简介:摘要目的探讨大量输血方案(MTP)在治疗多发伤患者早期大量输血和预防凝血病中的效果。方法回顾性分析2015年3月至2019年5月义乌市中心医院收治的多发伤患者117例,根据输血方案的不同分为对照组53例和观察组64例。对照组患者采取常规输血方案,观察组患者采取MTP输血方案。比较两组患者入院时及输血24 h后血常规及凝血功能变化、24 h内出血量及异体血液成分输入量、患者住院时间及病死率。结果输血24 h后两组患者血红蛋白(Hb)、红细胞比容(Hct)、血小板计数(Plt)水平较入院时均显著升高[(112.73±12.73)g/L比(96.74±10.28)g/L,(115.28±19.27)g/L比(95.37±11.47)g/L,(39.72±5.21)%比(31.47±4.22)%,(39.10±4.97)%比(30.56±4.13)%,(220.93±54.28)×109/L比(142.83±36.47)×109/L,(216.87±64.03)×109/L比(148.96±40.22)×109/L;t=7.818、6.464、9.844、9.621、9.554、6.538,均P<0.05],而入院时、输血24 h Hb、Hct、Plt组间比较差异均无统计学意义(t=0.681、1.172、0.864、0.746、0.740、1.363,均P>0.05);输血24 h观察组患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)时间较入院时均显著降低[(13.21±2.93)s比(16.28±4.26)s,(46.28±3.97)s比(54.37±6.42)s;t=4.705、8.574,均P<0.05],而对照组均无明显变化[(15.84±3.62)s比(16.93±5.17)s,(54.02±6.39)s比(55.29±7.02)s;t=0.212、0.332,均P>0.05],输血24 h后观察组PT、APTT时间均明显短于对照组(t=4.344、8.006,均P<0.05);输血24 h、入院时两组患者纤维蛋白原(Fib)水平均无明显变化[(4.30±0.48)g/L比(4.36±0.56)g/L,(4.41±0.58)g/L比(4.51±0.63)g/L;t=0.651、0.934,均P>0.05]。两组患者24 h出血量、新鲜冰冻血浆(RBC)输入量差异均无统计学意义[(2 684.92±703.47)mL比(2 725.86±810.32)mL,(17.28±3.74)U比(17.02±2.95)U;t=0.293、0.411,均P>0.05],观察组患者红细胞悬液(PF)输入量以及PF∶RBC比例均显著高于对照组[(9.28±3.27)U比(6.29±3.18)U,(0.55±0.12)比(0.39±0.10);t=4.985、7.733,均P<0.05]。观察组患者器官功能损评分、ICU住院时间均显著低于对照组[(5.93±1.64)分比(7.28±2.10)分,(7.21±1.85)d比(9.10±2.37)d;t=3.814、4.732,均P<0.05],观察组患者大出血致死率明显低于对照组[6.25%(4/64)比20.75%(11/53),χ2=5.457,P<0.05]。结论给予大量输血治疗方案的规范化救治策略,给予患者早期成比例成分血制品(红细胞悬液、新鲜冰冻血浆、血小板),可显著改善多发伤患者凝血功能,降低凝血病的发生,有助于降低患者大出血病死率,值得临床推广。
简介:摘要:在临床医学中,凝血功能障碍是一种最为常见的出血性疾病,发病原因有凝血功能异常、凝血因子含量降低等,分为单一性凝血因子缺乏导致的遗传性凝血功能障碍和在疾病基础上出现多种凝血因子减少导致的继发性凝血功能障碍两种。传统凝血项检测都是用来对患者的凝血功能障碍进行检测与评估,但由于操作过程十分复杂、需要等待较长时间,再加上以缺乏血小板的血浆作为检测基础,使血小板在凝血系统中起到的作用被进一步削弱,进而导致血栓形成以及纤维蛋白的溶解过程都无法动态呈现出来,不能真实完整地反映凝血全貌,因此在临床医学方面的实际应用便会受到很大的限制。 Hartert是提出血栓弹力图的第一人,但广泛应用在临床医学中是多年之后才发生的事情,它凭借着时效性强、操作简单等多种优势,获得了众多临床工作者的喜爱,可实现床旁快速检查,就连 CCTs很难检查到的凝血异常也能很快检测出来,并且在对血液中血栓形成和溶解过程进行可视化检测与分析时,其实时性表现也是十分出色的。临床方面有关血栓弹力图的综述大多集中在以学科应用进行概述,本文主要对血栓弹力图在几种临床常见凝血障碍性疾病中的应用效果进行介绍,希望能推动血栓弹力图在创伤患者凝血功能障碍治疗的应用。
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简介:【摘要】 目的:观察并分析小儿脓毒症患者炎症因子和凝血指标的变化意义及临床治疗;方法:选取我院 2018年 1月 ~2019年 12月期间收治的小儿脓毒症患儿 130例,使用随机数字分析法将其分为研究组和对照组,每组各 65例,对照组患儿采用常规输液外加抗感染、保护脏器功能等西药治疗,研究组患儿采取在对照组患儿的治疗基础上采用乌司他丁注射液进行治疗,观察并比较两组患儿治疗前后的炎症因子、凝血功能、两组患儿住院时和病死率; 结果:研究组患儿治疗前后的炎症因子、凝血功能以及两组患儿住院时间和病死率均优于对照组患儿(P<0.05); 结论:采用乌司他丁注射液对小儿脓毒症患儿进行治疗,效果显著,对患儿有积极意义,值得临床推荐。
简介: 【摘要】目的 研究凝血检验指标在弥漫性血管内凝血诊断中的作用效果。方法 抽取 2017年 12月~ 2018年 12月到我院进行弥漫性血管内凝血诊疗的 90例患者作为本次的研究对象,分为研究组,再选择同期到我院进行常规体检的 90例健康人员作为对照组,在其他条件相同的情况下,分别为两组进行弥漫性血管内凝血诊断人员实施凝血指标检验,比较两组检验人员诊断结果中的各项指标。结果 观察组诊疗患者的 APTT、 PT、 INR以及 TT水平明显比对照组健康人员的水平高,而 FIB水平明显比对照组健康人员的水平低,两组进行凝血指标检验的诊断效果差异具有统计学意义( P<0.05)。结论 对弥漫性血管内凝血患者实施凝血指标检验能够有效地诊断出患者的病情发展情况,为主治医生提供了更加可靠的依据对患者进行针对性的治疗,是一项值得推广的应用。 