ObjectiveTo explore the clinical application value of antithrombin Ⅲ (ATⅢ) in pulmonary thromboembolism (PTE).MethodsA retrospective study included 204 patients with confirmed PTE who were admitted to Fujian Provincial Hospital from May 2012 to June 2019. The clinical data of the study included basic conditions, morbilities, laboratory examinations and scoring system within 24 hours after admission. The relationship between ATⅢ and PTE in-hospital death was analyzed, and the value of ATⅢ to optimize risk stratification was explored.ResultsFor ATⅢ, the area under receiver operating characteristic curve (AUC) of predicting in-hospital mortality was 0.719, with a cut-off value of 77.7% (sensitivity 64.71%, specificity 80.21%). The patients were divided into ATⅢ≤77.7% group (n=48) and ATⅢ>77.7% group (n=156) according to the cut-off value, and significant statistically differences were found in chronic heart failure, white blood cells count, platelets count, alanine aminotransferase (ALT), albumin and troponin I (P<0.05). According to the in-hospital mortality, patients were divided into a death group (n=17) and a survival group (n=187), and the differences in count of white blood cells, ATⅢ, D-dimer, ALT, albumin, estimated glomerular filtration rate and APACHEⅡ were statistically significant. Logistic regression analysis revealed that ATⅢ≤77.7% and white blood cells count were independent risk factors for in-hospital death. The risk stratification and the risk stratification combined ATⅢ to predict in-hospital death were evaluated by receiver operating characteristic curve, and the AUC was 0.705 and 0.813, respectively (P<0.05). A new scoring model of risk stratification combined with ATⅢ was showed by nomogram.ConclusionsATⅢ≤77.7% is an independent risk factor for in-hospital death, and is beneficial to optimize risk stratification. The mechanism may be related to thrombosis, right ventricular dysfunction and inflammatory response.
ObjectiveTo explore the efficacy of thrombin in treatment of subcutaneous effusion after radical resection of breast cancer. MethodsOne hundred and ninety patients underwent radical resection of breast cancer from July 2008 to July 2013 in this hospital were divided into postoperative observation group and postoperative control group according to the operation time. A daily injection of thrombin by drainage tube was performed on day 3 after operation in the postoperative observation group, the negative pressure drainage only was performed in the postoperative control group. The drainage volume in 72 h after operation, time of extubation, cases of subcutaneous effusion were counted after operation. Then the patients with subcutaneous effusion were divided into subcutaneous effusion observation group and subcutaneous effusion control group according to the time of extubation, the thrombin was injected into cavity after pumping subcutaneous effusion with pressing and dressing in the subcutaneous effusion observation group and only pressed after pumping subcutaneous effusion in the subcutaneous effusion control group, respectively. The healing time of subcutaneous effusion was counted in these two groups. ResultsCompared with the postoperative control group, the drainage volume in 72 h after operation was less(P < 0.001), the time of extubation was earlier(P < 0.001), the rate of subcutaneous effusion was lower(P < 0.05), color of drainage fluid on day 2 after mastectomy was lighter(P < 0.001)in the postoperative observation group. Compared with subcutaneous effusion control group, when subcutaneous effusion was 20-50 mL or > 50 mL, the healing time of subcutaneous effusion was significantly shorter in the subcutaneous effusion observation group(P < 0.05). ConclusionsInjecting thrombin by drainage tube after operation can reduce the drainage volume, decrease the rate of subcutaneous liquid, and shorten the time of extubation. Injecting thrombin into cavity of subcutaneous liquid can shorten the healing time of patients with middle and large subcutaneous effusions after radical resection of breast cancer.
目的:探討腦損傷患者凝血功能水平與顱腦損傷傷情轉歸的相關性。方法:收集70例顱腦損傷患者的臨床資料,傷者抽取靜脈血2 mL,進行凝血功能檢測,分析結果與臨床資料等分別采用SPSS 11.5軟件進行χ2檢驗和logistic回歸分析。結果:在13例凝血功能異常患者中有5例(38%)傷情加重(較入院時腦內血腫體積增大,遲發性血腫等),明顯高于凝血功能正常而傷情加重者(12%,Plt;0.05);單因素和多因素logistic回歸分析提示凝血功能異常時腦損傷傷情加重的危險因素。結論:腦創傷后凝血功能異常時顱腦損傷患者傷情加重的危險因素。
目的：了解左旋門冬酰胺酶（L-ASP）對兒童急性淋巴細胞白血病凝血功能變化的影響。方法：觀察86例患兒在誘導緩解后治療期間，L-ASP使用前后活化部分凝血活酶時間(APTT)、凝血酶原時間(PT)、凝血酶時間(TT)、纖維蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚體變化情況。結果：與用藥前比,用藥結束后一天的PT、APTT、TT均顯著延長(P＜0.01);FIB、AT-Ⅲ顯著降低(P＜0.01),D-二聚體顯著升高(P＜0.01);用藥結束后1周時PT、APTT、TT、D-二聚體較用藥前差異無顯著性,FIB、AT-Ⅲ雖有回升,但仍低于正常(P＜0.01)。結論：L-ASP可引起ALL患兒凝血功能異常，尤其對FIB、AT-Ⅲ影響明顯，應引起臨床高度重視。Ｌ-Ａｓｐ主要影響蛋白質的合成而引起蛋白質成份的凝血因子減少,從而引起凝血功能障礙,且對纖維蛋白原的合成影響更為顯著。
