目的:探讨患者直接抗球蛋白试验(direct antiglobulin test,DAT)阳性强度的关键影响因素,对临床DAT阳性患者在抗生素用药或红细胞输血时提供指导.方法:回顾性分析首都医科大学附属北京世纪坛医院2015年1月至2020年12月27 382例次行DAT检测的患者资料,对患者性别、年龄、临床诊断、抗生素使用、红细胞输注、DAT阳性强度等进行统计分析.结果:共有27 382人次患者进行了 DAT检测,DAT阳性患者5 745人次(20.98％).将不同DAT强度患者按男、女分组后做Mann-Whitney U检验,结果显示,男性DAT+强度高于女性,组间差异有统计学意义(U=2 764 704.5,P＜0.001).将DAT阳性患者按年龄分为3组(＜18岁组、18～60岁组和＞60岁组)后做Kruskal-Wallis检验.结果 显示,不同年龄组间DAT阳性强度差异有统计学意义(H=200.4,P＜0.001),＜18岁组和＞60岁组DAT阳性强度高于18～60岁组.不同临床诊断之间分析结果显示DAT阳性强度差异有统计学意义(H=70.82,P＜0.001).Mann-Whitney U检验结果显示,使用抗生素和未使用抗生素组患者的DAT阳性强度分布不同,使用抗生素组患者DAT阳性强度更高(U=1 853 921.5,P＜0.001).红细胞输注组患者DAT阳性强度更高(U=3 315 953.5,P＜0.001),但多次红细胞输注并未引起DAT阳性强度变化(U=108 911.5,P=0.68).结论:在DAT阳性患者中,患者的性别、年龄、临床诊断、抗生素的应用、红细胞输注等均影响其DAT阳性强度,多次红细胞输注未见引起DAT+强度变化,临床上对DAT阳性强度较高的患者应谨慎使用抗生素及进行红细胞输注.

OBJECTIVE To investigate the related factors influencing plasma transfusion efficacy so as to improve the plasma transfusion efficiency. METHODS According to the clinical symptoms and the laboratorial results, the patients were divided into transfusion efficient and inefficient groups. A total of13090.8 units of plasma were transfused to 4423 patients. The clinical symptoms and the hemorrhage related index per- and pro-transfusion, plasma components sorts, storage time, and the dose of plasma (kg/ml) transfusion were analyzed. RESULTS The largest transfusion volume of plasma were in intensive care unit (ICU) accounted for 30.36%, the largest blood plasma per patient transfusion was in cardiac surgery (3.96 U). The analysis of transfusion efficiency showed that in terms of patient age, there were difference in transfusion efficiency among the patients with different ages (P＜0.001). The effective transfusion rate in the group of age ＜18 was 53%, which was higher than that in group of age 18-60(41%) and group of age ＞60 (30%); in terms of sex, the effective transfusion rate in female group was higher than that in male group (42% vs 37%) (P＜0.001); in terms of transfusion plasma volume/body weight, there were differences in transfusion efficiency (P＞0.05). The multi-factor logistic regression analysis showed that there was no significant correlation among the plasma sorts, storage time of the plasma pre-transfusion and transfusion efficiency(P＞0.05). The analysis of the non-hemolytic fever reaction caused by plasma transfusion revealed that there was no statistical difference between the plasma and the leukocyte-depleted plasma groups (P＞0.05). CONCLUSION The plasma transfusion effectiveness relates with age and sex, but not relates with the transfusion plasma voume/body weight, plasma sorts, and the duration of storage.