【关键词】凝血检验指标 ;弥漫性血管内凝血 ;健康人员 [Abstract] Objective To study the effect of coagulation test in the diagnosis of DIC. method From December 2017 to December 2018, 90 patients who came to our hospital for diagnosis and treatment of disseminated intravascular coagulation were divided into study group and 90 healthy persons who came to our hospital for routine physical examination at the same time were selected as the control group. Under the same conditions, the coagulation index test was carried out for the two groups for the diagnosis of disseminated intravascular coagulation, and the two groups were compared Each index in the diagnosis results of group B inspectors. Results the levels of APTT, Pt, INR and TT of the patients in the observation group were significantly higher than those in the control group, while the levels of FIB were significantly lower than those in the control group. There was a significant difference between the two groups in the diagnostic effect of coagulation index test (P < 0.05). Conclusion the test of coagulation index can effectively diagnose the development of patients with DIC, and provide a more reliable basis for the attending doctors to carry out targeted treatment for patients, which is worth popularizing.
简介: 摘要目的:探讨标本放置温度、时间及凝血真空采血管对凝血检验的影响。方法: 2018年 3-8月收治体检健康志愿者 80例,应用 2种不同的凝血真空采血管采集标本进行凝血检验。甲组使用 BD凝血真空采血管,乙组使用国产抗凝管。分析不同时间、不同温度对凝血检验结果的影响。结果:两组凝血酶时间( TT)、纤维蛋白原( FIB)、活化部分凝血活酶时间( APTT)、血浆凝血酶原时间( PT)比较,差异无统计学意义( P>0.05) ;低温保存 8h后, TT、 APTT、 PT高于即时检查,差异有统计学意义( P<0.05) ;室温保存 4h后, TT、 PT、 APTT高于即时检查结果,差异有统计学意义( P<0.05) ;FIB在室温、低温保存以及即时检查中差异均无统计学意义( P>0.05)。结论:不同质量的真空采集血管会对检查结果造成一定影响,而保存时间、放置温度均会影响检查结果,为了确保检验的准确性,应选择合适的凝血真空采集管,并在 2h内完成检查。 关键词 凝血检验 ;真空采集血管 ;放置时间 ;放置温度 Objective: To investigate the effects of temperature, time and blood vessel collection on blood coagulation test. Methods: from March to August 2018, 80 healthy volunteers were admitted for physical examination. Two kinds of blood coagulation vacuum blood collection specimens were used for coagulation test. In group A, blood vessels were collected by BD coagulation vacuum, and in group B, anticoagulation tubes made in China were used. The influence of different time and temperature on coagulation test results was analyzed. Results: there was no significant difference in TT, FIB, APTT and Pt between the two groups (P > 0.05); after 8 hours of cryopreservation, TT, APTT and PT were higher than those of the immediate examination (P < 0.05); after 4 hours of room temperature preservation, TT, Pt and APTT were higher than those of the immediate examination (P < 0.05) There was no significant difference in FIB in room temperature, cryopreservation and instant examination (P > 0.05). Conclusion: different quality of vacuum collection vessels will affect the results of the examination, while the storage time and temperature will affect the results of the examination. In order to ensure the accuracy of the examination, we should select a suitable coagulation vacuum collection tube and complete the examination within 2 hours.
