【摘要】 目的 对市场上流通使用的血塞通注射液在溶血性方面的状况进行考察与研究。 方法 按《中国药典》2005年版一部附录ⅩⅧ B中药注射剂安全性检查法应用指导原则和中药、天然药物刺激性和溶血性研究的技术指导原则，对11 个厂家共计27 批血塞通注射液每批次样品制备4 个浓度，进行溶血实验研究，并采用分光光度法（545 λ/nm）测定计算溶血率，比较各批次样品的溶血率。 结果 不同厂家甚至同一厂家不同批次的血塞通注射液溶血率存在一定差异。 结论 在临床使用中应注意用量，过量使用可能导致溶血引起的不良反应；同时，应注意溶血引起的临床不良反应的观测。【Abstract】 Objective To explore the hemolysis of Xuesaitong injection. Methods According to the Guiding Principles of safety tests on traditional Chinese medicine injection in Annex ⅩⅧ B, Chinese Pharmacopoeia, 2005 Edition 1, and Technical Guidelines of studies on the irritability and hemolytic activity of traditional Chinese medicine and natural medicine, a total of 27 samples of Xuesaitong injections (each sample was diluted into four concentrations) produced by 11 manufacturers had been examined. Spectrophotometry (545 λ/nm) was used to calculate the hemolytic rate. Results There was a certain difference in the hemolytic rate among several samples of Xuesaitong injections produced by different manufacturers, or even different batches by the same manufacturer. Conclusion The dosage of Xuesaitong injections should be noted in clinical use. Excessive use may lead to adverse reactions caused by hemolysis; at the same time, clinical adverse reactions caused by hemolysis should be observed.
Abstract： Objective To summarize the clinical experiences of performing extracorporeal membrane oxygenation (ECMO) on patients with heart and respiratory failure, and compare the clinical outcomes of Medtronic system and Quadrox PLS system. Methods We retrospectively analyzed the clinical data of 121 heart and respiratory failure patients who underwent ECMO treatment in Fu Wai Hospital from December 2004 to December 2009. Based on the different systems used, 121 patients were divided into two groups. In group M, there were 65 patients including 41 males and 24 females, with an age of 26.6±25.9 years; and they accepted Medtronic ECMO system treatment. In group Q, there were 56 patients including 39 males and 17 females, with an age of 32.4±23.9 years and they underwent Quadrox PLS ECMO system treatment. The evaluation of the clinical outcomes of these two different systems was based on the comparison of transmembrane pressure drop (TMPD), anticoagulation, hemolysis, plasma leakage, organ function, complication and hospital mortality between the two groups. Results Compared with group M, ECMO with Quadrox PLS system was associated with lower TMPD (at the beginning of ECMO: 15.0±6.0 mm Hg vs.28.0±5.0 mm Hg, P=0.000; 24 hours later: 16.0±5.0 mm Hg vs. 30.0±7.0 mm Hg, P=0.000) and less thrombus formation(7.1% vs.23.1%, P=0.037), less plasma leakage (0.0% vs. 50.8%, P=0.000), less hemolysis (14.3% vs. 29.2%, P=0.047). There were no significant differences between the two groups in support duration, complication rate, and hospital mortality(Pgt;0.05). Conclusion Both devices have similar effects for safe clinical application, but Quadrox PLS ECMO system has a relatively high biocompatibility with lower TMPD, less plasma leakage, and thrombus formation.
Objective To provide a ventricular assist device for patients with heart failure, Fu Wai （FW） axial blood pump was developed for partly or totally to assist the left ventricular function. Vitro hemolysis and animals tests were also employed to test the hydromechanics and hemocompatibility of the FW left ventricular assist devices developed in Fu Wai hospital. Methods Using vitro test loop, FW axial blood pump has been used to evaluate the performance of hemolysis， the pump has also been tested for hemolysis characteristic through five sheep experiments. Results At 8 400 r/min, the pump generates 5 L/min flow against 100 mm Hg, the normalized index of hemolysis (NIH) was0.17±0.06 mg/L. The plasma free hemoglobin of in vivo tests was around 30 mg/dl. Conclusion The results obtained in vitro and in vivo testing indicate an acceptable design for the blood pump, further in vivo tests will be performed before clinical use.
Abstract: Objective To summarize the clinical experience of plasma exchange （PE） during recardiopulmonary bypass (CPB) of patients with severe haemolysis in cardiac surgery. Methods Between January 2001 and December 2005, five patients required PE for severe haemolysis after cardiac surgery. There were periprosthetic leakage and infective endocarditis in 3 patients, congenital heart disease of pulmonary artery stenosis with unsatisfied right ventricular outflow tract patching in 1 patient and thrombosis during extracorporeal membrane oxygenation (ECMO) in 1 patient. They all need blood purification to avoid acute renal failure. Results Five patients were successfully treated with PE during CPB without major complications. The amount of plasma and blood transfused in the 5 patients were 2.2±0.8L and 0.6±0.3L respectively. The volume of plasma exchange and ultrafiltrate were 3.9±1.8L and 2.4±1.3L respectively.The electrolytes and bloodgas analysis in all patients were maintained at the normal levels. The hemodynamics was stable. After heart resuscitation CPB stopped smoothly. Disappearance of periprosthetic leakage and satisfaction of right ventricular outflow tract patching were observed by echocardiograms after peration.Extubation was performed 24h after the operation in 5 patients, and they were discharged 12 to 53 d after the operation with fully recovery. The urine was clear and the body temperature was normal. Before they left thehospital, the concentration of free hemoglobin was tested in 3 patients. The concentration of free hemoglobin was slightly higher in 1 patient (68mg/L), and normal in 2 patients (lt;40mg/L). Conclusion PE during CPB in severe haemolysis is a safe technique which can effectively prevent acute renal failure caused by severe mechanical haemolysis after cardiac surgery.
