肺癌并静脉血栓栓塞症的危险因素分析

目的 总结我院38例肺癌合并静脉血栓患者的临床资料,探讨其发生的危险因素.方法 对2010年4月至2015年7月本院38例肺癌合并静脉血栓患者(血栓组)与同期76例不存在静脉血栓的肺癌患者(非血栓组)的临床资料进行回顾性病例-对照分析.单因素分析后,对有可能有意义的因素进行多因素Logistic回归分析,查找肺癌合并静脉血栓的危险因素.结果 单因素分析显示腺癌、ⅢB～Ⅳ期、D二聚体增高、中心静脉置管、CEA增高是发生静脉血栓的危险因素(P＜0.05).多因素回归分析显示腺癌、ⅢB～Ⅳ期、D二聚体增高是肺癌发生静脉血栓的独立危险因素(P＜0.05).结论 肺腺癌、肿瘤晚期、D二聚体增高是肺癌合并静脉血栓的高危因素.     

脑卒中患者住院期间深静脉血栓形成的危险因素分析

目的探讨脑卒中患者住院期间深静脉血栓形成的危险因素。方法回顾性分析了2007年9月至2011年9月入住的80例脑卒中合并深静脉血栓(DVT)患者的临床资料,并对可能存在的相关因素进行分析。结果①48 h内DVT阳性率为11.25%(9/80),入住ICU期间DVT阳性率为16.25%(13/80);②经DVT危险因素分析得知:性别、年龄、静脉血栓栓塞病(VTE)病史、双下肢静脉曲张史、心功能不全、糖尿病、恶性肿瘤、外伤、感染性中毒症、镇痛麻醉药的使用、体质量指数(BMI)、WBC计数、中性粒细胞比例、PT、APTT、Fbg等因素与DVT的发生没有明显的相关性(P>0.05),而与近期手术史、中心静脉置管、休克、机械通气、肾衰、APACHEⅡ评分、D-二聚集(D-dimer)等因素具有明显的相关性(P<0.05);③对发生DVT的多因素进行Logistic线性回归分析,D-dimer、近期手术史以及肾衰为独立危险因素。结论脑卒中患者在入住ICU时,并发DVT的概率非常大,对患者造成了较大的影响,清楚地分析DVT患者的危险因素,能够对该症进行预防并及时地对其控制。     

PICC置管后上肢运动操联合抗凝治疗对静脉血栓发生率的影响

目的:探讨PICC置管后上肢运动操联合抗凝治疗对静脉血栓发生率的影响。方法:在医院肿瘤科2016年12月～2017年3月期间收治的行PICC置管患者中选取108例作为研究对象,并按照护理方案不同予以分组:对照组(n=54)采取以抗凝治疗为主的常规护理,研究组(n=54)则在对照组护理基础上加用上肢运动操,就两组患者PICC置管后静脉血栓发生率、置管侧腋静脉血液流速变化以及D-二聚体指标差异进行统计学分析。结果:(1)研究组患者PICC置管后的静脉血栓发生率是5.56%,低于对照组患者PICC置管后的静脉血栓发生率25.93%,比较差异有统计学意义(P<0.05),该组I级血栓、II级血栓、III级血栓发生率均低于对照组,但其比较差异无统计学意义(P>0.05);(2)护理前,研究组和对照组患者置管侧的腋静脉血液流速比较无统计学差异(P>0.05);护理后,研究组患者置管侧的腋静脉血液流速高于对照组(P<0.05);(3)研究组患者的D-二聚体指标水平是(0.23±0.09)mg/L,低于对照组患者的D-二聚体指标水平(0.42±0.15)mg/L(P<0.05)。结论:PICC置管后实施上肢运动操联合抗凝治疗护理,可有效增加血液流速,预防静脉血栓发生,值得临床推广应用。     

血液肿瘤患者PICC置管后并发静脉血栓的原因分析

目的 分析血液肿瘤患者PICC置管后并发静脉血栓的原因,并探讨其处理方法。方法 回顾性分析2014年6月至2017年7月在安徽医科大学第四复数医院行PICC置管的35例恶性血液病患者的临床资料,根据置管后是否发生血栓分为血栓形成组（5例）和未发生血栓组（30例）。通过单因素分析比较两组患者的一般资料、住院时间、穿刺血管、血脂,凝血指标的差异,采用logistic回归法分析影响PICC置管患者血栓形成的原因。结果 本组静脉血栓形成的发生率14.28%;血栓形成组女性（女/男=5/0）比例高于未发生血栓组（女/男=15/15）,差异有统计学意义（P<0.05）;血栓形成组止血药物使用率高于未发生血栓组,且穿刺血管多为头静脉,差异有统计学意义（χ²=3.889,7.622;P=0.049,0.022）;两组患者置管时间、止血药物使用天数、血脂和凝血指标的差别无统计学意义（P>0.05）;logistic回归分析显示止血药物使用和穿刺血管是影响PICC置管患者血栓形成的危险因素（OR=3.854、3.622,P均<0.05）。结论 血管选择、止血药物的使用是影响血液肿瘤患者PICC置管后静脉血栓形成的危险因素。     