简介:【摘要】目的 探究凝血检验指标在弥漫性血管内凝血诊断中的作用与效果。方法 于我院 2018年 4月 -2019年 4月间收治的弥漫性血管内凝血患者中随机抽取 62例为试验组研究对象, 62例患者均行凝血指标检查。并随机选取 62例同期进行凝血指标检查的健康人员为对照组研究对象,比较两组检验后的内源性凝血状态和纤维蛋白时间以及外源性凝血状态和纤维蛋白原含量。结果试验组患者检查后的 APTT和 TT以及 PT等指标均明显高于对照组患者检查后的 APTT和 TT以及 PT等指标,两组数据比较存在统计学差异( P<0.05)。试验组患者检查后的 FIB指标明显低于对照组患者检查后的 FIB指标, P<0.05,两组数据比较存在统计学差异。结论 在弥漫性血管内凝血疾病的诊断过程中,通过凝血检验指标检查可以准确、快速的筛选出发病者。其作用与效果均非常显著,针对患者不同指标的异常情况来进行针对性治疗,有利于减轻患者的临床症状 ,促进患者的身体康复,临床推广价值显著。
简介: 摘要 目的:探究凝血检验指标在诊断弥漫性血管内凝血中的应用价值。方法: 2018年 1月 -2019年 12月收治弥漫性血管内凝血患者 80例为试验组,另取同期健康受检者 80例为对照组。对比凝血检验结果。结果:试验组 PT、 APTT、 TT、 INR水平均高于对照组, FIB水平低于对照组,差异有统计学意义( P<0.05)。试验组高凝期、低凝期及纤溶期 PT、 APTT、 TT、 INR与 FIB水平对比,差异有统计学意义( P<0.05)。结论:采用凝血检验指标可有效检出弥漫性血管内凝血,有助于确定凝血分期。 关键词 凝血检验指标 ;弥漫性血管内凝血 ;诊断 Objective: To explore the application value of coagulation test indexes in the diagnosis of disseminated intravascular coagulation. Methods: from January 2018 to December 2019, 80 patients with disseminated intravascular coagulation were selected as the experimental group, and 80 healthy subjects were selected as the control group. The blood coagulation test results were compared. Results: the levels of Pt, APTT, TT and INR in the experimental group were higher than those in the control group, and the FIB level was lower than that in the control group (P < 0.05). There were statistically significant differences in Pt, APTT, TT, INR and FIB levels in the experimental group at high coagulation stage, low coagulation stage and fibrinolysis stage (P < 0.05). Conclusion: disseminated intravascular coagulation can be detected effectively by coagulation test indexes, which is helpful to determine the coagulation stage.
简介:摘要脓毒症是以宿主对感染反应失调为特征的可危及生命的临床综合征,为PICU收治患儿主要死亡原因之一。脓毒症时炎症、凝血反应相互促进,从而导致凝血功能障碍。脓毒症凝血功能障碍普遍存在,在多系统器官功能障碍(multiple organ dysfunction syndrome,MODS)的发生发展中起重要作用,对脓毒症的最终转归至关重要。脓毒症凝血功能障碍非单一途径驱动,内皮细胞、血小板、凝血因子等均起重要作用,故针对单一途径进行治疗难有良好效果。故该文对相关文献进行整理分析,对脓毒症凝血功能障碍发病机制、临床检测方法的研究进展进行综述,希望对临床寻找有效治疗方法及最佳干预时机提供参考。
简介: 摘要:目的 探讨分析凝血检验指标在诊断弥漫性血管内凝血中的临床价值。方法 将于 2017年 1月 -2018年 12月期间收治的弥漫性血管内凝血患者 100例纳入研究,即研究组,并抽取 100例同时间段来院进行健康健康的人群作为对照组;两组均接受凝血检验,并结合检查结果进行分析对比。结果 研究组的 PT、 APTT、 TT、 INR均高于对照组,而 FIB低于对照组, P<0.05;研究组高凝期的 PT、 APTT、 TT、 FIB均低于低凝期及纤溶期,而 INR则明显高于低凝期及纤溶期, P<0.05。结论 应用凝血检验指标诊断弥漫性血管内凝血的临床价值高,更有效评估弥漫性血管内凝血具体疾病分期,值得推广与应用。 关键词:凝血检验指标;弼漫性血管内凝血:诊断;作用; Abstract: Objective To explore the clinical value of coagulation test in the diagnosis of DIC. Methods 100 patients with DIC admitted from January 2017 to December 2018 were included in the study, i.e. the study group, and 100 healthy people who came to the hospital at the same time were selected as the control group; both groups received coagulation test, and the results were analyzed and compared. Results Pt, APTT, TT and INR in the study group were higher than those in the control group, while FIB in the study group were lower than those in the control group (P < 0.05); Pt, APTT, TT and Fib in the study group were lower than those in the low coagulation period and fibrinolysis period, while INR was significantly higher than those in the low coagulation period and fibrinolysis period (P < 0.05). Conclusion the clinical value of using coagulation test index to diagnose DIC is high, and it is more effective to evaluate the stage of DIC.