OBJECTIVE:To investigate the related factors influencing plasma transfusion efficacy so as to improve the plasma transfusion efficiency. METHODS:According to the clinical symptoms and the laboratorial results, the patients were divided into transfusion efficient and inefficient groups. A total of13090.8 units of plasma were transfused to 4423 patients. The clinical symptoms and the hemorrhage related index per- and pro-transfusion, plasma components sorts, storage time, and the dose of plasma (kg/ml) transfusion were analyzed. RESULTS:The largest transfusion volume of plasma were in intensive care unit (ICU) accounted for 30.36%, the largest blood plasma per patient transfusion was in cardiac surgery (3.96 U). The analysis of transfusion efficiency showed that in terms of patient age, there were difference in transfusion efficiency among the patients with different ages (P＜0.001). The effective transfusion rate in the group of age ＜18 was 53%, which was higher than that in group of age 18-60(41%) and group of age ＞60 (30%); in terms of sex, the effective transfusion rate in female group was higher than that in male group (42% vs 37%) (P＜0.001); in terms of transfusion plasma volume/body weight, there were differences in transfusion efficiency (P＞0.05). The multi-factor logistic regression analysis showed that there was no significant correlation among the plasma sorts, storage time of the plasma pre-transfusion and transfusion efficiency(P＞0.05). The analysis of the non-hemolytic fever reaction caused by plasma transfusion revealed that there was no statistical difference between the plasma and the leukocyte-depleted plasma groups (P＞0.05). CONCLUSION:The plasma transfusion effectiveness relates with age and sex, but not relates with the transfusion plasma voume/body weight, plasma sorts, and the duration of storage.

目的:探讨影响血浆输注效果的相关因素,以期进一步提高患者血浆输注有效率和临床输注的合理性.方法:根据输血后患者临床症状改善情况和实验室凝血检测值将患者分为血浆输注有效和无效2组.对4 423例患者的基本临床资料和13 090.8 U的血浆输注过程中涉及的主要因素如输血浆前PT、APTT、血浆种类、保存时间、输注血浆体重比(kg/ml)等进行分类统计分析.结果:外科监护室患者血浆用量最多,占总血浆输注比例最大(30.36％),人均用血浆量最大的科室为心外科(3.96 U).从输注效果上看,不同年龄组患者的输血效果有差别(P＜ 0.001),＜18岁组患者血浆输注有效率(53％)高于18-60岁和＜60岁组,18-60岁组和＞60岁组患者血浆输注有效率分别为41％和30％;女性患者输血浆有效率(42％)高于男性(37％)(P＜0.001);按不同血浆体重比进行血浆输注效果比较显示无显著差异(P＞0.05);通过多因素Logistic回归分析,普通冰冻血浆、去白细胞血浆和新鲜冰冻血浆3类血浆的临床输注效果间没有差异;输注前血浆保存时间与输注效果之间无显著相关性.去白细胞血浆与未经去白的血浆相比,并未降低非溶血性发热性输血反应的发生率.结论:血浆输注效果的主要影响因素有患者年龄、性别,但与血浆体重比、血浆种类和血浆保存时间关系不大;只要于保存期内输注,保存时间的长短与输注效果间没有显著相关性.

目的 探讨影响结直肠肿瘤患者围术期用血量的相关因素,以期进一步提高患者临床输血的合理性.方法 收集本院207例结直肠肿瘤患者临床信息、实验室检测信息以及围术期输血情况等资料.对输血过程中涉及的主要因素如患者年龄、性别、术前血红蛋白水平、术前凝血、手术时间、肿瘤部位、肿瘤体积、等进行分类统计分析.结果 手术患者术中出血量大于600 mL者18.8％ (39/207),而术中输血率为28.5％(59/207),较高的输血率与20.29％ (42/207)患者术前贫血(Hb＜ 100 g/L)相关.术中红细胞用血量占围术期用血量56.95％.通过多因素Logistic回归分析,对术中输红量影响最大的因素是手术时长和术前血红蛋白(P＜0.001).肿物大小与红细胞输注总量相关性很高,“部位_结肠”也有一定影响(P＜0.05).患者年龄、性别与围术期输血量无显著相关性(P＞0.05).术中红细胞和血浆输注比例合理,无搭配“全血”输注情况.结论 患者围术期输血量的主要影响因素有术前血红蛋白水平、手术时间、肿瘤大小及肿瘤部位,但与其年龄、性别关系不大.

