高压氧与降纤酶综合治疗脑血栓形成42例分析

目的：探讨高压氧与降纤酶结合治疗脑血栓形成的疗效。方法：把124例脑血栓形成患者随机分为A组、B组、C组,A组42例采用高压氧加降纤酶治疗;B组38例采用降纤酶治疗;C组44例采用常见规治疗。并分析和比较3组患者的治疗效果。结果A组治愈率80．36％,同时治疗前后血液流变学检查血浆比粘度、红细胞压积、低切变等差异有非常显著性意义（P＜0．01）;B组治愈率61．3％;C组治愈率52．3％。三组患者治愈率差异有显著意义（P＜0．01）。结论高压氧与降纤酶联合治疗脑血栓形成的效果优于常规组和单纯降纤酶治疗组的治疗效果,并能改善血液粘调度,是治疗脑血栓形成的好方法。     

Procoagulant Activity in Amniotic Fluid Is Associated with Fetal-Derived Extracellular Vesicles

Procoagulant activity in amniotic fluid (AF) is positively correlated with phosphatidylserine (PS) and tissue factor (TF)-expressing(+) extracellular vesicles (EVs). However, it is unknown if pathological fetal conditions may affect the composition, phenotype, and procoagulant potency of EVs in AF. We sought to evaluate EV-dependent procoagulant activity in AF from pregnant people with fetuses with or without diagnosed chromosomal mutations. AF samples were collected by transabdominal amniocentesis and assessed for common karyotype defects (total n = 11, 7 healthy and 4 abnormal karyotypes). The procoagulant activity of AF was tested using a fibrin generation assay with normal pooled plasma and plasmas deficient in factors XII, XI, IX, X, V, and VII. EV number and phenotype were determined by flow cytometry with anti-CD24 and anti-TF antibodies. We report that factor-VII-, X-, or V-deficient plasmas did not form fibrin clots in the presence of AF. Clotting time was significantly attenuated in AF samples with chromosomal mutations. In addition, CD24+, TF+, and CD24+ TF+ EV counts were significantly lower in this group. Finally, we found a significant correlation between EV counts and the clotting time induced by AF. In conclusion, we show that AF samples with chromosomal mutations had fewer fetal-derived CD24-bearing and TF-bearing EVs, which resulted in diminished procoagulant potency. This suggests that fetal-derived EVs are the predominant source of procoagulant activity in AF.     

颅内静脉系统血栓形成6例临床分析

目的：探讨颅内静脉系统血栓形成（CVT）的临床表现、影像学特征以及治疗方法对临床诊断的意义。方法：回顾性分析首都医科大学宣武医院收治的6例CVT患者的临床表现及影像学特征与治疗方法。结果：6例临床表现无特殊,4例经MRI＋MRV确诊,3例DSA检查确诊,1例介入治疗,4例抗凝治疗,2例保守,无死亡患者。结论：静脉系统血栓形成临床症状缺乏特异性,临床遇到急性起病的头痛、呕吐,伴或不伴有局灶性神经功能缺损或癫痫发作、意识障碍的青中年人,应高度怀疑CVT。早期应用抗凝、溶栓等治疗方法,对改善预后具有较高的临床应用价值。     

滇丹参、甘西鼠尾、褐毛甘西鼠尾水提取液对鼠血栓形成及微循环的影响

目的：观察云南产甘西鼠尾属药物滇丹参、甘西鼠尾、褐毛甘西鼠尾的水提取物对鼠血栓形成及微循环的影响。方法：用电刺激法造成大鼠颈动脉血栓形成,观察血流阻塞时间(OT值);小鼠尾静脉注射血栓形成诱导剂,观察滇丹参、甘西鼠尾、褐毛甘西鼠尾对抗肺血栓形成的作用;采用活体微循环观察方法,研究滇丹参、甘西鼠尾、褐毛甘西鼠尾对去甲肾上腺素和高分子右旋糖苷所致小鼠、大鼠肠系膜微循环障碍的影响。结果：滇丹参、甘西鼠尾、褐毛甘西鼠尾2、4g/kg时,能明显延长闭塞性血栓形成时间(OT值)(P＜0．01)。20、40g/kg时,能有效抑制胶原和肾上腺素复合液所致小鼠肺血栓形成(P＜0．0l,P＜0．05)。能显著改善微动脉、微静脉痉挛和血液流态,增加毛细血管开放数,加快血流速度(P＜0．0l,P＜0．05)。结论：滇丹参、甘西鼠尾、褐毛甘西鼠尾均能防止血栓形成、改善微循环障碍。     

置管溶栓与药物机械溶栓对急性下肢深静脉血栓的临床疗效对比

摘要 目的：对比分析置管溶栓（CDT）与药物机械溶栓（PMT）对急性下肢深静脉血栓（DVT）的安全性与有效性。方法：回顾性分析2018年1月至2021年12月在重庆医科大学附属巴南医院的98例单侧DVT患者临床资料,依据不同的治疗方式分为药物机械溶栓组（PMT组）48例和置管溶栓组（CDT组）50例,对比分析两组患者的围手术期指标、治疗后患侧大腿消肿率和小腿消肿率、血栓溶解率、并发症发生率及术后1年的PTS发生率。结果：PMT组患者的尿激酶使用量及住院时间较CDT组显著缩短,差异具有统计学意义（P<0.05）,但术中出血较CDT组显著增加,差异具有统计学意义（P<0.05）,PMT组患者的患肢消肿率和血栓溶解率显著高于CDT组,差异具有统计学意义（P<0.05）,两组患者的并发症发生率及术后1年的深静脉血栓形成后遗症发生（PTS）率无显著统计学差异（P>0.05）。结论：PMT比CDT具有更好的患肢消肿率及血栓溶解率,且PMT治疗能显著缩短住院时间及减少尿激酶用量,但两者的围手术期并发症发生率及术后1年PTS发生率无显著差异。     

