Core–Shell Microfiber Encapsulation Enables Glycerol‑Free Cryopreservation of RBCs with High Hematocrit

Cryopreservation of red blood cells(RBCs)provides great potential benefits for providing transfusion timely in emergencies.High concentrations of glycerol(20%or 40%)are used for RBC cryopreservation in current clinical practice,which results in cytotoxicity and osmotic injuries that must be carefully controlled.However,existing studies on the low-glycerol cryopreservation of RBCs still suffer from the bottleneck of low hematocrit levels,which require relatively large storage space and an extra concentration process before transfusion,making it inconvenient(time-consuming,and also may cause injury and sample lose)for clinical applications.To this end,we develop a novel method for the glycerol-free cryopreservation of human RBCs with a high final hematocrit by using trehalose as the sole cryoprotectant to dehydrate RBCs and using core–shell alginate hydrogel microfibers to enhance heat transfer during cryopreservation.Different from previous studies,we achieve the cryopreservation of human RBCs at high hematocrit(>40%)with high recovery(up to 95%).Additionally,the washed RBCs post-cryopreserved are proved to maintain their morphology,mechanics,and functional properties.This may provide a nontoxic,high-efficiency,and glycerol-free approach for RBC cryopreservation,along with potential clinical transfusion benefits.

Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion

Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice. Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference. Results In the hospitals where POC HGB/HCT device was used(n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011(39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased(n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow. Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.

Hematocrit and Slip Velocity Influence on Third Grade Blood Flow and Heat Transfer through a Stenosed Artery

A theoretical investigation concerning hematocrit and slip velocity influence on the flow of blood and heat transfer by taking into account the externally applied magnetic field has been carried out. The mathematical models considered in this work treated blood as a non-Newtonian fluid obeying the third grade fluid model. A suitable geometry of the stenosis is taken into account. Galerkin weighted residual and Newton Raphson methods are used to solve the equations that govern the flow of blood and heat transfer. Analytical expression for the velocity profile, temperature profile, volume flow rate, wall shear stress and resistance to flow were obtained. Graphical representation of results shows that the flow velocity, volumetric flow rate and shear stress increase while resistance to flow and heat transfer rate decrease when the slip velocity increases. Also, flow velocity and volume flow rate decrease while shear stress, heat transfer rate, and resistance to flow increase when the hematocrit parameter increases. Finally, increases in magnetic field parameter lead to decrease in flow velocity, flow rate and shear stress but increase the flow resistance.

Reference value of old people's hematocrit and geographical factors

This paper is written in order to provide a scientific basis for a unified standard of the reference value of Chinese healthy old people's hematocrit. It studies the relationship between the reference values of healthy old people's hematocrit, tested according to the Wintrobe Laws and five geographical factors. It is found that the altitude is the most important factor affecting the reference value of old people's hematocrit. As the altitude gradually increases, the reference value of their hematocrit also increases, the relationship is quite significant. By using the method of stepwise regression analysis, two multivariate regression equations are deduced:1=50.2+0.00248X1-0.0534X3-0.388X4+0.00383X5±2.2, 2=44.5+0.00231X1-0.0600X3-0.260X4+0.00341X5±2.1. If the geographical index values in a particular area in China are known, the reference value of old people's hematocrit in this area can be established by means of the regression equations. Furthermore, according to the dependent relationship of the reference value of old people's hematocrit on geographical factors, China can be divided into six regions: Qinghai-Tibet, Plateau, Southwest, Northwest, Southeast, North and Northeast.

Thermoacoustic assessment of hematocrit changes in human forearms

Abnormal hematocrit(Hct)is associated with an increased risk of pre-hypertension and all-cause death in general population,and people with a high Hct value are susceptible to arterial cardiovascular disease and venous thromboembolism.In this study,we report for the first time on the ability of thermoacoustic imaging(TAI)for in vivo evaluating Hct changes in human forearms.In vitro blood samples with different Hct values from healthy volunteers(n=3)were prepared after centrifugation.TAI was performed using these samples in comparison with the direct measurements of conductivity.In vivo TAI was conducted in the forearm of healthy volunteers(n=7)where Hct changes were produced through a vascular occlusion stimulation over a period of time.The results of in vitro blood samples obtained from the 3 healthy subjects show that the thermoacoustic(TA)signals changes due to the variation of blood conductivity are closely related to the changes in Hct.In addition,the in vivo TA signals obtained from the 7 healthy subjects consistently increase in the artery/muscle and decrease in the vein during venous or arterial occlusion because of the changed Hct value in their forearms.These findings suggest that TAI has the potential to become a new tool for monitoring Hct changes for a variety of pre-clinical and clinical applications.