围手术期血栓性疾病的防治

目的探讨血脂、手术时间、术中出血量、血红蛋白对围手术期血栓性疾病的影响,D二-聚体在血栓性疾病中的变化。方法将子宫及附件手术的患者39例分为2组,血栓组（n=9）,即术后有下肢静脉血栓形成的患者;对照组（n=30）,即术后无血栓形成的患者。比较2组手术时间、术中出血量、血红蛋白、血脂及术后D-二聚体的变化。结果血栓组手术时间、出血量、贫血程度均明显高于对照组（P＆lt;0.05）;2组血脂差异无统计学意义（P＆gt;0.05）。D二-聚体在2组术后第2天均升高;术后第7天,对照组均为阴性,血栓组仍高于正常。结论手术时间长、术中出血量多合并贫血的患者术后易出现下肢静脉血栓性疾病,高血脂不是术后静脉血栓形成的高危因素。D二-聚体可作为体内高凝状态和纤溶亢进的特异性分子标志物,对血栓性疾病的诊断、疗效观察有重要意义。     

ICU患者下肢深静脉血栓形成的原因与护理措施探究

目的探讨重症监护室(ICU)患者下肢深静脉血栓形成(DVT)的原因,制定预防性护理干预措施。方法选择2013年1月至2015年6月我院ICU收治的25例DVT患者作为研究对象,收集患者临床治疗资料,从卧床时间、静脉采血、镇静(肌松、利尿)药使用、机械通气方式、深静脉置管、心肺功能、输血等方面进行了单因素分析,探讨DVT形成因素,为制定预防性护理措施提供临床依据。结果单因素分析结果显示:卧床时间≥14 d,静脉采血≥20次,镇静、肌松、利尿药使用≥2种,机械通气方式采用呼气末正压通气,深静脉置管路径为股静脉穿刺,心肺功能均衰竭,输血量≥400 m L的DVT构成比,均高于同因素内其他参数,差异显著P<0.05,认为有通统计学意义。结论 ICU患者下肢深静脉血栓形成原因较多且负责,应制定针对性、预防性护理干预措施,减少下肢深静脉血栓形成。     

外科围术期静脉血栓形成的危险因素及其护理对策

目的:探讨外科围术期引起静脉栓塞的危险因素及其预防护理对策。方法:对580例患者的临床资料进行统计,对相关因素进行分析。结果:静脉栓塞的独立危险因子按照比值从高到低依次为外科手术、恶性肿瘤患者接受化疗、中心静脉置管、浅表静脉血栓、神经源性肢体麻痹或瘫痪。结论:手术、恶性肿瘤接受化疗、中心静脉置管、年龄、糖尿病是血栓形成的重要原因。     

血液净化治疗患者颈内静脉置管对血管的影响及防治研究

目的探讨血液净化治疗患者颈内静脉置管对血管的影响及防治研究。方法选取我院肾内科住院、血液净化中心维持性血液透析治疗各种原因导致的肾功能不全有插管史的患者72例,予彩色多普勒超检查综合颈内静脉置管对颈内静脉的影响因素。结果长期导管插管史患者20例,8例有纤维蛋白鞘形成,6例有附壁血栓形成,5例有静脉狭窄,其中3例颈内静脉明显狭窄;临时性导管插管史患者52例,17例有纤维蛋白鞘形成,24例有附壁血栓形成,7例有静脉狭窄,其中4例颈内静脉明显狭窄。结论纤维蛋白鞘形成、附壁血栓及导管内血栓是发生导管功能障碍的主要原因。超声对颈内静脉置管起始段观测较清晰,灵敏度尚好,安全无创,经济方便,可多角度、多方位观察,是监测和诊断颈内静脉置管导致各种导管功能障碍及置管相关并发症理想的方法,必要时与静脉造影相结合,有利于血液透析导管患者深静脉导管功能的维护。     

探讨PICC拔管前行置管侧上肢静脉彩色多普勒超声以确认有无导管相关性上肢静脉血栓的必要性

目的探讨经外周静脉置入中心静脉导管（PICC）拔管前行置管侧上肢静脉彩色多普勒超声检查以确认有无导管相关性上肢静脉血栓的必要性。方法对578例PICC置管患者在拔管前行置管侧上肢静脉彩色多普勒超声检查。结果发现无症状导管相关性静脉血栓形成65例,均于抗凝后血栓消退后再拔管。结论综述其导管相关性血栓形成的可能性及危险性,认为拔管前行置管侧上肢静脉多普勒超声检查以发现无症状的导管相关性上肢静脉血栓形成是必要的,予处理后血栓消失再拔管比不进行静脉彩超检查确认有无血栓形成而盲目拔管更安全。     

危重症患儿血栓栓塞的危险因素分析和干预

目的 分析危重症患儿静脉血栓栓塞（VTE）发病的主要危险因素,并探索有效的干预措施.方法 前瞻性研究321例PICU患儿,经影像确诊静脉血栓栓塞,分析各种因素对危重症患儿静脉血栓栓塞发病和预后的影响,针对性地制定干预措施.结果 30例患儿合并有症状性VTE,影响VTE的危险因素有：年龄、心脏疾病、手术情况、中心静脉导管、机械通气.有中心静脉置管（CVC）的患儿VTE发病率升高,VTE患儿病情重、死亡率升高.结论 PICU患儿VTE发病率较高,CVC的使用和机械通气是主要的危险因素,一定的干预可能减少VTE的发病和改善预后.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.