78例脑血栓患者清栓酶治疗前后体外血栓形成变化分析

本文对比了用清栓酶治疗前后脑血栓患者体外血栓形成各因素的变化,其中发现脑血栓患者治疗前体外血栓长度,湿干重量与健康人相比增长,加重[P<0.05或<0.01]。而清栓酶治疗后脑血栓患者体外血栓长度,湿干重量与治疗前相比明显降低(P<0.01)。从而证实了清栓酶具有降低血栓形成因子,抗血栓形成,改善微循环之功效。     

The influence of Annexin32, a new Ca2+-dependent phospholipid-binding protein, on coagulation time and thrombosis

The pharmacodynamics of Annexin32, a new Ca2+-dependent phospholipid-binding protein, was studied by measuring coagulation time in rabbits and venous thrombosis in rabbits and rats. Rabbits and rats were given Annexin32 by intravenous administration. Then Kaolin partial thromboplastin time (KPTT), thrombosis in vitro and in vivo were assayed. The results showed that KPTT of rabbits was prolonged (p < 0.01), and the length and weight of thrombus in vitro were reduced (p < 0.01) after administration of Annexin32 at 1 mg/kg. It also inhibited thrombosis in vivo and reduced the weight of venous thrombus significantly in rats (p < 0.01). All these results suggested that Annexin32 possesses the characteristic of antithrombotic effect and fewer side effects on coagulation time.     

Pharmacologic antagonism of thromboxane A2 receptors by trimetoquinol analogs in vitro and in vivo.

Although (-)-(S)-trimetoquinol [1-(3,4,5-trimethoxy-benzyl)- 6,7-dihydroxy-1,2,3,4-tetrahydroisoquinoline; TMQ] is recognized as a potent bronchodilator, (+)-(R)-TMQ is a selective antagonist of human platelet aggregation and serotonin secretion induced by thromboxane A2 (TXA2) agonists. To confirm the pharmacological actions of TMQ analogs, the interaction of the drugs with TXA2 receptors was examined in human platelets and in a mouse sudden death model. The inhibitory potencies of TMQ analogs (pIC50 values) for displacement of [3H]SQ 29,548 binding to platelets showed excellent correlation with the respective pIC50 (-log IC50) values for U46619-induced aggregation (r = 0.99, P less than 0.01) and serotonin secretion (r = 0.99, P less than 0.01) in human platelet-rich plasma and for whole blood aggregation (r = 0.99, P less than 0.01). In each system, the rank order of inhibitory potencies was rac-iodoTMQ greater than or equal to (+)-(R)-TMQ greater than rac-TMQ much greater than (-)-(S)-TMQ. Antithrombotic effects of TMQ analogs were evaluated in a mouse sudden death model. In vivo antithrombotic potencies of these compounds were consistent with the in vitro potencies as TXA2 receptor antagonists in platelet systems. Administration of rac-iodoTMQ, (+)-(R)-TMQ and rac-TMQ 15 min before the injection of U46619 (800 micrograms/kg, iv) protected mice against U46619-induced sudden death. On the other hand, (-)-(S)-TMQ did not protect animals against death. Protection of U46619-induced cardiopulmonary thrombosis by TMQ analogs was seen at doses of 3-100 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)     

脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响及其术后门静脉血栓形成的因素分析

目的:探讨脾切除及贲门周围血管离断术对肝硬化门静脉高压患者肝脏血流动力学的影响,并分析患者术后门静脉血栓形成的危险因素。方法:选择2016年1月-2017年12月在我院进行脾切除及贲门周围血管离断术的96例肝硬化门静脉高压患者,于术前、术后1d、3d、7d采用彩色多普勒超声对患者的肝脏血流动力学指标进行动态监测。统计术后7d内患者门静脉血栓的发生率,并将患者分为血栓组(n=28)和无血栓组(n=68),对两组患者的一般资料、手术指标、彩色多普勒超声监测指标等进行单因素分析,并采用Logistic多因素回归分析门静脉血栓形成的危险因素。结果:患者在术前、术后1d、3d、7d时的门静脉内径、最大流速、血流量呈逐渐降低的趋势,肝动脉内径、最大流速、血流量呈逐渐升高的趋势,且各时间点间两两比较差异有统计学意义(P0.05)。术后7d内有28例患者出现门静脉血栓,发生率为29.17%。血栓组和无血栓组患者在性别、年龄、体质量指数、手术时间、术前门静脉流速比较差异无统计学意义(P0.05);血栓组患者Child-Pugh分级为B级比例、术中出血量、脾质量、腹水量、术前门静脉内径均高于无血栓组,术后门静脉内径、术后门静脉流速均低于无血栓组(P0.05)。经Logistic多因素回归分析显示,患者术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素(P0.05)。结论:行脾切除及贲门周围血管离断术的肝硬化门静脉高压患者术后进行肝脏血流动力学监测,有助于患者术后的疗效判断,且术后门静脉内径、术后门静脉流速是门静脉血栓形成的危险因素。