Hematocrit level correlates with lungs resistivity in elderly patients with cardiogenic pulmonary edema

Regular monitoring of pulmonary congestion in car-diogenic pulmonary edema (CPE) patients is neces-sary for its adequate management via pharmaceuti-cal treatment. It is well known that the development of CPE is accompanied with an increase in hema-tocrit, plasma protein concentration and colloid os-motic pressure due to the decrease in the plasma volume. In the present study the mean left and right lung resistivity values taken pre- and post treatment with diuretics using a hybrid bio-impedance electri-cal impedance tomography system were correlate to the measured changes in hematocrit level. A marginal significant correlation was found between the abso-lute mean lung resistivity and hematocrit levels (Pearson’s correlation coefficient of R = 0.4, p-value = 0.057). When the change in the mean lung resistivity of a patient was plotted vs. the change in hematocrit readout, a significant linear correlation was found (R = 0.7, p-value = 0.02). These results support the validity of the resistivity measurements using bio-impedance system in monitoring changes of pulmonary edema in CPE patients.

Change and Relationship of Hematocrit and Electrocardiogram of the Crew in High Altitude Span Transportation

Objective: To investigate the effect of high altitude span transportation on the change of hematocrit and electrocardiogram of the crew in the plateau construction, and discuss their relationship. Method: By SPSS 11.0 statistical software, to treat hematocrit and electrocardiogram in the examination data of the the crew, who took part in the construction of Qinghai-Tibetan railway in 2003, before, during and after the construction. Then, we compared the data among the constructors in the fixed altitude during the same period. Result: The hematocrit of the crew slowly and continually rose to the maximum(p<0.01) after the construction in the high altitude span during one construction year, and the abnormal rate of electrocardiogram obviously decreased(p<0.05). The abnormal rate of electrocardiogram apparently improved when hematocrit reached 52% among the range from 45.12% to 52.24%, and the correlation analysis showed that the electrocardiographic change was closely and negatively correlated with the hematocrit among the range of hematocrit(p<0.05). Conclusion: Although the higher-level stress state of the crew made the hematocrit in the blood continually increase in the long-term high altitude span construction, the hematocrit reached the more reasonable hematocrit compensation and made it the optimum state of Hct in the end. As a result, the perfusion of tissues and organs was improved. The abnormal rate of electrocardiogram apparently improved because the oxygen delivery of the myocardium reached the optimum compensation.

紫绀型和非紫绀型先天性心脏病患儿的凝血参数特点

目的 凝血异常是未矫正先天性心脏病患儿的严重并发症和死亡原因,本研究旨在筛查先天性心脏病患儿凝血异常的患病率和相关因素,并比较紫绀型和非紫绀型患儿的凝血异常情况。方法 纳入年龄在0~3岁于2016年1月至2019年12月在中国医学科学院阜外医院就医的未矫正先天性心脏病患儿650例,包括245例紫绀型先天性心脏病和405例非紫绀型先天性心脏病。统计紫绀型与非紫绀型先天性心脏病患儿全血细胞计数和凝血常规检测结果,使用血小板计数、凝血酶原时间、活化部分凝血活酶时间、D-二聚体、纤维蛋白原和纤维蛋白降解产物测定值判断是否发生凝血异常。结果 紫绀型和非紫绀型先天性心脏病患儿凝血异常发生率分别是60.4%和44.7%。红细胞数、血红蛋白浓度、红细胞比容、红细胞体积分布宽度与血小板计数、凝血酶原时间、活化部分凝血酶原时间相关性具有统计学意义(P<0.05)。结论 未经矫正的先心病患儿凝血异常是常见的,相较于非紫绀型先天性心脏病患儿,紫绀型先天性心脏病患儿凝血异常更易发生。

