Objective To investigate the effects of component blood transfusion combined with heparin therapy on coagulation function and clinical outcomes in pregnant women with acute disseminated intravascular coagulation (DIC). Methods A retrospective analysis was conducted on the clinical data of 65 pregnant women with acute DIC who were treated in Obstetrics Department of Luzhou People’ s Hospital between March 2020 and March 2022. Pregnant women treated with component blood transfusion were included in the control group, while those treated with component blood transfusion combined with heparin were included in the observation group. Before and after treatment, the DIC scoring system was used for score evaluation. Coagulation function indicators and routine blood indicators were compared between the two groups of pregnant women. Adverse clinical outcomes and adverse reactions were observed in both groups of pregnant women. Results The study enrolled 65 pregnant women, comprising 30 in the observation group and 35 in the control group. Before treatment, there was no statistical difference in DIC score, coagulation function indicators, or routine blood indicators between the two groups (P>0.05). After treatment, the DIC score, prothrombin time, activated partial thromboplastin time, thrombin time, and D-dimer significantly decreased in both groups (P<0.05), and the above indicators in the observation group [3.39±0.48, (13.28±2.28) s, (24.68±2.06) s, (14.27±1.82) s, and (2.23±0.88) mg/L, respectively] were lower than those in the control group [4.11±1.56, (15.02±2.45) s, (26.79±3.18) s, (15.61±1.91) s, and (2.87±0.74) mg/L, respectively] (P<0.05). The levels of fibrinogen, platelet count, hemoglobin, and hematocrit significantly increased in both groups (P<0.05), and the levels in the observation group [(4.29±1.05) g/L, (175.36±20.46)×109/L, (84.09±7.27) g/L, and (25.49±3.13)%, respectively] were higher than those in the control group [(3.44±1.27) g/L, (145.77±21.12)×109/L, (76.58±7.13) g/L, and (23.03±3.05)%, respectively] (P<0.05). The observation group had a lower incidence rate of adverse clinical outcomes compared to the control group (33.3% vs. 74.3%, P<0.05). The incidence rates of adverse reactions were not statistically different between the two groups (P>0.05). Conclusions Component blood transfusion combined with heparin therapy for pregnant women with acute DIC can effectively improve their coagulation function, reduce the risk of bleeding, and further improve adverse clinical outcomes such as postpartum hemorrhage and hysterectomy. Additionally, this treatment approach demonstrates a high safety profile.
Objective To explore the feasibility of high-pressure injection to transfer human thrombomodulin (hTM) gene into arterial wall of rabbits.Methods Eighty-four healthy New Zealand rabbits were randomly divided into three groups: pcDNA3.1/hTM plasmid group (n=28), pcDNA3.1(+)/neo plasmid group (n=28) and untransfected group (n=28). After gene transfection, the model of arterial injury-blocking was established. Then, the expressions of hTM mRNA and protein in arterial wall were examined by RT-PCR and immunohistochemistry at 3 d, 7 d, 14 d and 28 d after operation. Results Seventeen rabbits died accidentally from the day of operation to 3 d after operation. The expressions of hTM mRNA of different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.01). For the expressions of hTM mRNA at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group, the difference of inter-group and intra-group was not significant (Pgt;0.05). hTM protein was expressed in every group and mainly localized in the inner lining of arterial wall. The expressions of hTM protein at different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.05). The expression of hTM protein at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group kept relative constancy, the difference of inter-group and intra-group was also not significant (Pgt;0.05). Conclusion High-pressure injection is feasible to transfer pcDNA3.1/hTM plasmid into arterial wall of live animals.
ObjectiveTo evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation （OLT） in Chinese. MethodsTwentyfive patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group （n=15） and liver neoplasm group （n=10）. Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase （120 min after operation was started）, ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinasecelite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinasecelite TEG was repeated.The measured variables included the r （reaction） time,representing the rate of initial fibrin formation K （coagulation） time, alpha angles （α） reflecting fibrinplatelet interaction, MA （maximal amplitude） indicating qualitative platelet function and percent fibrinolysis at 60 min. ResultsIn cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG （r，K，α and MA） values between celite and heparincelite TEG （P＜0.01）. ConclusionDuring OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.
