目的 分析反復發作的抗凝血類滅鼠藥所致獲得性凝血功能障礙的臨床特點，探討其診治方案。方法 對2009年3月－2010年12月收治的3例抗凝血類滅鼠藥所致獲得性凝血功能障礙患者的臨床表現、實驗室檢查和治療轉歸進行分析，并復習相關文獻。 結果 3例患者均以同時出現多部位出血為首發表現，經應用維生素K1、凝血酶原復合物、新鮮冰凍血漿、冷沉淀等治療，患者病情好轉，實驗室指標恢復正常。停藥（2、5周，3個月）后再次出現多部位出血，再給予維生素K1等治療，病情可緩解。 結論 維生素K1可作為首選的治療藥物，且對反復發作的患者同樣有效。為避免再發性出血，應維持治療至少3個月。
There is a close relationship between inflammation and coagulation response. Inflammation and coagulation are activated simultaneously during cardiopulmonary bypass, which induce postperfusion syndrome. Leukocyte depletion filter can inhibit inflammation by reducing neutrophils in circulation. But, its effects on blood conservation are limited. Aprotinin is a serine protease inhibitor, and can prevent postoperative bleeding by anti-fibrinolysis and protection of platelet function. But its effects on anti-inflammation and protection of organs are subjected to be doubted. The combination of leukocyte depletion filter and aprotinin can inhibit inflammation as well as regulate coagulation, and may exert a good protective action during cardiopulmonary bypass.
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.
The evaluation of blood compatibility of biomaterials is crucial for ensuring the clinical safety of implantable medical devices. To address the limitations of traditional testing methods in real-time monitoring and electrical property analysis, this study developed a portable electrical impedance tomography (EIT) system. The system uses a 16-electrode design, operates within a frequency range of 1 to 500 kHz, achieves a signal to noise ratio (SNR) of 69.54 dB at 50 kHz, and has a data collection speed of 20 frames per second. Experimental results show that the EIT system developed in this study is highly consistent with a microplate reader (R2=0.97) in detecting the hemolytic behavior of industrial-grade titanium (TA3) and titanium alloy—titanium 6 aluminum 4 vanadium (TC4) in anticoagulated bovine blood. Additionally, with the support of a multimodal image fusion Gauss-Newton one-step iterative algorithm, the system can accurately locate and monitor in real-time the dynamic changes in blood permeation and coagulation caused by TC4 in vivo. In conclusion, the EIT system developed in this study provides a new and effective method for evaluating the blood compatibility of biomaterials.
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。
Severe trauma is a challenging medical problem. Uncontrolled post-traumatic hemorrhage and traumatic coagulation dysfunction are closely related to the prognosis of these patients. In May 2019, the pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma published the fifth edition of the European guideline on management of major bleeding and coagulopathy following trauma. To assist Chinese in better understanding of the latest developments, this paper translated the main treatment recommendations in the guideline and interpreted the updated content from the fourth edition.
目的 采用已有的4種國際非孕彌散性血管內凝血（DIC）診斷評分標準對產科DIC的診斷進行評估，探索更適合產科DIC診斷的“金標準”。 方法 選擇2009年6月－2012年6月期間產科擬診DIC的孕產婦為研究對象，用日本衛生福利部（JMHW）提出的JMHW、日本危重病協會（JAAM）提出的JAAM、國際血栓與止血委員會（ISTH）提出的ISTH顯性和ISTH非顯性4種診斷評分標準聯合診斷和構建“金標準”，以此評價4種診斷標準對產科DIC診斷的特性。 結果 受試者工作特征（ROC）曲線分析顯示ISTH非顯性標準、ISTH顯性標準、JMHW、JAAM的ROC曲線下面積分別為0.939、0.865、0.867、0.867，ISTH非顯性標準靈敏度和特異度與“金標準”在不同診斷界值時較一致，同時優于其他3種診斷標準。 結論 ISTH非顯性標準較適合作為臨床產科DIC診斷，其對產科這一特殊發病人群的DIC診斷具有更科學的臨床診斷價值。
Objective To evaluate the predictive value of lactate dehydrogenase (LDH) to albumin (Alb) ratio (LAR) in the prognosis of severe pneumonia patients complicated with DIC. Methods A total of 312 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University from January 1, 2018 to March 1, 2023 were retrospectively collected. The clinical parameters, such as gender, age, underlying diseases, and lactate dehydrogenase, albumin etc. l of the first test on admission were collected. LAR, sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) within 24 hours were calculated. The firstly endpoint of the study was the incidence of disseminated intravascular coagulation (DIC), the secondary endpoint was the 30-day in-hospital mortality in severe pneumonia patients with DIC. Univariate and multivariate logistic regression were used to analyze the risk factors of severe pneumonia with DIC. The receiver operating characteristic curve (ROC curve) was drawn and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of LAR for the incidence of DIC in patients with severe pneumonia. Results The level of LAR was higher in the severe pneumonia patients with DIC than the severe pneumonia patients without DIC [LAR median ratio 12.72 (8.72, 21.89) vs. 7.23 (5.63, 10.90), P<0.001]. Multiple logistic regression analysis showed that LAR [OR=1.071, 95%CI 1.038 - 1.106, P<0.001] was the independent risk factor of the incidence of DIC in the patients with severe pneumonia. ROC curve analysis showed that the AUC for LAR to predict the incidence of DIC was 0.723, 95%CI 0.650 - 0.796, P<0.001. When the LAR cut-off value was 8.08, the sensitivity was 79.7% and the specificity was 56.1%. Kaplan-Meier survival analysis curve showed that the patients in the above LAR cut-off value group had a significantly lower 30-day survival rate than those in the below LAR cut-off value group (P<0.001). In the subgroup analysis and numerical variable transformed analysis, LAR was still the risk factor of DIC. Conclusion The increased LAR is a high risk factor of the incidence of DIC and mortality in patients with severe pneumonia, which is useful for predicting prognosis of patients with severe pneumonia.
目的:觀察凝血酶霧化吸入聯用酚妥拉明治療肺結核頑固性咯血的臨床效果。方法:將47例住院肺結核頑固性咯血患者隨機分為兩組,治療組采用凝血酶超聲霧化吸入聯用酚妥拉明靜滴,對照組采用垂體后葉素靜滴。結果:治療組總有效率87.50%,對照組總有效率86.96%。結論:在常規止血治療無效的基礎上,加用凝血酶超聲霧化吸入聯用酚妥拉明止血快,副作用少,是治療肺結核頑固性咯血的有效藥物。