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find Keyword "肝素" 71 results
  • Effects of Venous Remaining Needle Sealing with Heparin vs. Saline in China: A Meta-Analysis

    Objective To evaluate the effects of peripheral venous remaining needle sealing with heparin vs. saline in China. Methods A comprehensive, systematic bibliographic search of medical literature from databases of CNKI (1994 to December, 2009) and Wanfang (1990 to December, 2009) was conducted to identify randomized controlled trials (RCTs) related to catheter sealing with saline vs. heparin. The remaining time of venous needle, the incidence of phlebitis and the catheter blockage were compared, and the quality of RCTs was assessed and meta-analyses were conducted by RevMan 5.0 software. Results Nine RCTs involving 1 770 patients were included. The results of meta-analyses showed that: a) There was a significant difference between heparin sealing and saline sealing in catheter blockage (OR=0.44, 95%CI 0.32 to 0.62, Plt;0.05). The heparin sealing was much better to prevent catheter blockage; b) There was no significant difference between saline sealing and heparin sealing in the incidence of phlebitis (OR=1.26, 95%CI 0.64 to 2.50, Pgt;0.05); and c) The average remaining time of venous catheter between saline sealing and heparin sealing had significant difference (WMD=0.24, 95%CI 0.04 to 0.43, Plt;0.05). Heparin sealing had better effect than saline sealing. Conclusion The meta-analyses of current medical literature in China show that heparin sealing can reduce the incidence of catheter blockage and prolong the remaining time of catheter, although there is no significant effect in the aspect of the incidence of phlebitis.

    Release date:2016-08-25 02:48 Export PDF Favorites Scan
  • Meta-analyses of Pregnancy Outcomes in Women with Mechanical Heart Valves Treated by Different Anticoagulant Regimens

    Objective To assess different anticoagulant regimens in pregnant women with mechanical heart valves: taking oral warfarin throughout the pregnancy, or heparin in the 1st trimester and oral warfarin for the other trimesters. The main outcome measures were major maternal complications and perinatal outcomes. Methods The MEDLINE, EMbase, CBM and CNKI were searched. The quality of the included studies was evaluated and data were extracted by two reviewers independently. Meta-analyses were performed on the results of homogeneous studies. Result Seven studies involving 629 pregnancies in 469 patients met the inclusion criteria for this review, all of which were retrospective surveys. The comparison between the administration of heparin in the 1st trimester plus oral warfarin for the other trimesters and warfarin throughout the pregnancy showed that, there are not significant different in the incidence of major maternal complications and the incidence of adverse perinatal outcomes. Conclusion Compared with the administration of warfarin throughout the pregnancy, the administration of heparin in the 1st trimester and oral warfarin for the other trimesters might increase the incidence of major maternal complications, but with a similar incidence of adverse perinatal outcomes.

    Release date:2016-08-25 03:36 Export PDF Favorites Scan
  • Clinical Observation of Thrombocytopenia Induced by Heparin for Sealing Venous Remaining Needle

    目的 探讨静脉留置针封管用肝素诱导的血小板减少症(HIT)的临床特点。 方法 分析2010年1月-2011年12月,在1 215例静脉留置针肝素封管患者中发生的14例HIT患者的临床表现,血小板(PLT)、HIT抗体的变化,氯吡格雷、阿加曲班、地塞米松等治疗的结果。 结果 1 215例患者中:发生HIT 14例,发生率1.15%;HIT并血栓形成综合征4例,发生率0.33%。14例HIT患者中:经典型12例,占85.7%。出血7例,发生率50.0%,其中1级、2级出血发生率分别为42.9%(6/14)、7.1%(1/14),分别占出血的85.7%(6/7)、14.3%(1/7)。血栓形成4例,发生率28.6%,其中静脉血栓3例,占血栓形成的75.0%。14例均发生于肝素封管后第1~14天,其中第6~7天8例,占57.1%。PLT降低到最低值的时间为肝素封管后2~10 d内,其中2~5 d内13例,占92.9%。PLT降低的最低值为(1.81~101)×109/L,其中PLT(20~70)×109/L12例,占85.7%;PLT降至最低时下降的比值为51.1%~90.1%,其中50%~80%10例、占71.4%。1例至28 d死亡时血小板没有恢复至肝素封管前水平,其余13例患者PLT减少持续时间5~13 d,其中5~10 d 10例,占76.9%。14例(100%)HIT患者HIT抗体阳性,其中13例(92.9%)在PLT开始减少时即阳性,1例在PLT减少2周后呈阳性。14例HIT患者中12例(85.8%)痊愈,1例(7.1%)脑血栓后遗症,1例(7.1%)死于急性肺栓塞。 结论 静脉留置针封管用肝素可导致HIT,PLT减少及血栓、HIT抗体是诊断的可靠依据。及时停用肝素,必要时抗凝、抗PLT、类固醇激素治疗效果好,部分患者进展快,死亡率高。

    Release date:2021-06-23 07:35 Export PDF Favorites Scan
  • Clinical Observation of Low Molecular Weight Heparin Calcic and Ginkgo Biloba Extract in Treating Unstable Angina Pectoris

