝素涂层支架组(HCS)14例,测定术前1、5和10min冠状静脉窦血浆ET和MDA;测定术前、术后不同时间点外周血浆ET,MDA、血栓素B(TXB2)、6-酮-前列腺素F1α(PGF1α)、组织型纤溶酶原激活物(t-PA)及其抑制物(PAI-1)的变化。结果NCS组:ET-1术后即刻和12h呈现大小两个高峰,MDA术后5min达高峰(P<0.01);HCS组:ET-1术后5、10min和12h明显低于NCS组(P值分别小于0.05、0.01和0.05),MDA术后5min至1d均明显低于NCS组;NCS和HCS组术后TXB2,PGF1α明显升高,术后24h达高峰;PAI-1术后无明显变化。结论冠状动脉内支架植入(ICS)术后确有血小板活化,纤溶活性变化不大,肝素涂层支架可降低术后ET-1和MDA水平,这可能对术后防止急性血管痉挛和(亚)急性血栓形成有一定保护作用。     

肝素涂层支架植入术对冠心病患者血浆内皮素、丙二醛水平的影响及临床意义

目的 :研究肝素涂层支架植入术对冠状及体循环中血浆内皮素 （ET）和丙二醛 （MDA）水平的影响。方法　选择冠心病患者 30例 ,随机植入普通无涂层支架 （NCS） 16例和肝素涂层支架 （HCS） 14例 ,于手术前后不同时间点 ,同时采集冠状静脉窦和外周肘静脉血检测血浆 ET- 1和 MDA浓度。结果　 1NCS组 :ET- 1水平在支架后即刻和支架后 12 h呈现大小两个高峰 ,MDA水平在支架后 5 m in达高峰 （P<0 .0 1） ;2 HCS组 :ET- 1水平在支架后5 m in,10 min和 12 h明显低于同时间点 NCS组水平 （P值分别 <0 .0 5 ,<0 .0 1和 <0 .0 5 ） ,MDA水平于支架后5 m in至术后 1d均明显低于 NCS组 （均 P<0 .0 5 ）。结论　 HCS可降低术后 ET- 1和 MDA水平 ,这可能对支架植入术后防止急性血管痉挛和 （亚 ）急性血栓形成的发生有一定保护作用     

Effects of the heparin-coated Wiktor-I stent on recovering the balance of ET-1 and CGRP after intracoronary stent implantation

Despite the advances in the clinical use of inthe-coroM stents in the past decades, ther are shll lindta-tions to general aPplicability of the teCboque, such as(sub) acute thrombosis (3.5%), vasoSPaSm ofdistalartery and bleeding episodes or peripheral vascular com-plicahons (l3.5%). To trier imProve the clndcal re-sultS of intraCoronny stenting, attention is directed tOcoabog the stentS with materials tha can ndnizc therisk ofabruphng coronaIy occlusion and th6reby allow areduction in anti…     

Palindrome H新型肝素涂层带隧道带涤纶套导管对凝血系统的影响

背景:Palindrome H肝素涂层带隧道带涤纶套导管(简称Palindrome H肝素涂层导管)有望降低导管相关感染率和减少导管功能不良的发生,目前缺乏该导管对凝血系统影响的研究。目的:评估Palindrome H肝素涂层导管的对血液透析患者凝血系统的影响。方法:选取2014年1月至2016年6月在佛山市第一人民医院血液净化中心需维持性血液透析,而无法建立内瘘的患者,分为Palindrome H肝素涂层导管组和非肝素涂层Palindrome导管组2组,分别置管。所有患者每3个月检测血小板计数、凝血酶原时间、国际标准化比值(INR)、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原降解产物等指标,进行组间对比。试验方案通过了广东省佛山市第一人民医院医学伦理委员会的讨论审核,批准号:L[2014]第5号。结果与结论:最终纳入患者60例(Palindrome H肝素涂层导管组28例,Palindrome导管组32例),进行了为期30个月的随访,结果数据为置管后第0,3,6,9,12,15,18,21,24,27,30个月检测的平均值。结果显示两组患者的血小板计数、凝血酶原时间、国际标准化比值(INR)、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原降解产物等指标比较均无统计学差异(P>0.05),没有实验室检查表明发生了肝素诱导的血小板减少症。说明在临床应用中,Palindrome H肝素涂层导管与非肝素涂层Palindrome导管相比较,对患者凝血系统无明显影响。     

模拟体外循环下肝素涂层的稳定性实验

目的：评估肝素涂层体外循环管道肝素的稳定性。方法：测定肝素图层体外循环管道模拟体外循环法与浸泡法在不同时点的肝素脱落率。结果：在128h内，两组肝素结合表面均有不同程度的肝素分子脱落现象，肝素脱落率随时间增大，在一定时间内浸泡法结合的肝素表面的肝素最大脱落率为85％，而体外循环法结合表面的肝素脱落率为92％。体外循环组涂层表面中肝素的脱落率与浸泡组两者之间无显著差异。结论：短期内肝素结合体外循环管道比较牢固，满足临床使用。     

β-Thromboglobulin may not reflect platelet activation during haemodialysis with the HeprAN membrane

Background: When blood passes through the extracorporeal circuit during haemodialysis (HD) undesirable effects including platelet degranulation and coagulation activation take place. β-thromboglobulin (β-TG) is a sensitive marker of platelet activation. The aim of this study was to investigate platelet degranulation and coagulation activation during HD with the heparin-coated dialysis membrane HeprAN.