BISAP评分、NIR、HCT及钙离子评估急性胰腺炎严重程度及预后的临床价值

目的:探讨急性胰腺严重床旁指数(BISAP)评分、中性粒细胞和淋巴细胞比(NLR)、红细胞比容(HCT)、血清钙离子(Ca^(2+))与急性胰腺炎(AP)严重程度和预后的关系。方法:选取371例AP患者为研究对象,根据病情分为轻症AP组(MAP组,n=220)、中度重症AP组(MSAP组,n=111)及重症AP组(SAP组,n=40);根据患者预后分为死亡组(n=15)和生存组(n=356)。比较不同病情患者临床资料(性别、年龄、住院时间、住院费用)及不同病情和预后患者实验室检查指标[中性粒细胞与淋巴细胞比值(NLR)、红细胞比容(HCT)、Ca^(2+)、AP严重程度床旁指数(BISAP)评分],分析实验室检查指标与AP严重程度和预后的关系。结果:不同病情患者NLR、HCT、Ca^(2+)、BISAP评分均有统计学差异(P<0.05),且随病情加重,NLR、HCT、BISAP评分均增加(P<0.05),Ca^(2+)水平均降低(P<0.05)。生存组患者NLR、HCT水平及BISAP评分均低于死亡组(P<0.05),Ca^(2+)水平高于死亡组(P<0.05)。ROC曲线分析显示,NLR、HCT、Ca^(2+)水平与BISAP评分预测AP患者预后死亡的曲线下面积(AUC)分别为0.857(95%CI:0.817~0.891)、0.842(95%CI:0.801~0.878)、0.806(95%CI:0.762~0.845)、0.870(95%CI:0.831~0.902);灵敏度分别为80.00%、66.67%、73.33%、93.33%,特异度分别为92.70%、93.26%、80.06%、76.40%,均对AP患者预后死亡有较好的预测价值(P<0.05)。结论:NLR、HCT及血清钙离子水平及BISAP评分指标均可辅助评估AP病情严重程度,并对患者预后有一定的预测价值。

静脉-动脉体外膜肺氧合启动后即刻血液稀释对心脏疾病患者器官功能和治疗策略的影响

目的 探讨心脏疾病患者在静脉-动脉体外膜肺氧合(VA-ECMO)辅助启动后血液快速稀释对器官功能改变及临床治疗策略选择的影响。方法 回顾性分析2019年1月至2023年1月于中国人民解放军总医院第一医学中心心血管内科重症监护室接受VA-ECMO辅助的50例患者的临床资料。根据VA-ECMO启动后红细胞压积(Hct)下降的程度,将患者分为Hct下降≥30%组(Hct^(Δ30%+)组,n=17)和Hct下降<30%组(Hct^(Δ30%-)组,n=33)。比较两组患者器官功能相关生物标志物、接受输血、主动脉内球囊反搏(IABP)及持续肾替代治疗(CRRT)情况。采用SPSS 25.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验、χ^(2)检验或Fisher精确检验进行组间比较。结果 Hct^(Δ30%+)组65岁及以上患者占比52.9%(9/17),Hct^(Δ30%-)组65岁及以上患者占比36.4%(12/33)。Hct^(Δ30%+)组与Hct^(Δ30%-)组患者一般临床特征及VA-ECMO辅助前临床指标比较,差异均无统计学意义(P>0.05)。在VA-ECMO启动后,肌酸激酶同工酶、天冬氨酸氨基转移酶及丙氨酸氨基转移酶的峰值在Hct^(Δ30%+)组中更高,差异均有统计学意义(P<0.05)。Hct^(Δ30%+)组与Hct^(Δ30%-)组相比,接受IABP(70.6%和36.4%)和CRRT(64.7%和18.2%)治疗的患者比例更高;Hct^(Δ30%+)组患者输注悬浮红细胞和血浆的单位数更多,差异均有统计学意义(P<0.05)。结论 VA-ECMO启动后Hct降低≥30%的患者输血量更大、器官损伤更重,采用IABP或CRRT联合辅助比例更高。VA-ECMO启动后Hct降低≥30%作为一个新的临床指标,为治疗策略的选择及改善预后提供重要参考依据。

