急诊PCI术对血小板功能的影响

目的 研究冠心病患者经急诊皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)前后,二磷酸腺苷(adenosine diphosphate,ADP)及胶原(collagen,COL)诱导血小板聚集功能的变化及临床意义.方法 抽取52例保守治疗的急性心肌梗死患者、38例行急诊冠状动脉造影(coronary angiography,CAG)的患者及46例行急诊PCI的患者,分别于入院服药(阿司匹林、氯吡格雷)后即刻(即术前)、服药后2 h(即术后)及服药后24 h采取静脉血,测定ADP及COL诱导的血小板聚集功能.结果 PCI组ADP及COL诱导的血小板的聚集功能在术后即刻较术前明显增加(P<0 01),服药后24 h较术后即刻降低但较术前增高(P<0 01);CAG组ADP诱导的血小板聚集功能在术后即刻及服药后24 h较术前明显降低,(P<0 01),而COL诱导的血小板的聚集性在各时段无明显改变;保守治疗组服药后2 h的ADP诱导的血小板聚集率较服药即刻下降(P<0 01),服药后24 h的ADP诱导的血小板聚集率较服药即刻及服药2 h明显下降(P<0 01),而COL诱导的血小板聚集率在各时段无明显改变.结论 ADP及COL诱导的血小板的聚集功能在PCI后明显增强,应加强抗血小板治疗以降低血小板聚集功能.     

PL-11多参数血小板功能分析仪与流式细胞术检测血小板聚集功能的效果比较

目的:评价PL-11多参数血小板功能分析仪检测血小板聚集功能的价值。方法:使用PL-11多参数血小板功能分析仪与流式细胞术,检测95例服用氯吡格雷抗凝治疗的、脑梗死二级预防患者的血小板聚集功能,以流式细胞术中测定血小板血管扩张剂刺激磷蛋白(VASP,Vasodilator-stimulated phospho-protein)磷酸化而计算出来的血小板反应指数(PRI,Platelet Response Index)≥50%为氯吡格雷低反应性的标准,分析两种方法的相关性及差异。结果:经血小板聚集诱导剂二磷酸腺苷(ADP,Adenosine Diphosphate)诱导的PL-11最大血小板聚集率(MAR,Max Aggregation Ratio)与血小板反应指数(PRI)的相关性分析(r=0.898,P<0.001),说明两种检测方法存在明显相关。其中,PL-11测得最大血小板聚集率范围均较血小板反应指数广。结论:PL-11多参数血小板功能分析仪与流式细胞术检测血小板聚集功能的结果差异无统计学意义(P>0.05),具有一致性,其应用价值可供临床及实验室参考,可以用于氯吡格雷反应性的评价。     

复方银杏滴丸抗血栓及抑制血小板聚集作用实验研究

目的探讨复方银杏滴丸(CO-GBE)抗血栓形成及抑制血小板聚集的作用.方法①制造大鼠动静脉旁路血栓形成模型,测定血栓湿重及干重;②分别采用胶原、PAF、ADP诱导豚鼠血小板聚集,测定血小板在不同时间点的聚集率以及最大聚集率.结果.复方银杏滴丸 40、20、10 mg/kg均可以不同程度地抑制大鼠动静脉旁路血栓形成,减轻血栓干重及湿重(P<0.05,P<0.01);抑制不同诱导剂诱导的豚鼠血小板在不同时间点的聚集,降低其最大聚集率.结论.复方银杏滴丸可明显抗血栓形成,并具有高效广泛的血小板聚集抑制作用.     