目的 探讨肿瘤细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC) (CRS+HIPEC)应用于腹膜癌围手术期的输血总体情况与综合止血技术临床疗效.方法 以“首都医科大学附属北京世纪坛医院腹膜肿瘤外科临床科研数据库”中采用CRS+HIPEC治疗445例腹膜癌病例资料为研究对象,分析患者的临床病理特征和围手术期输血情况,进而对器官切除数量、腹膜剥除区域数量与围手术期输血量做相关性分析;为分析输血变化情况,按照手术日期顺序、肿瘤中心手术例次对患者收益程度影响的学习曲线规律,将患者分为第1时间段(2015.4.28-2017.3.1)组(n=220)和第2时间段(2017.3.2-2018.1.24)组(n=225),比较二者围手术期输血量.结果 本组患者的术中红细胞、血浆输注量约占围手术期总量的73.26％(1 564 U/2 135 U)、80.14％(276 500 mL/345 000 mL).术中、围手术期红细胞输注量与器官切除数量呈正相关性均为(r=0.24,P＜0.05),血浆输注量与腹膜剥除区域数量亦呈正相关性(r值分别为0.37、0.38,P＞0.05).第1、2时间段术中输血量,分别为红细胞(U):3.9±3.8vs3.1±3.0(P＜0.05);血浆(mL):673.6±450.2 vs570.2±371.6(P=0.01).结论 CRS+HIPEC围手术期患者的输血量与器官切除数量、腹膜剥除区域数量呈正相关,术中综合止血技术可减少这类手术围手术期输血需求.

Objective To analyze the effect of Huoluo Xiaoling decoction combined with Gualou Xiebai Banxia decoction on coagulation factor activity (R value),fibrinogen level (K value,Angle value) and platelet aggregation function(MA value) in patients with phlegm-obstruction and blood-stasis type coronary atherosclerotic heart disease(CHD).Methods Totally 119 patients with phlegm-obstruction and blood-stasis type CHD from January to December 2016 in Beijing Royal Integrative Medicine Hospital were randomly divided into control group A,observation group A,control group B and observation group B.The control group A (n =29) took aspirin;the observation group A (n =30) took aspirin and Huoluo Xiaoling decoction combined with Gualou Xiebai Banxia decoction;the control group B(n =32) took hydrogen clopidogel;the observation group B(n =28) took hydrogen clopidogel and Huoluo Xiaoling decoction combined with Gualou Xiebai Banxia decoction.Thromboelastography was performed after treatment to determine R value,K value,Angle value and MA value.Results R value in observation group A(B) was significantly higher than that in control group A(B) [(8.5 ± 1.6)min vs (5.1 ±1.7)min,(8.0 ± 1.5)min vs (6.0 ±0.6)min] (P ＜0.05).MA value in observation group A(B) was significantly lower than that in control group A(B) [(63.3 ± 4.2) mm vs (70.5 ± 6.7) mm,(56.0 ± 2.1) mm vs (68.2 ±1.3) mm] (P ＜0.05).K value and Angle value showed no significant differences between groups(P ＞ 0.05).Conclusion Huoluo Xiaoling decoction combined with Gualou Xiebai Banxia decoction can depress coagulation factor activity and platelet aggregation function in patients with phlegm-obstruction and blood-stasis type CHD.

目的 实施新的临床用血申请分级管理制度,评价临床用血申请分级审核的监管效果.方法 对2013年7月～2014年6月5 476张临床用血申请单进行质量审核,按照PDCA循环原理重新修订和实施医院临床用血申请分级管理制度,HIS系统建立主治或以上专业技术职称医师开具临床用血电子申请自动授权管理,输血科建立临床用血申请单全面质量审核及实时记录,定期统计分析、上报、公示临床用血申请分级审核签字情况,实施全医院临床用血申请分级管理的综合质量目标控制.结果 临床用血申请上级医师审核签字合格率大于96.97％;临床用血申请单科主任审核签字合格比例由22.97％上升到95.00％(P ＜0.01);医务处审核签字合格率由88.00％上升到95.00％.结论 执行新的临床用血申请分级管理制度可显著改善质量,有利于临床合理用血水平的提高.

