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To explore the causes of vascular crisis caused by replantation of severed finger ,and summarize the experience of prevention and treatment.Methods From April 2015 to February 2017,108 patients with wounded finger treated in the First People＇s Hospital of Yongkang were divided into two groups according to the occurrence of postoperative vascular crisis situation :the control group (56 cases,vascular risk),the observation group (52 cases,vascular crisis happened ).The clinical data of all patients were collected ,the various data were compared , and the causes of vascular crisis were analyzed.The observation group was given low molecular dextran treatment ,the changes of blood coagulation function indicators before and after treatment were observed .Results The age, disconnection plane,ischemia time had statistically significant differences between the two groups ( all P ＜0.05). After treatment,the four coagulation function index in the observation group [ fiber protease:(3.32 ±0.29) g／L, activated partial thrombin time:(27.56 ±2.08) s,thrombin time:(12.13 ±1.62) s,prothrombin time:(11.47 ± 1.29)s] were improved obviously (t＝4.86,8.63,6.04,4.70,all P＜0.05).Conclusion The age,disconnection plane and ischemic time are the factors that cause vascular crisis.In addition,postoperative pain, patients＇mood, postoperative posture and other factors may also lead to vascular crisis.Preoperative assessment of the condition should be done well,postoperative monitoring should be strengthened ,and prophylactic medication can be used to prevent vascular crisis.
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Objective@#To explore the causes of vascular crisis caused by replantation of severed finger, and summarize the experience of prevention and treatment.@*Methods@#From April 2015 to February 2017, 108 patients with wounded finger treated in the First People's Hospital of Yongkang were divided into two groups according to the occurrence of postoperative vascular crisis situation: the control group (56 cases, vascular risk), the observation group (52 cases, vascular crisis happened). The clinical data of all patients were collected, the various data were compared, and the causes of vascular crisis were analyzed.The observation group was given low molecular dextran treatment, the changes of blood coagulation function indicators before and after treatment were observed.@*Results@#The age, disconnection plane, ischemia time had statistically significant differences between the two groups(all P<0.05). After treatment, the four coagulation function index in the observation group [fiber protease: (3.32±0.29)g/L, activated partial thrombin time: (27.56±2.08)s, thrombin time: (12.13±1.62)s, prothrombin time: (11.47±1.29)s] were improved obviously (t=4.86, 8.63, 6.04, 4.70, all P<0.05).@*Conclusion@#The age, disconnection plane and ischemic time are the factors that cause vascular crisis.In addition, postoperative pain, patients' mood, postoperative posture and other factors may also lead to vascular crisis.Preoperative assessment of the condition should be done well, postoperative monitoring should be strengthened, and prophylactic medication can be used to prevent vascular crisis.
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Objective To evaluate the diagnostic value of procalcitonin in early ventilator-associated pneumonia. Methods CNKI database, Wanfang database and PubMed (2000-2014) were applied for document retrieval through keyword searching approach. Meta-analysis was used in all eligible studies. Results Thirteen studies were collected. The sample bank includes 1 137 cases , of which 599 cases were diagnosed as ventilator-associated pneumonia. Heterogeneity test showed that the homogeneity of the studies was good. The value of the weighted sensitivity was 59% (43% ~ 73%), the specificity was 89% (82% ~ 93%), the positive likelihood ratio was 3.69 (3.21 ~ 4.23), the negative likelihood ratio was 0.42 (0.32 ~ 0.55), and the SROC area under the curve (AUC) was 0.86. The value of the weighted sensitivity was 81%(73% ~ 87%), the specificity was 83%(73% ~ 90%). Conclusion Procalcitonin can be regarded as a valuable marker in early ventilator-associated pneumonia diagnosis , when the cut-off point of PCT is 2.0 μg/L.
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Objective To investigate the relationship between inflammation and blood coagulation function in the patients with acute exacerbation of chronic cor pulmonale (AECCP) and discuss the potential mechanism and influence on the patients. Methods The present study was based on 30 healthy controls and 141 cases of AECCP in our hospital from January 2011 to June 2014.Levels of white blood cell (WBC), neutrophil (NEUT), high-sensitivity C-reactive protein (hs-CRP, Complement 3 (C3), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and thrombin time (TT) in the patients were determined. Results Compared with the healthy controls, the patients had higher levels of WBC, NEUT, hs-CRP, PT, APTT, FIB, TT (all P < 0.001) and lower level of C3 (P < 0.001). Significant positive correlations were found between the levels of WBC, NEUT and FIB (r = 0.196 and r = 0.199, both P < 0.05); hs-CRP and APTT, FIB(r = 0.234, P < 0.01 and r = 0.466, P < 0.001); C3 and FIB(r = 0.466, P < 0.001), and significant negative correlations were observed between the levels of C3 and PT, APTT, TT (r=-0.258, P<0.01;r=-0.279, P < 0.01 and r = -0.168, P < 0.05, respectively). Compared with the survival patients, the cases of death had higher levels of WBC and NEUT (both P < 0.01). The area under receiver operating characteristic curve of WBC and NEUT, predicting the prognosis, was 0.666 (95% CI 0.552, 0.780; P < 0.01) and 0.695 (95% CI 0.558, 0.801; P = 0.001) respectively. Conclusions Inflammation and blood coagulation function disorder usually coexist in the patients with AECCP, and are closely associated with the severity. Levels of both WBC and NEUT can be used as prognosis predictors for the patients.
