血栓弹力图指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性分析

目的:探讨血栓弹力图(TEG)指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性。方法:选取2017年1月-2019年3月在我院收治的食管癌手术治疗需输血的99例患者作为研究对象,将99例患者随机分为常规凝血功能检测组和TEG组,常规凝血功能检测组采用常规凝血实验检查结果指导输血,TEG组采用TEG检查结果指导输血,对比两组输血前后的常规凝血实验检测指标以及临床用血量,对比TEG组输血前后的TEG指标,分析TEG指标与常规凝血实验检测指标的相关性。结果:两组患者输血前凝血四项和血小板计数(PLT)差异无统计学意义(P>0.05),输血后两组活化凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)均有不同程度的改善(P<0.05),TEG组PT、TT较常规凝血功能检测组低(P<0.05);输血后,TEG组患者凝血反应时间(R值)、血凝块形成时间(K值)较输血前降低,最大血凝块强度(MA值)、凝血综合指数(CI值)升高,凝血形成速率(Angle角)增大,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,R值与APTT呈正相关(P<0.05),K值与PLT呈负相关,与FIB呈正相关(P<0.05),Angle角、MA值、CI值与FIB、PLT呈正相关(P<0.05);TEG组新鲜冰冻血浆、冷沉淀输注量少于常规凝血功能检测组,差异有统计学意义(P<0.05)。结论:TEG能更好地指导食管癌手术患者各种血液成分的合理输注,有效改善凝血异常情况,减少输血用量,TEG指标与常规凝血实验检测指标存在一定的相关性。     

血栓弹力图评估胃癌患者围手术期凝血状态的应用研究

目的:探讨血栓弹力图评估胃癌患者围手术期凝血状态的临床应用价值。方法:选择2013年8月至2016年8月在我院进行治疗的胃癌患者80例作为观察组,同时选择同期在我院治疗的胃部良性疾病患者80例作为对照组。采用TEG评估两组患者的凝血功能,并且与常规凝血检查比较,分析两种凝血评估方法的准确率。结果:Ⅰ期胃癌患者的TEG各指标与对照组相比差异无统计学意义(P0.05),Ⅱ期胃癌患者的R值、K值、MA值以及CI值与对照组比较差异显著,具有统计学意义(P0.05),Ⅲ和Ⅳ胃癌患者的TEG各指标与对照组相比差异显著,具有统计学意义(P0.05);发生淋巴结转移的胃癌患者TEG各指标与对照组相比差异显著,具有统计学意义(P0.05),而没有发生淋巴结转移的患者与对照组相比差异无统计学意义(P0.05);进展期胃癌患者的TEG各指标与对照组比较差异显著,具有统计学意义(P0.05),而早期胃癌的TEG各指标与对照组差异不显著(P0.05);观察组患者治疗后,TEG检测血液发生低凝状态的检出率77.23%,常规检出率是46.15%;54例非出血患者中,TEG检出血液非凝状态的检出率为94.44%,常规检出率为77.78%。两种检测方法的检出率比较差异具有统计学意义(P0.05)。结论:胃癌患者的血液处于高凝状态,且高凝状态与病情发展的恶性程度呈正相关,TEG评估胃癌患者围术期的凝血状态较常规凝血检验更准确。     

血栓弹力图联合凝血指标评估脓毒症病情严重程度的临床价值分析

目的:探讨血栓弹力图(TEG)联合常规凝血指标评估脓毒症病情严重程度的临床价值。方法:选取2015年11月-2016年11月兰州军区兰州总医院重症医学科收治的重症感染患者97例为研究对象。依据脓毒症3.0将患者分为脓毒症(Sepsis)组(67例)、脓毒症休克(Septic Shock)组(30例)。完善相关检查后,检测和比较两组常规凝血功能指标(活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-D)),描绘TEG(血凝时间(R)、血块成型时间(K)、α角、血块强度(MA))的差异及以上指标之间的相关性。结果:脓毒症休克组PT、APTT、FIB和D-D水平均较脓毒症组显著升高(P0.05),R、K均较脓毒症组显著缩短(P0.05),而α角、MA均较脓毒症组显著增大(P0.05)。TEG中R值、K值与PT、APTT呈正相关(r=0.439、0.267、0.379、0.136),与FIB、D-D呈负相关(r=-0.397、-0.671、-0.628、-0.534);α角、MA值与PT、APTT呈负相关(r=-0.127、-0.238、-0.459、-0.213),与FIB、D-D呈正相关(r=0.386、0.53、0.687、0.652)。结论:TEG联合凝血指标可较真实地判断脓毒症患者凝血纤溶状态,为脓毒症患者病情严重程度的判断提供更可靠的依据。     