【Abstract】 Objective To report 1 case of acute hemolytic anemia after liver transplantation because of ABO compatibility and therapeutic experience. Methods The patient with liver cancer underwent orthotopic piggyback liver transplantation on September 2010 after radiofrequency ablation of the tumors. The donor and recipient ABO blood types were type O and type A, separately. Acute hemolytic anemia occurred at 10 days after transplantation and hemoglobin decreased to 56 g/L. The bone marrow showed active hyperplasia; and myeboid∶erythroid was 0.52∶1. The immunosuppressants were used and type O washed red blood cells were transfused immediately. Results The general condition of the patient was improved; hemoglobin increased gradually and returned to 111 g/L at 34 days after liver transplantation. At 12 months of follow-up, hemoglobin was within normal range. Conclusion Using graft blood type washed red blood cells transfusion and immunosuppressants could be an effective therapeutic procedure in the patient with ABO compatility graft when acute hemolytic anemia occurrs.
Objective To assess the effectiveness of intravenous immunoglobulin G (IVIG) in reducing the need for exchange transfusion in neonates with proven haemolytic disease due to Rh and/or ABO incompatibility. To evaluate the effectiveness of IVIG in reducing the duration of phototherapy and hospital stay. Methods We electronically searched CENTRAL, MEDLINE (1966 to May 2008), EMBASE (1992 to May 2008), CBMdisc (November 1979 to May 2008), and also checked the reference lists of all papers identified. According to the Cochrane Handbook for Systematic Reviews of interventions, randomized controlled trials comparing IVIG and phototherapy with phototherapy alone in neonates with Rh and/or ABO incompatibility were identified and analyzed. Results Six RCTs were included. The meta-analysis showed that, IVIG can significantly decrease the requirements of exchange transfusion (RR=0.27, 95%CI 0.18 to 0.42), the duration of hospitalization (WMD= –1.11, 95%CI –1.60 to –0.63) and the duration of phototherapy (WMD= –0.82, 95%CI –1.16 to –0.47). Conclusions Intravenous immunoglobulin (IVIG) is recommended for treating hemolytic disease of the newborn because it is effective in decreasing the requirements of exchange transfusion, the duration of hospitalization and phototherapy. Well designed studies with large sample in multi-center are required for further proving.
Objective To assess the clinical application of lysophosphatidic acid (LPA) as the early warning index for cerebral ischemic stroke (CIS). Methods Trials were collected through electronic searches of PubMed, The Cochrane Library, CBM, CNKI, Wanfang, and VIP (from the date of database establishment to June 2009). We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of the included studies, performed descriptive analysis and meta-analysis with The Cochrane Collaboration’s RevMan 4.2 software. Results A total of 22 studies were included. The results of meta-analyses showed that, there was a significant difference about LPA level in cerebral infarction (CI) group vs. healthy control group (WMD=2.00, 95%CI 1.85 to 2.15), and in transient ischemia attach (TIA) group vs. healthy control group (WMD=2.48, 95%CI 2.18 to 2.78); and a difference was noted about 24 hours LPA level in CI group vs. healthy control group (WMD=2.40, 95%CI 1.81 to 2.99). Conclusions According to the included studies, the contents of LPA is higher in CIS than that in healthy control group. It would be helpful to measure LPA in the TIA period for intervention. However, more high quality trials are expected for further study, in order to prove the value of LPA as early warning index because of the heterogeneity and poor quality of the current included studies.
目的 检测血细胞减少患者外周血红细胞和中性粒细胞细胞膜糖基磷脂酰肌醇（GPI）连接的补体调节蛋白衰变加速因子（CD55)和膜反应性溶血抑制物（CD59）表达情况，并探讨其临床意义。 方法 2006年7月－2011年3月，采用直接免疫荧光标记法流式细胞仪检测182例血细胞减少患者外周血CD55及CD59表达情况，其中阵发性睡眠性血红蛋白尿（PNH）9例，再生障碍性贫血（AA）-PNH综合征8例，AA 83例，骨髓增生异常综合征51例，自身免疫性溶血性贫血11例，造血功能停滞6例，缺铁性贫血7例，巨幼细胞性贫血4例，脾功能亢进3例。 结果 PNH及AA-PNH患者CD55、CD59抗原缺失率均较其他血细胞减少者明显增高。 结论 流式细胞仪检测外周血中红细胞和中性粒细胞膜CD55和CD59抗原表达缺失率是目前诊断PNH可靠和敏感的方法，也是对PNH、AA-PNH早期诊断敏感指标，并且PNH克隆检测还能为诊断疾病提供鉴别诊断依据。