连续性血液净化枸橼酸体外抗凝技术在高危出血患者中的应用

目的研究枸橼酸体外抗凝技术行连续性血液净化(continuous blood purification,CBP)的抗凝效果,解决高危出血倾向患者需行CBP时抗凝难的问题。方法32例高危出血倾向患者随机分为A、B两组,每组16例。均行CBP治疗,均采用枸橼酸抗凝剂为碱基的置换液。A组患者置换液输注速度为2 000 mL/h,血流量200 mL/min,枸橼酸浓度为13.3 mmol/L;B组置换液输注速度为4 000 mL/h,血流量250 mL/min,枸橼酸浓度为7 mmol/L。通过外周静脉补充钙剂。监测患者每日治疗前及结束时全血活化凝血时间(WBACT)、血气分析、血清离子钙及总钙水平。结果32例患者共行CBP治疗112次,总治疗时间1 238.3 h;置换液输入前WBACT与治疗前差异不显著,输入置换液后两组滤器后WBACT(s)较滤器前在2、4、6 h各时间点的延长均有显著性差异(P<0.01);治疗后患者碱剩余(BE)及pH无大幅度上升,无碱中毒出现;治疗前后血清总钙、离子钙水平无显著变化;不加重全身出血倾向,无其他严重不良反应。结论枸橼酸体外抗凝技术能解决高危出血倾向患者行CBP时抗凝难题。     

补钙速率对新型枸橼酸盐透析液抗凝效果的影响

目的　研究补钙速率对高危出血肾衰竭患者应用新型枸橼酸盐浓缩抗凝血液透析效果的影响。方法　 2 8例患者按补钙速率分为 5组进行枸橼酸盐透析液血液透析。透析期间观察患者症状、静脉压、血钙浓度、活化凝血时间(ACT)和血气分析的变化。结果　补钙速率为 4 5mL·h-1时 ,患者未出现低钙的临床表现 ,血钙浓度仅在透析后 1h升高 (P <0 .0 5 ) ;静脉端ACT比动脉端显著延长 (P <0 .0 1) ;透析前后血气分析结果未见明显差异 (P >0 .0 5 )。结论　补钙速率为 4 5mL·h-1枸橼酸盐血液透析液进行血透抗凝安全有效     

新型抗凝血透析液在高危出血肾衰患者血透中的抗凝效果

目的　研究新型枸橼酸盐浓缩抗凝血液透析液在高危出血肾衰患者血液透析临床应用的抗凝效果。方法　 3 8例患者按抗凝方式分为二组 :Ⅰ组无肝素血液透析 ;Ⅱ组枸橼酸盐透析液血液透析。透析期间观察患者出血、体外循环凝血、游离钙、ACT和静脉压变化 ,并用扫描电镜观察滤器中空纤维内膜纤维蛋白沉积和血细胞聚集情况。结果　Ⅰ组 18例中 12例静脉压升高 ,7例透析器及管路发生严重凝血 ,未完成 4h血液透析。Ⅱ组 2 0例静脉端ACT明显延长 ,游离钙明显下降 ,动脉端ACT和游离钙正常 ,透析器及管路无严重凝血 ,全部完成 4h透析。结论　新型枸橼酸盐浓缩抗凝血液透析液抗凝透析效果良好     

3,6-[二甲氨基]-二苯骈碘杂六环枸橼酸盐对离体豚鼠心脏钙反常的保护作用

观察了ＩＨＣ－６５对离休豚鼠心脏钙反常的影响，结果表明：ＩＨＣ－６５可使冠脉流出液中ＣＰＫ和蛋白质漏出量比钙反常组明显减少。同时升高心肌ＣＰＫ和ＧＳＨｐｘ活性，减少ＭＤＡ的生成。说明ＩＨＣ－６５对离休豚鼠心脏钙反常有保护作用。其机制可能与抑制脂质过氧化作用有关。     

来曲唑与克罗米酚在诱导多囊卵巢综合征患者排卵中的作用

目的探讨来曲唑(LE)与克罗米酚(CC)在诱导多囊卵巢综合征(PCOS)患者排卵中的作用。方法选择在我院就诊的PCOS排卵障碍患者46例(58个周期),随机分为LE组和CC组,分别用LE、CC进行促排卵治疗,比较两组发育及成熟卵泡数、排卵数、平均卵泡直径、子宫内膜厚度及形态、排卵率、黄体化卵泡未破裂(LUF)的发生率及妊娠率。结果CC组发育和成熟卵泡数、注射绒毛膜促性腺激素(hCG)日及排卵后1周血清雌二醇浓度、LUF发生率较LE组显著升高(P<0.05),而注射hCG日子宫内膜厚度、子宫内膜三线征阳性率(A型%)显著低于LE组(P<0.05);两组血清孕酮浓度、排卵率及妊娠率无显著性差异。结论LE适合PCOS患者的诱导排卵治疗,有望作为PCOS患者的一线促排卵药物。     

Solute clearance effect of citrate anticoagulation hemodialysate for hemodialysis in patients with high risk of bleeding