糖化血红蛋白联合血细胞比容、甲状腺功能指标对妊娠期糖尿病的诊断价值研究

目的探讨糖化血红蛋白(HbA1c)联合血细胞比容(HCT)、甲状腺功能指标[血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]对妊娠期糖尿病(GDM)的诊断价值。方法回顾性分析200例进行早期GDM筛查的孕妇临床资料,所有孕妇均进行孕12~16周HbA1c、HCT、甲状腺功能指标检查及孕中期口服葡萄糖耐量实验(OGTT)检查。比较不同检查方法的检查结果,比较孕中期OGTT正常与异常孕妇的HbA1c、HCT、甲状腺功能指标,分析孕12~16周HbA1c、HCT、甲状腺功能指标检查对GDM的诊断敏感性及特异性。结果200例孕妇进行孕12~16周HbA1c、HCT、甲状腺功能指标检查,192例正常、正常率为96.0%,8例异常、异常率为4.0%;经孕中期OGTT检查,正常183例、正常率为91.5%,17例异常、异常率为8.5%;孕12~16周HbA1c、HCT、甲状腺功能指标检查的异常率与孕中期OGTT检查比较差异无统计学意义(P>0.05)。孕中期OGTT异常者的HbA1c(9.07±0.61)%、HCT(40.41±3.23)%、TSH(4.01±0.85)mlU/L均明显高于正常者的(4.69±0.35)%、(37.72±2.98)%、(1.95±0.78)mlU/L,FT_(3)(3.68±0.54)pmol/L、FT_(4)(10.22±1.59)pmol/L均明显低于正常者的(4.52±0.73)、(14.01±1.76)pmol/L,差异具有统计学意义(P<0.05)。以孕中期OGTT检查结果为金标准,孕12~16周HbA1c、HCT、甲状腺功能指标检查对GDM的诊断敏感性及特异性分别为41.2%和99.5%。结论HbA1c联合HCT、甲状腺功能指标对GDM的早期诊断具有较高的特异性,可作为GDM患者的诊断指标。

红细胞压积、红细胞分布宽度与妊娠期高血压疾病的关系分析

目的 本研究旨在分析红细胞压积(Hct)和红细胞分布宽度(RDW)与妊娠期高血压疾病的关系。方法 随机选取465例规律产检的孕妇进行回顾性研究分析,其中260例正常妊娠的女性作为对照组, 150例妊娠期高血压疾病孕妇作为妊娠期高血压组, 55例子痫前期孕妇作为子痫前期组。检测并比较三组孕妇的红细胞压积和红细胞分布宽度水平。结果 对照组、子痫前期组、妊娠期高血压组孕20周的血清红细胞分布宽度水平分别为(12.40±1.32)%、(14.43±1.76)%、(15.29±1.45)%,红细胞压积水平分别为(33.50±3.50)%、(34.20±3.04)%、(35.40±3.84)%;孕28周的血清红细胞分布宽度水平分别为(12.37±1.26)%、(14.55±1.56)%、(15.35±1.34)%,红细胞压积水平分别为(34.00±3.51)%、(36.00±3.21)%、(37.20±4.35)%。孕20、28周,子痫前期组、妊娠期高血压组的血清红细胞分布宽度、红细胞压积水平与对照组相比显著升高,且子痫前期组高于妊娠期高血压组,差异有统计学意义(P<0.05)。对照组、子痫前期组、妊娠期高血压组孕20、28周的红细胞分布宽度、红细胞压积水平组内比较,差异均无统计学意义(P>0.05)。结论 妊娠期高血压疾病、子痫前期孕妇的红细胞压积水平和红细胞分布宽度水平与正常妊娠妇女存在显著差异,可以作为妊娠期高血压疾病的辅助诊断指标,有助于早期进行疾病识别和干预。

Postoperative Changes in Hemoglobin and Hematocrit in Patients Undergoing Primary Total Hip and Knee Arthroplasty

INTRODUCTION Total hip arthroplasty （THA） and total knee arthroplasty （TKA） are currently two effective treatments for many diseases of the hip and knee. Despite the ability to minimize intraoperative blood loss, postoperative hemoglobin （Hgb） loss is expected, and a number of studies have reported on hidden blood loss after THA and TKA.