目的 比較進展性慢性肝病及重癥肝炎患者原位肝移植(OLT)圍手術期凝血功能的變化。方法 回顧性分析我中心2004年1月至2005年12月期間行OLT治療進展性慢性肝病及重癥肝炎患者各37例的圍手術期血小板(PLT)、凝血酶原時間(PT)、活化部分凝血活酶時間(APTT)及纖維蛋白原(FIB)的變化。結果 2組患者除術前PT、APTT,術后第5 d PLT、FIB和術后第7 d FIB的差異有統計學意義外（plt;0.05），其余時段2組患者的PLT、PT、APTT及FIB 間差異均無統計學意義（Pgt;0.05）, 提示重癥肝炎患者凝血功能損害更為嚴重； OLT術后，2組患者的凝血功能均逐漸恢復正常, 但并非完全同步。結論 進展性慢性肝病與重癥肝炎患者OLT圍手術期凝血功能變化顯著，應注意監測及處理，但術后2組間各指標間比較差異并不明顯。
Objective To identify the risk factors for coagulopathy after Stanford type A acute aortic dissection (AAD) repair to offer evidence for improvement of patients' prognosis. Methods We retrospectively analyzed the clinical data of 95 patients undergoing Stanford type A AAD repair in Beijing Anzhen Hospital between January 2013 and December 2014. Patients with thromboelastography-coagulation index (TEG-CI) ≤–3 after surgery were allocated to a coagulopathy group (n=17, average age 48.70 years), whereas patients with TEG-CI >–3 after surgery were allocated to a control group ( n=78, average age 46.80 years). Multivariate analysis was used to identify risk factors for coagulopathy after surgery. Results Seventeen patients suffered from coagulopathy after surgery. Patients in the coagulopathy group had larger amount of fluid drainage than that in the control group (P=0.008). Risk factors for postoperative coagulopathy were activated partial thromboplastin time (APTT) at the end of surgery ( OR=0.011, 95% confidence interval 0.001 to 0.021, P=0.035), fibrinogen degradation products (FDP) at the end of surgery (OR=0.004, 95% confidence interval 0.001 to 0.007, P=0.022) and platelet count (×109/L) at the end of surgery (OR=–0.002, 95% confidence interval –0.003 to 0.000, P=0.049). The lower risk of postoperative coagulopathy was related to the platelet count at the end of surgery up to 137.00 ×109/L. Conclusion Postoperative coagulopathy could be related to the clinical and experimental variables. In a representative sample of Chinese adults undergoing Stanford type A AAD surgery, APTT, FDP and platelet count at the end of surgery are independent risk factors associated with postoperative coagulopathy. Adding haemostatic, such as fibrinogen and prothrombinase complex, is good for improving the recovery of coagulation function to reduce bleeding and postoperative blood transfusion, as well as adding platelet, plasma and other coagulation factors after AAD surgery.
ObjectiveTo investigate the correlations between lipopolysaccharide(LPS), phospholipase A2 (PLA2) and platelet-activating factor (PAF) with coagulopathy after severe chest and abdominal injuries and their mechanisms. MethodsClinical data of 82 patients with severe chest and abdominal injuries whose trauma index (TI) was greater than or equal to 17 points in No. 253 Hospital of People's Liberation Army from January 2009 to June 2012 were retrospectively analyzed (severe chest and abdominal injury group). Those patients who had concomitant traumatic brain injuries or died in the Emergency Department were excluded from this study. There were 58 male and 24 female patients with their age of 16-76 (43.59±16.33)years. There were 17 patients with open injuries and 65 patients with closed injuries. There were 23 patients with fall injuries, 47 patients with traffic injuries, 8 patients with blunt force injuries, and 4 patients with penetrating injuries. Forty-two healthy volunteers who received routine medical examinations in the outpatient department of our hospital were chosen as the control group, including 27 males and 15 females with their age of 24-47 (37.32±10.45) years. Blood platelet (PLT) count, D-dimer (D-D), activated partial thromboplastin time (APTT), LPS, PLA2 and PAF were compared between the 2 groups, and linear correlation analysis was performed. ResultsPLT of the severe chest and abdominal injury group patients were significantly lower than that of the control group[(83.44±38.52)×109/L vs. (191.52±23.31)×109/L]. D-D[(1 823.89±608.02) U/L vs. (105.78±44.53) U/L], APTT [(68.24±24.12) s vs. (22.47±9.41) s], LPS[(438.66±106.02) U/L vs. (87.38±46.51) U/L], PLA2 [(41.35±14.26) ng/ml vs. (7.47±5.27)ng/ml] and PAF[(15 765.31±4 431.65) ng/L vs. (3 823.45±529.72) ng/L] of the severe chest and abdominal injury group patients were significantly higher than those of the control group(P < 0.001). PLT was significantly negatively correlated with LPS, PLA2 and PAF with all the respective correlation coefficient(r)less than-0.933 5. D-D and APTT were significantly positively correlated with LPS, PLA2 and PAF with all the respective r larger than 0.921 6. ConclusionLPS, PLA2 and PAF participate in the pathogenesis of coagulopathy in patients with severe chest and abdominal injuries. Early intervention against LPS, PLA2 and PAF may improve coagulopathy and survival rate of patients with severe chest and abdominal injuries.