    目的:观察低分子肝素钙联合舒血宁(银杏叶提取物)治疗不稳定型心绞痛疗效。方法:选择符合诊断标准的不稳定型心绞痛患者88例。随机分为治疗组与对照组,对照组给予常规药物治疗,治疗组在常规治疗的基础上给予低分子肝素钙和舒血宁注射液治疗。结果:2周结束后治疗组各项观察指标较对照组明显改善,两组差异明显(Plt;005)。结论:低分子肝素钙联合舒血宁治疗不稳定型心绞痛效果显著。

    Release date:2016-08-26 02:21 Export PDF Favorites Scan
  • Comparative Study on the Efficacy and Safety of Thrombolysis and Anticoagulation Therapy for Patients with Acute Sub-Massive Pulmonary Thromboembolism

    Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.

    Release date:2016-09-14 11:22 Export PDF Favorites Scan
  • A Clinical Comparative Study on Intrapleural Heparin Versus Urokinase in the Management of Tuberculous Pleurisy

    Objective To compare the effects of heparin versus urokinase injection intrapleurally in the management of pleural thickening and adhesion due to tuberculous exudative pleurisy. Methods Sixty patients with tuberculous pleurisy were allocated into three groups randomly. Sodium heparin ( heparin group) , urokinase ( urokinase group) , and 0. 9% saline ( control group) were intrapleurally injected respectively. The concentrations of fibrinogen and D-dimer in pleural effusion were measured before and after the injection. The duration of absorption and the total drainage volume of pleural effusion were recorded. The pleural thickness and adhesion were observed two months after the injection. Results In 72 hours after the intrapleural injection, the concentration of fibrinogen( g/L) in the pleural effusion was significantly increased in the heparin group( 1. 13 ±0. 44 vs 0. 34 ±0. 19, P lt; 0. 001) , and significantly decreased in the urokinase group( 0. 25 ±0. 16 vs 0. 38 ±0. 15, P lt; 0. 05) when compared with baseline. Concentrations of D-dimer in the pleural effusions were significantly higher than those at baseline in both the heparin group and the urokinase group( 57. 0 ±17. 6 vs 40. 0 ±15. 4, P lt; 0. 05; 74. 5 ±16. 4 vs 43. 8 ±14. 9, P lt; 0. 001) . There were no significant differences in the absorption duration of pleural effusion among the three groups( P gt;0. 05) . The total drainage volume of pleural effusion was higher in the heparin group and the urokinase group compared to the control group( P lt;0. 01) . And the total volume of pleural effusion was significantly higher in the heparin group and the urokinase group than that in the control group( 2863 mL and 2465 mL vs 1828 mL,P lt;0. 01) . Two months after the intervention, the pleura were thinner[ ( 1. 37 ±0. 82) mm and ( 1. 33 ±0. 85) mmvs ( 3. 06 ±1. 20) mm, P lt; 0. 01] and the incidence of pleural adhesion was significantly lower[ 15% and 20% vs 50% , P lt; 0. 05] in the heparin and the urokinase groups than those in the control group.Conclusion Intrapleural heparin has similar effects with urokinase for prevention pleural thickness andadhesion in tuberculous pleurisy with good availability and safety.

    Release date:2016-09-14 11:23 Export PDF Favorites Scan
  • 肝素诱导的血小板减少症一例的诊治体会

    肝素诱导的血小板减少症(heparin-induced thrombocytopenia,HIT)是一种罕见疾病,以血小板减少和血栓形成为主要特征。HIT可分为Ⅰ型和Ⅱ型。Ⅰ型HIT较常见,不是免疫性反应,很可能与肝素直接激活血小板有关,是一种良性反应。血小板计数多大于100×109/L,极少显著降低,且可自行恢复。Ⅱ型HIT则是免疫介导的综合征,与很多因素有关,各种给药方式都可引发,如静脉或皮下注射,甚至接触极少量肝素等。本文报告1例行冠脉介入手术使用肝素后发生血小板减少,肺泡出血及深静脉血栓形成,改为磺达肝癸钠抗凝后病情好转出院患者的诊治经过,并结合相关文献进行讨论,以提高对这一罕见疾病的认识及处理能力。临床资料 患者男性,61岁。因“持续胸骨后压榨样疼痛8 h”于2010年2月28日入院。患者于入院前8 h无明显诱因下出现持续性胸骨后压榨性疼痛,无心悸、呼吸困难、咳嗽、咯血,无头晕、意识丧失,休息后无法缓解。患者至我院急诊就诊,行心电图检查示急性前壁非ST段抬高性心肌梗死。立即急诊行冠脉造影+内支架植入术,在前降支近段,回旋支,前降支第一对角支处分别植入3枚Firebird球囊支架,术中应用普通肝素8500 U抗凝。患者术中血压、心率稳定,未诉不适。术后给予低分子肝素钙0.4 mL皮下注射1次/12 h抗凝,术后以“冠心病,急性心肌梗死”收入我院心血管内科。既往有高血压病史10余年,最高血压为200/110 mm Hg(1 mm Hg=0.133 kPa),不规律服药,血压控制不佳。无吸烟,饮酒史。入院体检:体温37.3 ℃,脉搏112次/min,呼吸23次/min,血压155/83 mm Hg。神志清,精神萎靡,心率112次/min,律齐,各瓣膜区未闻及明显杂音,两肺叩诊音略浊,右下肺可闻及少许散在湿啰音,各瓣膜区未及病理性杂音。腹部、脊柱、四肢检查无明显异常发现。

