Objective To preliminarily summarize the diagnosis and treatment of coagulopathy in patient with severe hepatic cirrhosis who underwent orthotopic liver transplantation (OLT). Methods Preoperative coagulability, the replacement therapy by coagulation factors and platelet pre-and intraoperatively, intra-operative bleeding amount and blood transfusion amount and the relation to the postoperative course were analyzed retrospectively in 6 patients with severe hepatic cirrhosis who underwent OLT in the last year. Results All of the 6 patients had a Child-c preoperative hepatic function, 2 with prolongation of bleeding time. All of the 6 had a decrease of platelet count, with a mean platelet count of 25.3×１０９／Ｌ. Mean prolongation of prothrombin time was 10.7 seconds as compared with controls. Mean prolongation of activated partial thromboplastin time was 23.1 seconds as compared with controls. Mean fibrinogen was 1.5 g/L. Mean pre- and intra- operative transfusion of fresh frozen plasma was 788 ml, platelet 7.1×１０12， cryopreciptitate 5.5 units, fibrinogen 2.8 grams and lyophilized prothombin complex concentrate (LPCC) 1 700 units. The first 4 cases in the early period had a mean bleeding amount of 8 672.5 ml, with a mean transfusion of 9 215.0 ml. One of the 4 with the most massive intraoperative bleeding was complicated by severe internal milieu disturbance, DIC and fungus infection and died of the infection. Postoperatively the last 2 cases in the late period had a complete preoperative replacement of coagulation factors and platelet and had a only mean bleeding amount of 2 700 ml with a mean transfusion amount of 3 638 ml. Conclusion We initially consider that a preoperative complete replacement of coagulation factors and platelet according to the coagulability tests may lessen intraoperative bleeding and transfusion and make the patient an uneventful postoperative course.
目的:觀察蛇傷患者凝血、抗凝和纖溶系統各項指標的變化并探討其臨床意義。方法:以36例蛇傷患者和32例健康體檢者為研究對象,測定血漿凝血酶原時間(PT)、部分凝血活酶時間(APTT)、纖維蛋白原(Fg)、血管性血友病因子(vWF)、凝血酶調節蛋白(TM)、組織型纖溶酶原激活物(tPA)、纖溶酶原激活物抑制物1(PAI1)含量。結果:與正常對照組比較,蛇傷患者PT、APTT、vWF、TM、tPA、PAI1水平明顯升高,Fg水平明顯降低(Plt;001)。結論:蛇傷患者存在凝血、抗凝、纖溶系統的紊亂,早期使用抗蛇毒血清對于防治彌散性血管內凝血(DIC)和多器官功能障礙(MODS)的發生有積極意義。
目的:探討自體血液回收技術對循環、血細胞和凝血功能的影響及應用效果。方法: 選擇急診大失血手術患者27例,采用ZITI-2000型血液回收機回收血液,經過濾、離心、清洗后回輸給患者。分不同時點觀察HR、SBP、MAP、DBP、SPO2的變化,并監測RBC、Plt、HB、Hct、FIB、PT、APTT的變化。計算輸血量和異體輸血率。隨機選擇8例進行回收原血和回輸 血血細胞學比較。結果:(1)術前血壓較低,心率較快,回輸血液后,HR顯著降低(Plt;0.01),SBP和MAP顯著升高(Plt;0.01)。(2)術前RBC、HB和Hct均低于正常水平,回輸后各時點均升高明顯(Plt;0.01)。術前FIB和Plt低于正常水平,回輸后各時點增高,但無顯著意義。PT、APTT無明顯變化。(3)回收原血平均每例3735mL,回輸血平均每例1589mL,異體輸血率為25％。(4)回輸血RBC、HB和Hct均顯著高于回收原血(Plt;0.01)。結論:自體血液回收技術用于臨床安全可靠,能有效維持循環的穩定,對凝血功能無明顯影響,節約血源,減少異體輸血。
目的：了解左旋門冬酰胺酶（L-ASP）對兒童急性淋巴細胞白血病凝血功能變化的影響。方法：觀察86例患兒在誘導緩解后治療期間，L-ASP使用前后活化部分凝血活酶時間(APTT)、凝血酶原時間(PT)、凝血酶時間(TT)、纖維蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚體變化情況。結果：與用藥前比,用藥結束后一天的PT、APTT、TT均顯著延長(P＜0.01);FIB、AT-Ⅲ顯著降低(P＜0.01),D-二聚體顯著升高(P＜0.01);用藥結束后1周時PT、APTT、TT、D-二聚體較用藥前差異無顯著性,FIB、AT-Ⅲ雖有回升,但仍低于正常(P＜0.01)。結論：L-ASP可引起ALL患兒凝血功能異常，尤其對FIB、AT-Ⅲ影響明顯，應引起臨床高度重視。Ｌ-Ａｓｐ主要影響蛋白質的合成而引起蛋白質成份的凝血因子減少,從而引起凝血功能障礙,且對纖維蛋白原的合成影響更為顯著。
Objective To evaluate the predictive value of lactate dehydrogenase (LDH) to albumin (Alb) ratio (LAR) in the prognosis of severe pneumonia patients complicated with DIC. Methods A total of 312 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of the Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University from January 1, 2018 to March 1, 2023 were retrospectively collected. The clinical parameters, such as gender, age, underlying diseases, and lactate dehydrogenase, albumin etc. l of the first test on admission were collected. LAR, sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) within 24 hours were calculated. The firstly endpoint of the study was the incidence of disseminated intravascular coagulation (DIC), the secondary endpoint was the 30-day in-hospital mortality in severe pneumonia patients with DIC. Univariate and multivariate logistic regression were used to analyze the risk factors of severe pneumonia with DIC. The receiver operating characteristic curve (ROC curve) was drawn and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of LAR for the incidence of DIC in patients with severe pneumonia. Results The level of LAR was higher in the severe pneumonia patients with DIC than the severe pneumonia patients without DIC [LAR median ratio 12.72 (8.72, 21.89) vs. 7.23 (5.63, 10.90), P<0.001]. Multiple logistic regression analysis showed that LAR [OR=1.071, 95%CI 1.038 - 1.106, P<0.001] was the independent risk factor of the incidence of DIC in the patients with severe pneumonia. ROC curve analysis showed that the AUC for LAR to predict the incidence of DIC was 0.723, 95%CI 0.650 - 0.796, P<0.001. When the LAR cut-off value was 8.08, the sensitivity was 79.7% and the specificity was 56.1%. Kaplan-Meier survival analysis curve showed that the patients in the above LAR cut-off value group had a significantly lower 30-day survival rate than those in the below LAR cut-off value group (P<0.001). In the subgroup analysis and numerical variable transformed analysis, LAR was still the risk factor of DIC. Conclusion The increased LAR is a high risk factor of the incidence of DIC and mortality in patients with severe pneumonia, which is useful for predicting prognosis of patients with severe pneumonia.