红细胞比容、血流S/D比值及同型半胱氨酸在妊娠期糖尿病患者中的表达及对妊娠结局的影响

目的探究红细胞比容、血流S/D比值及同型半胱氨酸在妊娠期糖尿病患者中的表达及对妊娠结局的影响。方法选取我院2021年1月~2023年1月纳入的86例妊娠期糖尿病患者为研究组,另外选取同时期86例妊娠期健康孕妇作为对照组,分别对两组孕妇以及研究组不同疾病严重程度孕妇之间的红细胞比容、血流S/D比值、同型半胱氨酸表达水平进行比较,观察记录两组孕妇不良妊娠结局的发生情况。结果研究组孕妇的红细胞比容明显低于对照组,血流S/D比值及同型半胱氨酸表达水平均明显高于对照组,差异有统计学意义(P<0.05);轻度、中度、重度妊娠期糖尿病患者的红细胞比容、血流S/D比值及同型半胱氨酸水平存在明显差异,且随着疾病严重程度的增高,红细胞比容越低,血流S/D比值及同型半胱氨酸水平越高,差异有统计学意义(P<0.05);研究组孕妇的不良妊娠结局总发生率明显高于对照组,差异有统计学意义(P<0.05)。结论红细胞比容、血流S/D比值及同型半胱氨酸在妊娠期糖尿病患者中的表达水平异于健康孕妇,同时还与孕妇的妊娠结局存在一定的关联,血流S/D比值及同型半胱氨酸较高水平的表达与红细胞比容较低的情况增加了妊娠期糖尿病孕妇不良妊娠结局的发生率。

Hematocrit is associated with in-hospital mortality in sepsis with streptococcus pneumoniae infection based on MIMIC-Ⅳ database

Background Streptococcus pneumoniae,as a respiratory tract common pathogen,can cause invasive disease and sepsis.This study aimed to investigate the association of factors with clinical outcomes in sepsis with streptococcus pneumoniae infection based on MIMIC-IV database.Methods The sepsis patients with streptococcus pneumoniae infection were included.Different variables between the survivor group and the non-survivor group were analyzed.Multivariable logistic regression was applied to identify the factors which were associated with clinical outcomes.Results A total of 80 sepsis patients with streptococcus pneumoniae infection were included.The in-hospital mortality was 23.75%(n=19).Significant differences were found in heart rate,white blood cell,RDW,MCV and hematocrit between the survivor group and the non-survivor group.The area under the ROC curve of hematocrit was 0.758 with a sensitivity of 73.7%and a specificity of 72.1%.The cut-off value of hematocrit was 30.8%.Conclusions Hematocrit level was identified to be negatively associated with in-hospital mortality in sepsis with streptococcus pneumoniae infection.