Objective To study the solute clearance effect of the new concentrated anticoagulation hemodiaiysate of citrate for hemodialysis in patients with high risk of bleeding. Methods Forty-two kidney failure patients with high risk of bleeding were divided into two groups (Group A and Group B) according to their hemodialysis manners. Patients in Group A were hemodialyzed with bicarbonate hemodialysate with low-molecular-weight heparin (dalteparin) anticoognlation and those in Group B with the new citrate antieoagnlation hemodialysate prepared in our hospital without any other anticoagulant. Blood urea nitrogen (BUN) and creatinine (Cr) concentrations were measured before and after dialysis, and Kt/V and urea reduction rate (URR) were calculated. In addition, activated clotting time (ACT) and ionized calcium (iCa2 ) concentration were also measured at the arterial and venous ends. Results ACT was extended and iCa2 concentration decreased significantly at the venous end compared with those at the arterial end in Group B (P<0.01). BUN and Cr concentrations were markedly decreased after dialysis compared with those before dialysis in both groups (P<0.01), and no significant difference in solute clearance effect, as indicated by Kt/V and URR, was observed between Group A and Group B (P>0.05). Conclusion The solute clearance effect of the new concentrated anticoagnlation hemodialysate of citrate is excellent during hemodiaiysis in kidney failure patients with high risk of bleeding.     

I-65对豚鼠右心室游离壁缺血再灌注心肌电活动的影响

利用一对玻璃微电极同时记录内外膜下心肌细胞的跨膜电位,研究了模拟缺血再灌注条件下,３,６－［二甲胺基］－二苯骈碘杂六环枸橼酸盐对离体豚鼠心室肌心律失常及跨壁传导等电生理特性的影响。结果显示,其可明显性降低心律失常发生率、改善缺血再灌过程的跨壁传导阻滞、相对增加有效不应期、减少触发活动的发生。     

应用新型枸橼酸盐浓缩抗凝血液透析液时影响血侧枸橼酸钠浓度的因素

目的　观察新型枸橼酸盐浓缩抗凝血液透析液进行血液透析时影响血侧枸橼酸盐浓度的因素。方法　采用体外试验模拟血液透析在不同滤器、不同血侧液体浓度和酸碱度以及不同流速的血液侧液体和透析液状态下检测血测枸橼酸盐浓度。结果　血侧枸橼酸盐浓度F 6 0 >FB 1 3 0UGA >GA HP 1 3 0 >F 6 >FB 1 3 0AGA >WS 70。透析液流速 5 0 0mL·min- 1 >2 5 0mL·min- 1 ;血流速 1 0 0mL·min- 1 >2 0 0mL·min- 1 。结论　血侧枸橼酸盐浓度受血流量和透析液流量影响。应用枸橼酸盐浓缩抗凝血透液时 ,应选用高通量滤器或壁薄 ,亲水性好 ,表面积大于 1 .3m2 低通量滤器     

新型枸橼酸盐浓缩抗凝血液透析液的溶质清除效果

目的　研究新型枸橼酸盐浓缩抗凝血液透析液的溶质清除效果。方法　以犬为试验动物 ,应用自制枸橼酸盐浓缩抗凝血液透析液进行血液透析 ,检测透析器前后血BUN和Cr,并计算透析器全血清除率。结果　透析器后血BUN、Cr较透析器前明显降低 (P <0 .0 1 ) ;枸橼酸盐浓缩抗凝血液透析液组透析器全血清除率高于普通肝素碳酸氢盐血液透析液组 ,但无统计学差异 (P >0 .0 5 )。结论　新型枸橼酸盐浓缩抗凝血液透析液的溶质清除效果良好     

EXPERIMENTAL STUDIES ON A NEW TYPE CONCENTRATED ANTICOAGULANT HEMODIALYSATE OF CITRATE IN DOGS

Ａｔｐｒｅｓｅｎｔ ,ｏｎｅｏｆｔｈｅｍａｊｏｒｄｉｆｆｉｃｕｌｔｉｅｓｉｎｂｌｏｏｄｐｕｒｉｆｉｃａｔｉｏｎｏｆｐａｔｉｅｎｔｓｗｉｔｈａｈｉｇｈｒｉｓｋｏｆｂｌｅｅｄｉｎｇｉｓｔｈｅａｄｅｑｕａｔｅａｎｔｉｃｏａｇｕｌａｔｉｏｎｐｒｏｂｌｅｍｆｏｒｍａｉｎｔａｉｎｉｎｇｅｘｔｒａｃｏｒｐｏｒｅａｌｃｉｒｃｕｌａｔｉｏｎ .Ｅｘｉｓｔｅｎｔａｎｔｉｃｏａｇｕｌａｎｔｓｍｉｇｈｔｗｏｒｓｅｎｂｌｅｅｄｉｎｇ .Ｔｈｅｓａｌｉｎｅ ｆｌｕｓｈｈｅｍｏｄｉａｌｙｓｉｓｍａｙｂｅｓｅｌｅｃｔｅｄ ,ｂｕｔｔｈ…