Sak衍生体对高血脂大鼠血小板功能的影响及其作用机制

目的: 观察Sak衍生体对高血脂大鼠血小板功能的影响并探讨其作用机制。方法: 30只Wistar大鼠制备高脂大鼠模型,随机分为药物组、高脂组及正常对照组。药物组大鼠尾静脉注射Sak衍生体进行干预,剂量为0.5 mg?kg-1,隔天注射,共15次;其他两组大鼠注射生理盐水作为对照,在给药前和最后一次给药24 h后采血,检测各组大鼠的血小板黏附率和二磷酸腺苷二钠(ADP)诱导的血小板聚集率;采用放免法检测血小板中钙调蛋白(CaM)含量以及ADP诱导的血小板聚集时血栓素(TXA2)的释放量。结果:与高脂组大鼠比较,药物组高脂大鼠血小板黏附功能及ADP诱导的血小板聚集率明显降低（分别是63.5%±6.71%与44.7%±8.13%,P<0.05;91.56%±9.01%与81.22%±3.45%,P<0.05）,血小板中CaM含量与TXA2的释放量明显降低（P<0.05或P<0.01）。结论:Sak衍生体通过对引起血小板活化途径的干预,抑制血小板的黏附及聚集。     

血小板无力症45例临床分析

目的回顾近年来血小板无力症(glanzmann’s thrombasthenia,GT)临床诊断治疗的现状,探讨进一步精确诊断的必要性。方法分析我中心过去7年间收治的45例确诊和临床疑诊GT患者临床资料、出血积分和血小板聚集试验结果,并和同期收治的另一遗传出血性疾病vWD进行比较。结果临床确诊和疑诊GT的患者分别为34例和11例,其中确诊患者的两个或以上出血表现发生率较疑诊患者明显增多(P0.05);二磷酸腺苷(ADP)和花生四烯酸(AA)诱导的血小板聚集均较疑诊GT患者、血管性血友病(von Willebrand’s disease,vWD)患者显著低下(P0.05);疑诊GT患者ADP和胶原(Col)诱导的血小板聚集均较vWD患者显著低下(P0.01),确诊GT患者Col诱导的血小板聚集较vWD患者也显著低下(P0.01),而瑞斯托霉素(Risto)诱导的血小板聚集较vWD患者显著增高(P0.01)。确诊GT的患者中,出血积分和ADP诱导的、Col诱导的、AA诱导的血小板聚集水平间无显著相关性。GT患者的临床出血积分和贫血发生显著相关(P0.05)。结论临床出血积分可更好地反映GT患者出血状况,临床确诊的GT患者诊断较为可靠,疑诊GT的患者诊断可能存在异质性。     

甲基莲心碱对家兔、大鼠及人血小板聚集功能的影响

以阿斯匹林为对照,观察甲基莲心碱(Nef)对家兔、大鼠及人血小板聚集功能的影响。结果表明,Nef体外能明显抑制ADP、Adr、胶原诱导的不同种属动物的血小板聚集,呈剂量依赖性。对ADP、胶原诱导的家兔血小板聚集IC_(50)分别为16、22 μmol/L;对ADP、胶原、Adr诱导的人血小板聚集的IC_(50)分别为35、102、89 μmol/L。Nef 500 μmol/L明显降低ADP诱导的高脂喂养大鼠的血小板聚集率,并出现解聚。等摩尔浓度时,Nef作用强于阿斯匹林。     

熟大白菜汁对血小板聚集的影响

目的 观察熟大白菜汁体内、外对二磷酸腺苷(ADP)、胶原诱导的血小板聚集的影响.方法 将生理盐水和熟大白菜汁分别与正常人富血小板血浆(PRP)孵育,加入血小板聚集诱导剂,观察熟大白菜汁对血小板聚集的影响;普通白兔随机分为两组,分别定量饲以生理盐水、熟大白菜汁,观察不同时间后血小板聚集情况.结果 ADP、胶原诱导下,熟大白菜汁与对照组相比对人血小板聚集抑制作用明显,其抑制率分别为72.39％和80.89％;普通白兔在饲以熟大白菜汁后,ADP诱导的兔血小板聚集率从第1周开始降低,血小板聚集的抑制率在第1、3、5、8周末分别为42.8％、45.7％、53.6％、48.5％.胶原诱导的兔血小板聚集率从第5周开始降低,血小板聚集的抑制率在第5、8周末分别为54.9％、56.3％.结论 ADP或胶原诱导下,熟大白菜汁体内、外能够明显抑制血小板聚集,具有潜在的预防与治疗血栓性疾病的前景.     