血栓弹力图测定结果的比对研究

目的:探讨裕泽毅血栓弹力图仪与美国血计公司TEG血栓弹力图仪检测结果相关性,可信度与优劣。方法:根据美国NCCLS-EP9-A,从我院随机抽取60例病人,分别取静脉血2ml、枸橼酸抗凝处理充分混匀后进行测定。用裕泽毅血栓弹力图仪与TEG血栓弹力图仪及两家公司生产的试剂进行平行交叉测定,观察其相关性。结果:美国血技公司TEG血栓弹力图仪对于两家公司的试剂检测结果高度相关(r0.8);裕泽毅公司血栓弹力图仪和试剂对于TEG血栓弹力图仪和试剂检测结果高度相关(r0.8)。结论:裕泽毅公司机器和试剂可以替代TEG机器和试剂进行血栓弹力图检测,能为临床医生提供可靠、准确、有价值的诊断指导依据。     

不同抗凝策略对急性多发性创伤伴下肢骨折患者DVT和肺栓塞发生率的影响

目的:探讨不同抗凝策略对急性多发性创伤伴下肢骨折患者下肢深静脉血栓(DVT)和肺栓塞发生率的影响。方法:将2017年1月～2017年12月我院收治的200例急性多发性创伤伴下肢骨折患者按照随机数表法分为观察组和对照组,每组各100例。对照组予以低分子肝素钙,观察组予以利伐沙班。随访1月,比较两组患者DVT、肺栓塞的发生情况,术前、术后1 d、术后5 d血栓弹力图指标、血液流变学的变化,术中失血量、术后引流量及者用药不良反应的发生情况。结果:①随访1月,观察组DVT的发生率显著低于对照组(P0.05),两组肺栓塞的发生率对比差异无统计学意义(P0.05);②术后1 d时,两组R时间、K时间均短于术前(P0.05),α角、MA值、中切全血粘度、低切全血粘度、血浆粘度均高于术前(P0.05),但两组以上指标组间对比差异无统计学意义(P0.05);术后5 d时,两组R时间、K时间均长于术前1 d时(P0.05),α角、MA值、中切全血粘度、低切全血粘度、血浆粘度均低于术前1 d时(P0.05),且观察组以上指标改变幅度均大于对照组(P0.05);③两组术中失血量、术后引流量、不良反应发生率对比差异无统计学意义(P0.05)。结论:利伐沙班和低分子肝素钠均有利于改善急性多发性创伤伴下肢骨折患者血液流变学和凝血功能,但前者效果更佳,更有利于降低DVT的发生风险。     

血栓通联合通脉丹对老年髋部骨折围手术期D-二聚体的影响

目的观察血栓通联合通脉丹对老年髋部骨折围手术期D-二聚体的影响。方法将我院2012年6月～2015年4月收治的208例老年髋部骨折住院手术患者随机分为对照组和实验组各104例,对照组于皮下注射低分子量肝素钙,实验组静滴注射用血栓通+口服通脉丹治疗,并对两组患者进行检测用药前、术前1天及术后第1、3、5、7天的血浆D-二聚体等含量,比较两组的患肢周径及肿胀率,安全指标,下肢静脉血栓的发生率。结果两组患者用药前及术前第1天血浆D-二聚体含量比较,差异无显著统计学意义(P0.05);而术后第1、3、5、7天比较,实验组均低于对照组,差异有显著统计学意义(P0.05)。实验组患者在术后第1、7天的患肢周径及肿胀率均低于对照组,差异有显著统计学意义(P0.05)。两组患者治疗前后的尿、大便常规及肝肾功能、心电图检查等指标比较,无显著性差异(P0.05);且术前1天及术后第1天两组的血小板比较无显著性差异(P0.05),术后第3、5、7天实验组优于对照组(P0.05)。两组患者深静脉血栓发生率比较,实验组的发生率为0.96%(1/104),对照组为2.88%(3/104),差异有显著统计学意义(P0.05)。结论血栓通和通脉丹联用可抑制D-二聚体升高,从而降低老年髋部骨折术后下肢深静脉血栓发生率,缩短住院期间,降低医疗负担,值得推广。     