目的 比较进展性慢性肝病及重症肝炎患者原位肝移植(OLT)围手术期凝血功能的变化。方法 回顾性分析我中心2004年1月至2005年12月期间行OLT治疗进展性慢性肝病及重症肝炎患者各37例的围手术期血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)的变化。结果 2组患者除术前PT、APTT,术后第5 d PLT、FIB和术后第7 d FIB的差异有统计学意义外（plt;0.05），其余时段2组患者的PLT、PT、APTT及FIB 间差异均无统计学意义（Pgt;0.05）, 提示重症肝炎患者凝血功能损害更为严重； OLT术后，2组患者的凝血功能均逐渐恢复正常, 但并非完全同步。结论 进展性慢性肝病与重症肝炎患者OLT围手术期凝血功能变化显著，应注意监测及处理，但术后2组间各指标间比较差异并不明显。
目的:观察蛇伤患者凝血、抗凝和纤溶系统各项指标的变化并探讨其临床意义。方法:以36例蛇伤患者和32例健康体检者为研究对象,测定血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、血管性血友病因子(vWF)、凝血酶调节蛋白(TM)、组织型纤溶酶原激活物(tPA)、纤溶酶原激活物抑制物1(PAI1)含量。结果:与正常对照组比较,蛇伤患者PT、APTT、vWF、TM、tPA、PAI1水平明显升高,Fg水平明显降低(Plt;001)。结论:蛇伤患者存在凝血、抗凝、纤溶系统的紊乱,早期使用抗蛇毒血清对于防治弥散性血管内凝血(DIC)和多器官功能障碍(MODS)的发生有积极意义。
目的 分析反复发作的抗凝血类灭鼠药所致获得性凝血功能障碍的临床特点，探讨其诊治方案。方法 对2009年3月－2010年12月收治的3例抗凝血类灭鼠药所致获得性凝血功能障碍患者的临床表现、实验室检查和治疗转归进行分析，并复习相关文献。 结果 3例患者均以同时出现多部位出血为首发表现，经应用维生素K1、凝血酶原复合物、新鲜冰冻血浆、冷沉淀等治疗，患者病情好转，实验室指标恢复正常。停药（2、5周，3个月）后再次出现多部位出血，再给予维生素K1等治疗，病情可缓解。 结论 维生素K1可作为首选的治疗药物，且对反复发作的患者同样有效。为避免再发性出血，应维持治疗至少3个月。
Objective To review the progress of a disintegrin and metalloproteinase with thrombospondin motif 4 (ADAMTS-4) and ADAMTS-5 in osteoarthritis. Methods Recent literature about the ADAMTS-4 and -5 in osteoarthritis was analyzed; the structure, function, inhibitors of the ADAMTS-4 and -5, and the relationship between the proteases and osteoarthritis were analyzed and summarized. Results ADAMTS-4 and -5 can reduce chondrocyte and extracellular matrix by degrading aggrecan and cartilage oligomeric matrix protein, which induced the pathogenesis of osteoarthritis. Conclusion ADAMTS-4 and -5 have been demonstrated to play important roles in osteoarthritis. It can better guide treatment and prevention of osteoarthritis to further study related mechanism of ADAMTS-4 and -5, and to promote the establishment of a clinical drug targets.
ObjectiveTo explore the ultrasonic morphological indexes influencing the effectiveness of ultrasound-guided thrombin injection (UGTI) in the treatment of iatrogenic femoral artey pseudoaneury (IFAP).MethodsThe patients with IFAP treated by UGTI in the West China Hospital of Sichuan University from 2015 to 2017 were collected according to the inclusion criteria. The demographic data, comorbidities, clinical symptoms, ultrasonic morphological parameters, thrombin dosage, and postoperative complications were analyzed. The risk factors of technical success of UGTI were analyzed by logistic regression analysis. The technical success was defined as absence of flow within the FAP immediately after UGTI. ResultsA total of 53 patients who met the criteria of inclusion were included in this study. The technical and treatment success rates of UGTI were 84.9% (45/53) and 96.2% (51/53), respectively. No deep venous thrombosis, arterial thromboembolism, infection, bleeding, allergy, and other complications or death occurred in all patients. There were no statistical differences in the age, clinical symptoms, comorbidities (except hypertension, P=0.040), ultrasonic morphological parameters (except femoral artery diameter, P<0.001), and thrombin dosage between the patients with technical success and failure (P>0.05). Multivariate logistic regression analysis showed that the smaller femoral artery diameter was the risk factor of the technical failure [OR=0.350, 95%CI (0.165, 0.743), P=0.006]. Further adjustment of thebaseline data of patients (excluding patients with hypertension), the logistic regression analysis still found that smaller femoral artery diameter was the risk factor of the technical failure [OR=0.419, 95%CI (0.205, 0.860), P=0.018].ConclusionsUGTI in treatment of IFAP is minimally invasive and has a higher technical success rate. Smaller femoral artery diameter might affect technical success rate of UGTI.
Perioperative monitoring of blood coagulation is critical to better understand causes of hemorrhage, to guide hemostatic therapies, and to predict the risk of bleeding. Point-of-care (POC) coagulation monitoring devices assessing the viscoelastic properties of whole blood may overcome several limitations of routine coagulation tests in the perioperative setting. The advantage of these techniques is that they have the potential to measure the clotting process, starting with fibrin formation and continue through to clot retraction and fibrinolysis at the bedside, with minimal delays. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red blood cells, and thereby providing useful additional information on platelet function. Viscoelastic POC coagulation devices are increasingly being used in clinical practice, especially in the management of patients undergoing cardiac and liver surgery, assessment of hypo-and hypercoagulable states, guiding pro- and anticoagulant therapies, monitoring of antiplatelet therapy and procoagulant therapy. To ensure optimal accuracy and performance, standardized procedures for blood sampling and handling, strict quality controls and trained personnel are required.