灯盏细辛注射液对颅脑损伤后凝血相关因子的影响

目的:观察灯盏细辛注射液对急性颅脑损伤患者血液中凝血相关因子的影响。方法:选取急性颅脑损伤后住院治疗的患者83例,随机分为治疗组42例与对照组41例,对照组给予常规治疗,治疗组在对照组的基础上加用灯盏细辛注射液静脉滴注,每日1次,连续用药14天。动态监测患者部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体的变化。结果:急性颅脑损伤后患者的部分凝血活酶时间延长、凝血酶原时间延长、但D-二聚体下降。结论:急性颅脑损伤后早期应用灯盏细辛注射液治疗,对患者凝血相关因子的水平产生影响,可以有效地预防颅脑损伤后微血栓的形成,改善患者的预后。

凝血功能检验在心脑血管疾病预后评估中的应用效果

目的探讨凝血功能检验在心脑血管疾病预后评估中的应用效果。方法选取2018年4月至2020年10月灵宝市第一人民医院收治的心脑血管疾病患者56例作为研究组,选取同期来本院进行健康体检者56例作为对照组;将研究组按预后情况再分为2组:预后良好组39例和预后致残组17例。两两比较4组凝血功能水平[活化部分凝血活酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、凝血酶原时间(PT)],随后进行多因素Logistic回归分析。结果与对照组比较,研究组APTT、TT、PT水平显著降低,FIB水平显著升高,差异有统计学意义(均P<0.001);与预后致残组比较,预后良好组APTT、TT、PT水平显著升高,FIB水平显著降低,差异有统计学意义(均P<0.05);Logistic回归分析显示,APTT、TT、PT低表达,FIB高表达是影响心脑血管疾病患者预后的独立危险因素(均P<0.001)。结论凝血功能检验可用于心脑血管疾病患者预后评估,为疾病治疗提供一定参考依据,具有较为积极的临床意义。

内镜下金属钛夹对急性非静脉曲张性上消化道出血患者PT、APTT水平的影响

目的探讨内镜下金属钛夹对急性非静脉曲张性上消化道出血患者PT、APTT水平的影响。方法选取万宁市人民医院2018年1月至2020年1月收治的105例急性非静脉曲张性上消化道出血患者,采用随机数字表法分为对照组(n=52,内镜下注射药物止血治疗)和观察组(n=53,内镜下金属钛夹治疗)。比较两者患者治疗后临床疗效、临床指标及并发症、不良事件的发生情况;检测治疗前后两组患者凝血功能和炎性因子指标。结果观察组患者肠鸣音恢复时间、平均止血时间、住院时间短于对照组,输血量低于对照组;与治疗前比,两组患者治疗后血清hs-CRP水平均降低,PT、APTT均缩短,且观察组患者血清hs-CRP水平低于对照组;PT、APTT短于对照组;观察组患者不良事件总发生率低于对照组,临床治疗总有效率高于对照组(均P<0.05)。结论相较于注射止血治疗方法,内镜下金属钛夹治疗急性非静脉曲张性上消化道出血效果显著,并能够抑制机体炎症反应,改善凝血功能。

桃红四物汤联合低分子肝素钙预防Pilon骨折术后深静脉血栓形成随机平行对照研究

[目的]观察桃红四物汤联合低分子肝素钙预防Pilon骨折术后深静脉血栓形成效果。[方法]使用随机平行对照方法,将30例住院患者按病志号抽签方法简单随机分两组;术前均牵引治疗,肿胀消退软组织条件好转行切开复位内固定术;多腔室空气压力治疗仪对患肢足、小腿中上段、大腿多室交替使用,避开骨折踝关节周围,2h/d。对照组15例LMWH,脐周皮下注射5000U/12h,直至术后第10天。治疗组15例桃红四物汤(桃仁、红花各10g,熟地黄、白芍、当归、川芎各15g),1剂/d,水煎300m L,早晚口服;西药治疗同对照组。连续治疗10d为1疗程。观测临床症状、动态监测凝血酶原(PT)、活化部分凝血活酶时间(APTT)、血小板计数、不良反应。治疗1疗程,判定疗效。[结果]PT、APTT、血小板检测结果两组均有改善(P<0.05),两组间无明显差异(P>0.05)。静脉血栓总发病率治疗组低于对照组(P<0.05)。[结论]桃红四物汤联合低分子肝素钙预防Pilon骨折术后深静脉血栓形成,疗效满意,无严重不良反应,值得推广。