血栓弹力图评价心力衰竭合并肺部感染患者凝血状态的价值研究

摘要 目的：探讨血栓弹力图（TEG）评价心力衰竭合并肺部感染患者凝血状态的价值。方法：选取来我院就诊的心力衰竭合并肺部感染患者70例作为研究组,同时选取非心力衰竭合并肺部感染并且无凝血相关疾病患者70例作为对照组。检测常规凝血相关指标、血小板指标以及TEG相关参数,分析TEG相关参数与常规凝血检查指标和血小板指标之间的相关性。以超声检查血栓是否发生为判断标准,对常规凝血检查指标、血小板指标和TEG参数分别进行回归分析,得到回归分析方程后绘制ROC曲线,比较TEG、常规凝血检查和血小板指标评价心力衰竭合并肺部感染患者凝血状态的效能。结果：研究组PT、TT和APTT、PLT水平较对照组显著降低,FIB和D-D较对照组显著升高,差异均具有统计学意义（P<0.05）。研究组中R值、K值较对照组显著下调,而α角和MA值较对照组显著上调,差异具有统计学意义（P<0.05）。R值与PT、 TT以及APTT呈正相关（P<0.05）;K值与FIB呈负相关,与APTT、PLT呈正相关（P<0.05）;α角与FIB、D-D呈正相关,与PLT呈负相关（P<0.05）;MA值与PT、 PLT呈负相关,与FIB呈正相关（P<0.05）。ROC曲线显示,APTT、 D-D、PLT诊断血栓的曲线下面积、特异度和灵敏度均小于TEG。结论：相比于传统常规凝血检查和血小板检查,TEG可以更加全面反映心力衰竭合并肺部感染患者的凝血状态,快速准确地判断心力衰竭合并肺部感染患者是否发生血栓。     

脉血康胶囊对老年慢性稳定性冠心病血栓前状态的影响及疗效观察

目的观察脉血康胶囊对老年慢性稳定性冠心病血栓前状态的疗效。方法选取90例老年稳定性冠心病合并血栓前状态患者为研究对象,随机分为对照组和观察组各45例,对照组予以阿司匹林抗血小板治疗,观察组在对照组的基础上加脉血康胶囊治疗,两组均随访12周后比较治疗效果。结果与对照组相比,TEG结果显示,观察组治疗后较对照组R值、K值明显延长,α角、MA值、CI值明显下降(P0.05);观察组患者心绞痛的治疗总有效率明显高于对照组,差异有统计学意义(P0.05)。结论脉血康胶囊能明显改善老年稳定性冠心病患者血栓前状态,减轻心绞痛症状。     

血栓通注射液联合利伐沙班预防下肢骨折术后下肢深静脉血栓形成疗效及对患者血液流变学的影响

目的:探讨血栓通注射液联合利伐沙班预防下肢骨折术后下肢深静脉血栓(DVT)形成的疗效及对患者血液流变学的影响。方法:选取2012年4月到2015年7月西安医学院第一附属医院收治的125例下肢骨折术后患者,随机分为对照组63例和观察组62例,对照组患者给予血栓通治疗,观察组患者在对照组的基础上给予利伐沙班治疗。观察两组治疗前后DVT发生率、血清D-二聚体(DD)、同型半胱氨酸(Hcy)以及高敏C-反应蛋白(hs-CRP)、血液流变学指标包括红细胞压积(HTC)、全血黏度(WBV)和纤维蛋白原的变化以及用药安全性。结果:术后3周,观察组DVT的总发生率为9.7%(6例),显著低于对照组的44.4%(28例),差异具有统计学意义(P0.05)。治疗后,两组患者的血清DD、Hcy、hs-CRP、HTC、WBV以及纤维蛋白原水平均较治疗前明显降低(P0.05),且观察组该6个指标显著低于对照组,差异均具有统计学意义(P0.05)。此外,观察组的不良反应发生率为9.68%,对照组为7.94%,两组间比较无明显差异(P0.05)。结论:血栓通注射液联合利伐沙班可有效减少DVT的发生并改善患者的血液高凝状态,是一种预防下肢骨折术后DVT形成的有效方案。     