Objectives To analyze the objective indicators for evaluating clinical blood transfusion and the characteristics of using blood components for the patients in the Intensive Care Unit(ICU) and to improve appropriate blood use in critically ill patients.Methods A retrospective review for the usage of blood components and clinical basic data of the ICU patients from 2010 to 2013 has been done with the homegrown data mining software.The objective indicators for evaluating clinical blood transfusion and the characteristics of using blood components in patients of ICU were analyzed and compared.Results The numbers of patients were growing at over 30% in the ICU during past four years.At the same time,total incidence rate of blood transfusion,incidence rates of red cell transfusion,plasma transfusion,platelet transfusion,and average transfused units of red blood cell,plasma and platelet blood components per discharge patient and per transfused patient from the ICU exhibited an obvious downward trend.During the same period,total mortality,average length of stay,total cost,and incidence rate of nosocomial infection have shown a consistent decline.The indicators related with blood transfusion compared between transfused and non-transfused patients were significantly different(P0.01).Conclusion The effects of the patient blood management have shown an apparent improvement during the past four years in our ICU.A transfusion trigger based on evidence-based medicine was implemented,and was beneficial for monitoring appropriate blood use in clinical transfusion and improving overall health quality of ICU patients.

Objective To establish a electronic platform for the clinical blood transfusion quality and education and training management systems,and to promote the clinical blood transfusion management and the construction of the blood transfusion culture in the hospital. Methods A electronic platform has been built in the HIS Local Area Network in accordance with the technical standards and system architecture based on Web,which had an independent server address. The portal page of the electronic platform was instantly browsed on all workstationu0027s IE of the clinical departments for implementation of the clinical blood transfusion management and education training. A lot of contents,such as the objective,indicators for evaluating clinical blood transfusion and so on,were displayed to public. The electronic and pre- formatted quality records and technical records for ISO15189 accreditation have been put into effect. Results The electronic platform of the clinical blood transfusion quality and education and training management systems has been with a reliable software and hardware during last three years. It has a substantial platform for a more convenient communication between blood transfusion department and other clinical departments. Conclusion The electronic platform of the Clinical Blood Transfusion Quality and Education and Training Management Systems based on Web can improve the quality of clinical blood transfusion management and enhance the culture of rational blood transfusion.

Objective To investigate the effect of different antiplatelet or anticoagulation therapy on postoperative pocket hematoma after electrophysiological devices placements (EPD). Methods The clinic data of 410 patients who took anti-platelet or anticoagulation therapy and needed to be implanted EPD from February 2012 to February 2015 were selected. According to the type of therapy, patients were divided into 4 groups:dual anti-platelet drug (DAP) treatment group (DAP group, 114 cases), low-molecular-weight heparin (LMWH) bridging treatment group (LMWH group, 98 cases), aspirin (ASA) alone group (ASA group, 94 cases) and warfarin group (104 cases). The incidence of pocket hematoma after electrophysiological devices placements was observed. The risk factors of pocket hematoma were analyzed. Results The incidence of pocket hematoma was higher in LMWH group than that in the other 3 groups: 18.4% (18/98) vs. 4.4% (5/114), 3.2% (3/94) and 2.9% (3/104), and there was statistical difference (P<0.05). But there were no significant differences in the incidence of pocket hematoma among DAP group, ASA group and warfarin group (P>0.05). The multiple Logistic regression analysis revealed that LMWH bridging therapy was an independent risk factor for the development of pocket hematoma (OR=7.105, 95%CI 1.872-17.283). Conclusions LMWH bridging therapy can increase the risk of development of pocket hematomas after electrophysiological devices placement.