高甘油三酯血症性急性胰腺炎患者血清肌酐、PLT和HCT水平与病情严重程度和预后的关系

目的分析高甘油三酯血症性急性胰腺炎(HLAP)患者血清肌酐、血小板压积(PLT)和红细胞压积(HCT)水平与病情严重程度及其预后的关系。方法回顾性选取2019年2月至2021年3月遂宁市中心医院收治的108例HLAP患者作为研究对象,按照病情程度分为轻症组(n=68)、中度重症组(n=24)与重症组(n=16),并根据患者预后情况分为预后良好组(n=72)与预后不良组(n=36)。检测不同病情程度、不同预后的HLAP患者血清肌酐、PLT、HCT水平;分析病情程度与肌酐、PLT、HCT相关性,以及血清肌酐、HCT与PLT间的相关性;并以Logistic回归模型分析影响HLAP患者预后的相关因素。结果重症组血清肌酐、HCT水平分别为(169.28±21.73)μmol/L、0.42±0.06,均高于轻症组[(72.49±10.46)μmol/L、0.31±0.05]与中度重症组[(125.87±19.45)μmol/L、0.38±0.04],中度重症组高于轻症组,差异均有统计学意义(P<0.05);重症组PLT为0.09±0.01,低于轻症组(0.14±0.02)与中度重症组(0.12±0.02),中度重症组低于轻症组,差异均有统计学意义(P<0.05)。HLAP患者病情程度与血清肌酐、HCT呈正相关(P<0.05),与PLT呈负相关(P<0.05);血清肌酐、HCT与PLT呈负相关(P<0.05),血清肌酐与HCT呈正相关(P<0.05)。预后不良组血清肌酐、HCT均分别为(172.63±30.45)μmol/L、0.45±0.06,均高于预后良好组[(61.72±11.06)μmol/L、0.37±0.06],PLT为0.08±0.01,低于预后良好组(0.15±0.02),差异均有统计学意义(P<0.05)。Logistic回归分析发现,血清肌酐、HCT为患者预后危险因素(P<0.05),PLT为预后保护因素(P<0.05)。结论血清肌酐、PLT、HCT与HLAP病情程度密切相关,且均为患者预后独立影响因素,其检测可为HLAP诊治及预后评估提供重要依据。

罗沙司他联合多糖铁复合物对慢性肾脏病合并肾性贫血患者贫血状态及铁代谢相关指标的影响

目的:探讨罗沙司他联合多糖铁复合物对慢性肾脏病(CKD)合并肾性贫血患者贫血状态及血清转铁蛋白(TRF)、血清铁蛋白(SF)及转铁蛋白饱和度(TSAT)的影响。方法:选取2020年8月-2021年8月肇庆市第一人民医院收治的82例CKD合并肾性贫血患者,按随机数字表法将其分为对照组(41例)和观察组(41例)。对照组给予重组人促红素(rHuEPO)联合多糖铁复合物治疗,观察组给予罗沙司他联合多糖铁复合物治疗,两组患者均持续治疗8周。比较两组治疗前后贫血指标、铁代谢指标、脂代谢指标水平及治疗期间的不良反应发生情况。结果:与治疗前比较,治疗后两组患者的血浆红细胞计数(RBC)、血红蛋白(Hb)及红细胞压积(Hct)及血清TRF、SF、TSAT水平均升高,且观察组均高于对照组;与治疗前比较,治疗后两组患者血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均下降,且观察组均低于对照组(P<0.05)。观察组不良反应发生率为9.76%,低于对照组的34.15%,差异有统计学意义(P<0.05)。两组治疗后血清高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P>0.05)。两组治疗后血清高密度脂蛋白胆固醇(HDL-C)水平与治疗前比较,差异均无统计学意义(P>0.05)。结论:罗沙司他可有效纠正CKD合并肾性贫血患者的贫血状态,改善机体铁代谢和脂代谢,且安全性较高。

膝关节镜术中使用止血带对肌酸激酶等血生化及血常规指标的影响

目的检测膝关节镜手术中止血带的使用对围手术期血红蛋白变化、肝肾功能以及肌酸激酶等指标的影响,以评估止血带使用对检验学指标的影响。方法对2020年1月至2021年12月间我院因膝关节半月板损伤接受膝关节镜手术的患者进行了回顾性分析,其中止血带组88例,无止血带组56例。对患者的基线数据、术前及术后第一天的血红蛋白(HGB)及红细胞压积(HCT)差值、术前及术后第一天谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、肌酸激酶(CK)及肌酸激酶同工酶MB(CK-MB)进行测定并行统计学分析,以P<0.05为差异有统计学意义。结果两组间的手术前后HGB及HCT差值差异无统计学意义(P>0.05)。术前两组患者的CK水平差异无统计学意义,术后止血带组的CK水平明显高于非止血带组,异常患者比例也明显高于非止血带组(P<0.05)。两组间术前及术后的ALT、AST、Cr、CK-MB水平差异无统计学意义。结论止血带的使用并不能减少围手术期失血程度,且可导致术后CK的明显升高,提示其造成了一定程度的肌肉损伤。