In-vitro anticoagulant activity of fucoidan derivatives from brown seaweed Laminaria japonica

Fucoidan, a group of sulfated heteropolysaccharides, was extracted from Laminaria japonica, an important economic alga species in China. The anticoagulant activity of fucoidan and its derivatives (including sulfated, phosphorylated, and aminated fucoidan) was examined using in-vitro anticoagulant systems. The correlation between chemical variations within the fucoidan group and anticoagulant activity was determined. The in-vitro anticoagulant properties of fucoidan and its derivatives were determined by measuring activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT). The results indicate anticoagulant activity in all samples using APTT and TT assays; however, only the fucoidan derivatives affected the PT assay. Thus, the fucoidan derivatives were able to inhibit both intrinsic and extrinsic blood coagulants. Fucoidan (FPS) and its derivatives presented better anticoagulant activity than low molecular weight fucoidan (DFPS) and its derivatives, suggesting that molecular weight and proper conformation are contributing factors for anticoagulant activity of polysaccharides. Amino groups have a positive charge and can thus change the charge density of fucoidan. Accordingly, among the tested samples, aminated fucoidan (NF) was the most active reflecting the importance of charge density for anticoagulant activity. Available data obtained using in-vitro models suggest that the sulfate content, sulfate/total-sugar ratio, molecular weight, and the substituted group of fucoidan are important factors for anticoagulant activity but that the influence of sulfate, phosphate and amino groups on anticoagulant activity was different.

Sulfated polysaccharides with antioxidant and anticoagulant activity from the sea cucumber Holothuria fuscogliva

Sea cucumber is a traditional nutritional food and medicinal resource with many bioactive components in China. Holothuriafuscogliva is a big sea cucumber with a rich of bioactive polysaccharides. To investigate the bioactivities of the polysaccharides from sea cucumber H. fuscogliva, we prepared the sulfated polysaccharides （HfP） from sea cucumber H. fuscogliva using a protease hydrolysis method. Antioxidant activities of HfP were investigated, including hydroxyl radical scavenging activity and superoxide radical scavenging activity. And, the anticoagulant activities of HfP were studied, including the activated partial thromboplastin time （APTT）, prothrombin time （PT） and thrombin time （TT）. The average molecular weight was 1 867.1 Da, with a sulfate content of 20.7%. In addition, the molar ratio of monosaccharide composition of HfP was Man： Rha： Glc A： Glc： Gal： Xyl： Fuc=0.083 6： 0.437： 0.134： 0： 1.182： 0.748： 1. It had a strong antioxidant activity, the hydroxyl and superoxide radical scavenging activity ECs0 of HfP was 3.74 and 0.037 mg/mL, respectively. It also showed a good anticoagulant activity in our study. The APTT of HfP was much higher than that of heparin sodium, and the PT and TT of HfP was close to that ofheparin sodium at a low concentration. Therefore, HfP shows a good antioxidant and anticoagulant activity and it may become a potential candidate of the natural antioxidant and anticoagulant and will have a good application future in health product or medicine industry.