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ObjectiveTo study the correlation between serum paraoxanase-1 (PON-1) activity and blood lipid and their changes before and after nasal continuous positive airway pressure ventilation (nCPAP) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to investigate the effect of PON-1 on the occurrence of candiovascular diseases in OSAHS patients.MethodsAccording to the apnea hypopnea index(AHI),86 OSAHS patients were divided into mild group(24 cases,5 ＜ AHI ≤20),moderate group (25 cases,20
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Twenty eight patients with multiple organ dysfunction syndrome (MODS) underwent continuous venovenous hemofiltration (CVVH)in ICU from June 2003 to June 2008, including 13 cases treated with predilution mode and 15 with postdilution mode. The changes of oxygenate index( PaO2/FiO2 )during CVVH were retrospectively analyzed. The total case fatality rate of this group of patients was 46%(13/28). There was a significant increase in PaO2/FiO2 of 28 cases during the first 48 h of CVVH (P ＜0. 05);the levels of PaO2/FiO2 in predilution group had increased significantly within 48 h during CVVH (P＜0. 05), while those in postdilution group had not significantly changed (P ＞ 0. 05). There was a significant increase in Pa02/FiO2 for the survival patients during the first 48h CVVH( P ＜ 0. 05 ), while no significantly change in the fatal cases(P ＞0. 05 ). In summary, oxygenate function and outcome of patients with MODS can be improved by CVVH, and predilution may be a more effective mode.
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Objective To study the diagnostic values of a distintegrin and metalloproteases-8 (ADAMS) in non-small cell lung cancer(NSCLC).Methods The serum protein level of ADAM8 was assayed by ELISA in 62 NSCLC patients,27 lung benign lesions and 32 healthy people.Results The serum levels of ADAM8 of NSCLC [(456.88±143.87)ng/L] were higher than those with lung benign lesions[ (271.63±74.20) ng/L] and normal controls(253.09±72.15 ng/L) (P<0.01), but there was no significant difference between lung benign lesions and normal controls (P0.05).No significant difference was found between adenocarcinoma and squamous cell carcinoma in serum ADAM8 level,the serum levels of ADAM8 in NSCLC with stages Ⅲ-Ⅳ [ (498.80 ± 151.80) ng/L] were higher than those with stages Ⅰ -Ⅱ[(385.80±95.85) ng/L] (P <0.01 ).The diagnostic sensitivity of detection of ADAM8 for NSCLC was 77.4% and the specificity was 90.6%.Conclusion The overexpression of ADAM8 in serum of NSCLC patients indicates that ADAM8 is related with occurrence and metastasis of NSCLC;De-tection of ADAM8 could assist the diagnosis for NSCLC.
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Objective To study the expression of distintegrin and metalloprotease (ADAM10) in serum of lung cancer patients and its clinical significance. Methods The serum protein level of ADAM10 was assayed by ELISA in 44 lung cancer patients,34 benign lung lesions and 31 healthy subjects. The serum protein level of CEA was assayed by radioimmunoassay. Results The serum concentration of ADAM10 and CEA was higher in patients with lung cancer than benign lung lesions and normal controls(P <0.01) ,theft was distinct statistical difference be-tween lung cancer and lung benign lesions,normal controls(P <0.01) ,but no statistical difference between lung be-nign lesions and normal controls(P >0.05) ; the serum concentration of ADAM10 of lung cancer with lymph node metastasis were significantly higher than those of lung cancer without lymph node metastasis, there was statistical difference (P < 0.01) ; the serum concentration of CEA of lung cancer with lymph node metastasis were slightly higher than those of lung cancer without lymph node metastasis, but there was no difference (P > 0.05) ; the serum concentration of ADAM10 and CEA in adenocarcinoma were higher than squamous cell carcinoma and small cell lung cancer(P <0.01 ,P <0.05). The single item detection of ADAM10 or CEA to the lung cancer diagnostic sensitivity is 51.7% ,56.9% respectively,the union detection reaches 84.5% . Conclusion ADAM10 is related with occur-rence and metastasis in lung cancer. The union detection of ADAM10 and CEA can raise the lung cancer diagnostic sensitivity.
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Objective To study the characteristics of respiratory impedance in patients with chronic obstructive pulmonary disease (COPD),obstructive sleep apnea hypopnea syndrome (OSAHS).Methods The respiratory impedance were measured by Impulse Oscillometry(IOS) technique and polysomnography(PSG) were done synchronously in 11 COPD patients,15 OSAHS patients,4 overlap syndrome patients(COPD+OSAHS) and 10 control group. Results Zrs、R5、Rc and RP in COPD group,OSAHS group and COPD+OSAHS group were higer than those in contml group.Zrs、R5、R5-20、Fres.Rc and Rp in COPD group and COPD+OSAHS group were significantly higerthan those in OSAHS group.R20 and Rc in OSAHS group were higher than those in COPD group and control group (P<0.05).Rc in OSAHS group was still significantly higher than that in COPD group (P<0.05). The level of sleep efficiency was positive correlated with FEVl/pre% of COPD(r=0.632),while the levels of rouse frequence (r=-0.672),time of SaO2 <90% (-0.868) and ODI (-0.846) were negative correlated with FEVl/pre% of COPD.Condusion For OSAHS patients, there is some dysfunction in peripheral airway tract;For COPD patients,ODI and time of SaO2<90% are good index for the severity of disease.