Methods: Four HD sessions were evaluated in each of 12 chronic HD patients. None of the patients used oral warfarin, other anticoagulants or antiplatelet drugs. In the first session the HeprAN membrane or a conventional polyflux membrane was used in a randomized manner and thereafter alternately in a cross-over design, and 50% of the conventional dalteparin dose was given at start of HD. Prothrombin fragment 1?+?2 (PF1?+?2), β-TG and anti-factor Xa activity were measured repeatedly.

Results: No dialysis sessions were terminated early due to clotting of the extracorporeal system. Activation of intravascular coagulation as assessed by change in PF1?+?2 during 4?hours of HD was the same with the two membranes. β-TG concentration decreased significantly during 4?hours of HD with the HeprAN membrane but remained stable with the polyflux membrane.

Conclusion: There were no differences in clotting scores or coagulation activation with the two membranes. The decrease in β-TG during HD with the HeprAN membrane suggests β-TG to be an inferior marker of platelet degranulation when using a heparin-coated dialysis membrane. A possible mechanism for the decline in β-TG concentration may be adherence of this heparin-binding protein to the heparin-coated dialysis membrane.     

Early and long-term results of coronary artery bypass grafting in dialysis patients

OBJECTIVE: We evaluated the surgical outcome of coronary artery bypass grafting in dialysis patients. METHODS: We retrospectively analyzed 25 consecutive dialysis patients requiring isolated coronary artery bypass grafting. Their mean age was 61.6 years and average dialysis duration 80.4 months. RESULTS: Eight patients (32%) had emergency or urgent surgery. The mean number of bypassed vessels was 3.3 +/- 1.2. Internal thoracic artery grafts were used in 19 patients and gastroepiploic artery grafts in 5. Two (8%) died during hospitalization and complications occurred in 11 (44%). No cerebral complications were observed. All survivors showed ameliorated symptoms and improved overall function. Of 14 late deaths, 5 were cardiac-related, with 2 involving obvious myocardial ischemic events. Actuarial survival, including hospital deaths, at 1 year was 70.9%, at 3 years was 43.5%, and at 5 years was 34.8%. Cardiac-death-free survival was 70.2% at 3 years and 70.2% at 5 years. CONCLUSION: Coronary artery bypass grafting in dialysis patients is associated with a higher incidence of complications but has acceptable surgical mortality and effectively relieves angina symptoms.     

肝素涂层膜肺对体外循环炎症反应的影响

目的　本研究旨在观察心脏瓣膜置换术患者在体外循环 (CPB)各时段炎症因子和血流动力学的变化 ,并探讨肝素涂层膜肺对其的影响。方法　选择择期行双瓣置换术的患者 2 0例 ,随机分成两组 :A组为肝素化膜肺组 ,B组为对照组。全部患者分别在麻醉诱导前、主动脉阻断开放前、开放主动脉后 30min和术后 2h时取血测定细胞因子IL - 1β、IL - 6、IL - 8、TNF的浓度。并且分别在麻醉诱导前和术后 2h测定血流动力学指标。 结果　两组患者血液中的细胞因子 (IL - 1β、IL - 6、IL - 8、TNF)浓度 ,于CPB开始后即迅速上升。在CPB过程中IL - 1β、IL - 6、IL - 8和TNF的浓度均处于较高水平 ,且与麻醉诱导前相比部分有显著性差异 (p<0 .0 5 )。其中IL - 1β和IL - 6的浓度在术后 2h时仍有缓慢上升 ,IL - 8和TNF的浓度则在术后稍有下降。A组 (肝素化膜肺组 )和B组 (对照组 )相比较 ,细胞因子 (IL - 1β、IL - 6、IL - 8、TNF)浓度上升的程度均较小。开放 30min时IL - 1β和IL- 8的浓度在两组间有显著性差异 (p <0 .0 5 ) ,术后 2h时IL - 6的浓度在两组间的差异也有显著性 (p <0 .0 5 ) ,但TNF的浓度在两组间无显著性差异。结论　肝素化膜肺能改善CPB管路与血液的生物相容性 ,减少血液与异物表面接触引起的炎症反应