    Release date:2016-08-30 11:58 Export PDF Favorites Scan
  • Impact of Preoperative Use of Low-molecular-weight Heparin on Early Outcomes of Off-pump Coronary ArteryBypass Grafting

    Objective To investigate the impact of preoperative use of low-molecular-weight heparin (LMWH) on early outcomes of off-pump coronary artery bypass grafting (OPCAB) . Methods Clinical data of 809 patients undergoingisolated OPCAB from April 1st,2011 to September 30th,2012 in the First Affiliated Hospital of China Medical University were retrospectively analyzed. All the patients were divided into LMWH group and control group according to preoperative use of LMWH or not. In LMWH group,there were 386 patients including 290 male and 96 female patients with their age of 49-81 years,who routinely received anticoagulation therapy with LMWH (LMWH sodium or LMWH calcium,4 000 U twice a day,subcutaneous injection) after discontinuation of anti-platelet therapy until the day before surgery. In the control group,there were 423 patients including 321 male and 102 female patients with their age of 46-78 years,who didn’t receive LMWH or any other anticoagulant after discontinuation of anti-platelet therapy. Postoperative mortality,incidence of perioperative myocardial infarction (MI),operation time,amount of blood loss and transfusion,and incidence of postoperative acute renal injury were compared between the 2 groups. Results Intraoperative blood loss (296±94 ml vs. 249±81 ml,P=0.03),postoperative thoracic drainage (526±159 ml vs. 410±125 ml,P=0.02),blood transfusion (2.6±1.1 U vs. 1.4±0.9 U,P=0.04) and operation time (172±34 min vs. 154±41 min,P=0.04) of LMWH group were significantly larger or longer than those of the control group. There was no statistical difference in postoperative mortality(1.0% vs. 1.2%,P=1.00)or incidence of perioperative MI(4.4% vs. 3.8%,P=0.55)between the 2 groups. Conclusion For OPCAB patientswith stable ischemic heart disease,preoperative management without use of LMWH can decrease operation time and amountof blood loss and transfusion without increasing postoperative mortality or incidence of perioperative MI.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 滴定法预测肝素-鱼精蛋白量减少体外循环术后出血

    出血是心脏术后患者常见并发症之一。两种滴定法预测鱼精蛋白的用量均能够减少术后出血,但依赖于对血容量的正确估计。(1)根据滴定结果绘制肝素和鱼精蛋白剂量-反应曲线,从而计算鱼精蛋白需要量; (2)使用系列鱼精蛋白梯度杯绘制肝素-鱼精蛋白滴定结果曲线,从而直接读出鱼精蛋白的使用量。如心功能异常导致患者血容量变化,可在第一次滴定后进行第二次滴定实验,再根据这一实验结果补充鱼精蛋白。后者对于瓣膜疾病导致的患者血容量增高尤为适用。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Heparin-free Cardiopulmonary Bypass and Early Systemic Inflammatory Response

    Abstract: Objective To explore the feasibility of using protamine-agarose gel to achieve heparin-free cardiopulmonary bypass (CPB). Methods A total of 12 healthy adult dogs were chosen, the dogs were between 2-3 years old,either male or female, with their mean body weight of 23.3±3.7 kg (ranging from 20 to 28 kg). All the dogs were randomly divided into two groups with 6 dogs in each group. In the heparinized group, conventional CPB technique was used; in the non-heparinized group, protamine-agarose gel column was used to absorb plasma clotting factors in CPB without use of heparin. At the beginning of CPB and 1 h, 2 h, 3 h after CPB, arterial blood samples were collected from dogs in both groups. The expression levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured by enzyme-linked immunosorbent assay(ELISA)and compared. Results There was no thrombus formation in the membrane oxygenators during CPB by naked eye observation in both groups. Activated coagulation time (ACT) was always greater than 480 s during CPB. The vital signs of the dogs were all stable during CPB. At the beginning of CPB, there was no statistical difference in plasma concentrations of TNF-α, IL-6, IL-8 between the two groups. At 1 h, 2 h and 3 h after CPB, the expression levels of TNF-α and IL-8 of the non-heparinized group were significantly higher than those of the heparinized group (CPB 3 h TNF-α:156.48±16.65 ng/L vs. 115.87±15.63 ng/L, t=4.356, P=0.001;CPB 3 h IL-8:365.38±46.18 ng/L vs. 299.29±34.50 ng/L, t=2.808, P=0.019). There was no statistical difference in the expression level of IL-6 between the two groups (P>0.05). Conclusion Using protamine-agarose gel to absorb plasma clotting factors is an effective technique to establish heparin-free CPB. But this method can induce significant systemic inflammatory response.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
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