祛瘀散烫疗对髋部骨折术后下肢深静脉血栓预防效果观察

目的观察中药制剂祛瘀散烫熨术对髋部骨折术后下肢深静脉血栓(DVT)的预防价值。方法选取髋部骨折术后患者100例,随机分为对照组和观察组各50例。对照组患者术后按常规方法护理,观察组患者术后在常规护理基础上于术后24h拔除引流管后加用中药祛瘀散对术肢进行烫熨,观察比较两组患者术前、术后组内及组间血浆D-二聚体指标变化情况。结果两组患者术前血浆D-二聚体比较,差异无统计学意义(P0.05);术后两组患者血浆D-二聚体比较,观察组明显低于对照组(P0.05)。结论中药制剂祛瘀散烫熨术对髋部骨折术后下肢DVT形成有预防作用,可降低术后下肢深静脉血栓形成的风险,减少髋部骨折术后并发症的发生。     

Characteristics of the membranes of the pellicle of the ciliatePseudomicrothorax dubius

Summary The membranes of the pellicle of the ciliatePseudomicrothorax dubius are investigated using thin section electron microscopy and freeze-fracture replicas. The plasma membrane is covered by a surface coat and is connected to the outer alveolar membrane by short, sometimes branched, bridges. The inner alveolar membrane is coated on both sides. The epiplasm lies in intimate contact with the cytoplasmic surface of this membrane, and there is a corresponding deposit on the other surface. This deposit is regularly striated.The epiplasmic layer and the alveoli are interrupted at sites of cytotic activity,e.g., the attachment sites of trichocysts, the cytoproct, and the parasomal sacs. The striated deposit ends where the epiplasm ends, indicating a direct relationship between these two epimembranous layers.There is a deposit along the sides of the first part of the tip of the trichocysts, and in this region the trichocyst membrane is free of intramembranous particles.The membrane of the parasomal sacs has a coat on both surfaces. That on the extraplasmic surface is similar to the surface coat of the plasma membrane. The origin of the cytoplasmic coat is unknown. The cytotic activity of these sacs is indicated by their highly irregular profiles.     

The early development of the tail and the transformation of the shape of the nucleus of the spermatid of the domestic fowl,Gallus gallus

Summary The differentiation of the spermatid, especially in reference to the formation of the flagellum, and transformation of the shape of the nucleus was investigated in the domestic fowl.In the early stage of the spermatid, a prominent Golgi apparatus appears around the centrioles. The Golgi vesicles then surround the axial-filament complex which develops from the distal centriole. These vesicles fuse to form continuous membrane at the earliest stage of flagellar formation, and in the succeeding stage Golgi lamellae are attached to the plasma membrane of the developing flagellum. From these observations, it is assumed that Golgi apparatus may be a source of the membrane system of the flagellum.The microtubules distributed around the nucleus form the circular manchette. The anterior region of the nucleus with the manchette is cylindrical in shape and the posterior region without it remains irregular in shape. When the circular manchette has been completed, the whole nucleus acquires a slender cylindrical shape. The circular manchette then changes into the longitudinal manchette. The nuclei of spermatids without a longitudinal manchette are abnormal in shape. In view of these observations it is assumed that the nuclear shaping of the spermatid may be accomplished by circular manchette and the maintenance of shape of the elongated nucleus by longitudinal manchette.The authors wish to thank Mr. Takayuki Mori for his helpful suggestions and technical advices     

Characterization of the composition of the aqueous humor and the vitreous body of the eye of the frog Rana temporaria L

This study aimed to analyze the aqueous humor (AH) and the vitreous body (VB) of the eye of the adult frog Rana temporaria L. as a representative species of amphibians, which lead a semi-terrestrial life. The presence of collagen, albumin, uric acid and electron donors was shown in both media; however, there are slight differences in their concentrations. To determine collagen, a spectral-fluorescent probe, cyanine dye, was used. The presence of collagen in AH of the frog was found at the first time. The total content of electron donors (ascorbic and uric acids, tryptophan, and tyrosine) in VB and HA was roughly estimated at ~ 1.5 × 10^− 4 mol/L. Both VB and AH absorb light in similar UV regions. The total protein and albumin contents in AH were found to be somewhat higher than those in VB. The uric acid content was at an equally low level in both intraocular media. It is supposed that the similarity of VB and AH compositions shown in this work is due to some exchange between VB and AH contents in the course of accommodation. The role of intraocular fluids in physiological functions of the eye and in protecting the retina against UV light is discussed.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418