Open Surgical Insertion of Tenkchoff Straight Catheter Without Guide Wire

Objective To compare the clinical outcomes of open surgical peritoneal dialysis catheter （PDC） insertion with guide wire and the outcomes of PDC insertion without guide wire. Methods Data of the patients receiving open surgical Tenkchoff straight catheter insertion in our department from January 2005 to January 2011 were retrospectively analyzed. The 117 patients in whom PDC insertion was conducted with the guidance of guide wire were enrolled into group A, and the 121 cases receiving PDC insertion without guide wire were enrolled into group B. The incidences of post-operative complications （catheter obstruction, catheter displacement, bloody dialysate, and dialysate leakage）, catheter survival, and patient survival rates were compared between the 2 groups. Results The baseline characteristics （gender, age, body mass index, prothrombin time, activated partial thromboplastin time, platelet count, serum creatinine, follow-up time, primary diseases, and outcomes） of the 2 groups were comparable （all P〉0.05）. In post-operative complications, only the incidence of early bloody dialysate showed significant difference, being 16.2% in group A and 7.4% in group B （P=0.04）. Catheter and patient survival rates were not significantly different between the two groups. Overweight patients showed a higher incidence of catheter obstruction compared with normal weight patients [16.0% （4/25） vs. 3.3% （7/213）, P=0.02], but no differences in post-operative between the 2 groups. complications were found among overweight patients Conclusions Open surgical Tenkchoff straight catheter insertion without guide wire does not lead to higher risk of post-operative complications and catheter removal. It may be an alternative option when guide wire is not available.

Anticoagulation early after mechanical heart valve replacement

Objective： To explore the changes of coagulation activity and the characters of anticoagulation early after mechanical heart valve replacement. Methods： All patients only took warfarin orally for anticoagulation. The predicted international normalized ratio （INR） was 1.5 to 2.0. Several coagulation markers were monitored early after valve replacement. Complications associated with anticoagulation were recorded and analyzed. The patients were divided into three groups based on the number and position of mechanical valve prothesis, including group M （mitral valve replacement）, group A （aortic valve replacement） and group D （mitral and aortic valve replacement）.Comparison was made between the three groups. Results： Three events of mild cerebral embolism and five events of mild bleeding occurred during the early postoperative period. One patient suffered from mild cerebral embolism on the 4th day after operation, accompanied by large volume of pericardial drainage. Two patients with bleeding had lower INRs than predicted range. However, INR in one patient with mild cerebral embolism was in the predicted range. There was no significant difference in thrombo time （TT）, activated partial thromboplastin time （APTT） and 1NR on the 3rd day after operation compared to those before operation; meanwhile, plasma fibrinogen （FIB） concentration was higher than that before operation （P〈0.05）. 1NR had no significant changes on the 2nd day after the beginning of anticoagulation compared to that before operation; however, 1NR was significantly elevated on the 4th day （P〈0.05）. Warfarin doses and INRs were similar among the three groups, but FIB concentrations in plasma were higher in groups M and D than in group A （P〈0.01）. Conclusion： Hypercoagulabale state exists early after mechanical heart valve replacement. When anticoagulation begins is determined by the change of coagulation markers, not by the volume of chest or pericardial drainage. INR can not accurately reflect the coagulation state sometimes, especially during the first 3 days after anticoagulation. The number and position of mechanical valve prothesis could affect coagulation state. Therefore, anticoagulation therapy should be regulated accordingly.

临产孕妇凝血四项指标检测的应用分析和临床价值

探究临床孕妇开展纤维蛋白原(Fibrinogen,Fib)、凝血酶时间(Thrombin time,TT)、活化部分凝血活酶时间(Activated partial thromboplastin time,APTT)以及凝血酶原时间(Prothrombin time,PT)指标检测的作用。方法:选择本院收治的385例临产孕妇为试验组,研究启动于2021年1月,结束在2022年2月。另选择同时期且相同年龄段的健康体检女性300例作为常规组,常规组女性均未妊娠。全部女性均开展血常规和凝血四项检查,其中试验组孕妇分别在临产前以及临产后进行凝血四项检查。对比两组女性凝血四项指标水平以及血常规指标水平;对比试验组孕妇临产前以及临产后凝血四项指标水平。结果:试验组女性Fib水平高于常规组,TT、APTT以及PT水平均低于常规组(P<0.05)。试验组女性血红蛋白以及红细胞计数水平均低于常规组,白细胞计数水平高于常规组(P<0.05)。试验组孕妇临产后Fib水平低于临产前,TT、APTT以及PT水平均高于临产前(P<0.05)。结论:针对临产孕妇开展凝血四项检查,能够有效判断孕妇出血和血栓风险,进行血常规检查则可提示感染等风险,可为临床医护人员制定针对性干预措施提供参考,发挥一定效果。