创伤性失血病人输血前后血细胞比容和酸碱度变化及其与凝血功能的关系分析

目的:探讨创伤性失血病人输血前后血细胞比容(HCT)和酸碱度(pH)变化及其与凝血功能的关系。方法:选取创伤性失血病人102例进行前瞻性研究临床实验,采用血凝仪检测各组HCT、pH指标,采用血栓弹力图仪检测凝血反应时间(R)、凝固角(a-Angle)和血栓最大幅度(MA);采用Pearson回归分析检验输血前后的HCT、pH与R、a-Angle、MA值与凝血功能的相关性。结果:输血前,A、B、C组HCT、pH、纤维蛋白原(Fib)、a-Angle值、MA值比较,A组<B组<C组(P<0.05);凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、R值比较,A组>B组>C组(P<0.05);输血后,A、B、C组各凝血指标差异均无统计学意义(P>0.05),且较输血前均有所改善(P<0.05)。输血前,pH、a-Angle值、MA值:D组<E组<F组(P<0.05);PT、TT、APTT、R值:D组>E组>F组;pH值F组<G组,R值F组>G组(P<0.05~P<0.01),F组和G组的a-Angle值、MA值、PT、TT、APTT、R值差异无统计学意义(P>0.05),D、E、F组的Fib值差异均无统计学意义(P>0.01),且均小于G组(P<0.05~P<0.01);输血后D、E、F、G组的pH、Fib、PT、TT、APTT、R值、a-Angle值、MA值差异无统计学意义(P>0.05),且较输血前显著改善,组内比较差异有统计学意义(P<0.05)。HCT、pH水平越高,创伤性失血病人的ICU住院时间、出血时间越短(P<0.05~P<0.01)。Pearson相关分析发现,HCT和pH(<7.45)同PT、TT、APTT、R值、住院时间、出血时间等凝血指标呈负相关关系(P<0.01),同Fib、a-Angle值、MA值等凝血指标呈正相关关系,且HCT、pH在创伤性失血的凝血指标同样呈正相关关系(P<0.01)。结论:创伤性失血病人的凝血功能障碍的严重程度与HCT、pH下降有关,且HCT水平越低,酸中毒的发生率越高、预后越差,故做好输血前后的HCT、pH检测对创伤性失血的临床诊治十分必要,二者也是影响其凝血功能的重要指标。

红细胞压积对便携式血糖仪检测结果的影响及其外部校正的可行性评估

目的 探讨红细胞压积(hematocrit, HCT)对便携式血糖仪检测结果的影响,并评估通过HCT值外部校正提高便携式血糖仪检测结果准确性的可行性。方法 收集70份肝素钠抗凝静脉血标本,调整其血糖水平和HCT后,分别使用3种便携式血糖仪(以仪器A、仪器B、仪器C表示)和生化分析仪检测其血糖水平,评估每台便携式血糖仪检测结果的绝对偏差或相对偏差与标本HCT值的相关性,并通过HCT值对便携式血糖仪的检测结果进行外部校正,评估其检测结果外部校正前后与生化分析仪检测结果的可比性。合格率≥95%,表示为可比性合格的仪器。结果 共65份标本纳入研究,HCT<35%时,仪器A、B、C的合格率依次为100.00%、16.67%、41.67%;35%≤HCT≤55%时,仪器A、B、C的合格率依次为100.00%、100.00%、89.47%;HCT>55%时,仪器A、B、C的合格率依次为96.92%、38.46%、53.85%。与生化分析仪的检测结果比较,仪器A的检测结果具有可比性,而仪器B和C则不具有可比性,且HCT<35%或HCT>55%时,仪器B和C检测结果的绝对偏差或相对偏差与标本HCT值存在高度相关性。HCT值外部校正前,仪器仪器A、仪器B和仪器C的总体合格率分别为96.92%、38.46%、53.85%;外部校正后,其总体合格率分别为33.85%、81.54%、76.92%,与校正前的总体合格率比较,差异均具有统计学意义(P<0.01)。结论 标本HCT值偏低或偏高将影响部分便携式血糖仪检测结果的准确性,故便携式血糖仪临床应用前应进行抗HCT干扰能力评价,并根据评价结果及其所服务人群来选择适宜的便携式血糖仪,必要时,可通过HCT值外部校正的方法来提高便携式血糖仪检测结果准确性。