机采血小板冰冻前后聚集功能及临床应用的实验研究

目的:探讨冰冻血小板经非程序降温-80℃保存复苏后同冰冻前在体外的聚集功能和临床输注后的聚集功能,旨在比较新鲜血小板和冰冻血小板各自的优势,为临床选择使用提供可参考依据.方法:用光学法对18例浓缩血小板冰冻前后对胶原、花生四烯酸、ADP、瑞斯托霉素诱导的聚集功能进行实验检测分析并对血小板数量变化进行了比较.结果:冰冻复苏血小板有破坏、数量较冰冻前减少15%(P<0.01),血小板解冻后体外对胶原、花生四烯酸、ADP、瑞斯托霉素诱导的聚集功能严重受损,其平均聚集功能仅为冰冻前的63%(P<0.01),输注后在体内的聚集效果冰冻血小板不如新鲜血小板(P<0.01).结论:-80℃直接冰冻血小板体外聚集反应功能严重受损,临床止凝血远期效果有待评价,非急诊使用浓缩血小板,建议尽可能使用新鲜浓缩血小板.     

人参皂苷Re对ADP、PAF、AA诱导家兔血小板聚集功能的影响

[目的]研究人参皂苷Re对血小板聚集功能的影响。[方法]采用体外实验通过Born法观察人参皂苷Re对二磷酸腺苷钠盐(ADP)、血小板活化因子(PAF)、花生四烯酸(AA)诱导的家兔血小板聚集率的影响。[结果]人参皂苷Re体外抑制ADP、PAF、AA诱导的家兔血小板聚集差异有统计学意义(P0.05,P0.01)。半数抑制浓度(IC50)分别为0.197、0.242、0.443 g/L。[结论]人参皂苷Re呈剂量依赖性抑制体外ADP、PAF、AA诱导的血小板聚集,且抗ADP诱导的血小板聚集作用强于PAF、AA。     

吲哚布芬对血小板聚集及血栓形成的影响

目的 通过动物实验,研究注射剂型吲哚布芬静脉给药后对血小板聚集及血栓形成的影响。方法 每项实验用动物50只,分5组,每组10只,动物按体质量随机分为生理盐水对照组（NS组）、吲哚布芬低、中、高剂量组及阿司匹林（ASA组）对照组,药后30min,分别检测由二磷酸腺苷（ADP）、花生四烯酸（AA）及血小板活化因子（PAF）诱导的Wistar大鼠血小板1min、5min的聚集率及最大聚集率;胶原-肾上腺素诱发的KM小鼠血栓性偏瘫甚至死亡的时间及电刺激Wistar大鼠颈动脉血栓形成的时间。结果 大鼠血小板聚集实验显示,与NS组比较,吲哚布芬中、高剂量组和ASA组能抑制由ADP、AA及PAF诱导的大鼠血小板不同时间点的聚集（P<0.05或P<0.01）,与ASA组比较,在ADP及AA诱导的实验中,吲哚布芬高剂量组对血小板1min/5min聚集率的抑制作用有统计学差异（P<0.05）;胶原-肾上腺素诱导的小鼠肺栓塞实验显示,与NS组比较,吲哚布芬中、高剂量组及ASA组小鼠存活时间明显延长（P<0.01或P<0.05）,与ASA组比较,吲哚布芬高剂量组的小鼠存活时间延长有统计学差异(P<0.05);电刺激大鼠颈动脉血栓形成实验显示,与NS组比较,吲哚布芬中、高剂量组和ASA 组均能明显抑制血管栓塞时间（P<0.05或P<0.01）,与ASA组比较,吲哚布芬抑制血管栓塞时间虽无统计学差异,但吲哚布芬高剂量组抑制血栓形成时间明显高于ASA组。结论 吲哚布芬具有显著的抑制血小板聚集和血栓形成作用,且呈现一定的量效关系,吲哚布芬抑制血小板聚集及血栓形成作用强于ASA。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.