心脏瓣膜病在我国是一种常见病、多发病。其中需要介入治疗的主要是风湿性心脏病，经皮二尖瓣狭窄，先天性心脏病肺动脉瓣狭窄和主动脉瓣狭窄。

Objective To standardize statistics of the Objective Indicators for assessing clinical blood transfusion during last three years and promote patient blood management.Methods Retrospective review of the clinical blood transfusion and the medical foundation data of the hospital with standard statistics methods from 2010 to 2012.The Objective Indicators for assessing clinical blood transfusion with the three years are defined and calculated for analyzing their effects of improving the patient blood management.Results The total rate of blood transfusion of the different year is respectively:5.26%,4.83%,4.08%.The rate of red blood cell transfusion and plasma transfusion,mean number of units transfused red blood cell,fresh frozen plasma and platelet per inpatient and per surgical operation show a obvious reduction.Autologous blood transfusion rate of surgical department and the hospital are raised significantly.There are some queues for prior to 30 numbers with the departments,the diseases,the doctors,the operations transfused different blood components.Conclusion To standardize define and statistic of the Objective Indicators for assessing clinical blood transfusion.It has made significant progress for clinical reasonable blood transfusion and patient blood management in the hospital during the last three years.

BACKGROUND:Given the increasing number of patients who require dual antiplatelet (DAP) therapy and electrophysiological device (EPD) placement, perioperative antiplatelet management is a current challenge. In this study, we investigated the incidence of pocket hematoma formation after EPD placement in patients undergoing DAP therapy or an alternative low-molecular-weight heparin (LMWH) regimen.METHODS:This clinical observational study was performed from July 2010 to July 2012. In total, 171 patients were enrolled in the analysis after meeting the inclusion criteria. These patients were divided into two groups: 86 patients were treated with DAP therapy at the time of device implantation, and the DAP therapy was discontinued for 5 to 7 days and replaced with enoxaparin before device implantation in the other 85 patients. Adenosine phosphate (ADP)-mediated platelet aggregation and arachidonic acid-induced platelet aggregation were tested preoperatively. We compared the incidence of pocket hematoma between the two groups and the association of pocket hematoma development with ADP-mediated platelet aggregation and arachidonic acid-induced platelet aggregation.RESULTS:The incidence of pocket hematoma in the patients who continued DAP was lower than that in the patients who replaced the dual antiplatelet regimen with LMWH (3.49% vs. 16.47%, respectively; X (2) = 6.66, P < 0.01). Among the patients who continued DAP therapies, the rate of ADP-mediated platelet aggregation inhibition in patients with pocket hematomas was higher than that in patients without pocket hematomas. None of the patients undergoing DAP or enoxaparin therapy developed pocket infection, thromboembolic events, or other serious complications. Multiple logistic regression analysis revealed that LMWH therapy was an independent risk factor for the development of pocket hematoma (RR = 0.054, 95%CI = 0.012-0.251). Furthermore, patients undergoing LMWH therapy were 5.1-fold more likely to develop pocket hematomas than were DAP-treated individuals.CONCLUSION:Continuance of DAP therapy does not increase the risk of pocket hematoma formation after EPD placement.

Objective To study the effect of adenosine diphosphate (ADP)-mediated platelet aggre-gation inhibition rate on pocket hematoma in patients after arrhythmia control device placement . Methods Eighty-six patients who underwent arrhythmia control device placement in our hospital from January 2010 to June 2013 after anti-platelet therapy were divided into hematoma group (n=43) and non-hematoma group (n=43) .Risk factors for pocket hematoma during perioperative pe-riod were analyzed .Results The ADP-mediated platelet aggregation inhibition rate was signifi-cantly higher in hematoma group than in non-hematoma group (P<0 .05) .However ,no signifi-cant difference was found in arachidonic acid-mediated platelet aggregation inhibition rate between the two groups (P>0 .05) .Multivariate binary logistic analysis indicated that the ADP-mediated platelet aggregation inhibition rate more than 80% was the risk factor for pocket hematoma(OR=0 .264 ,95% CI:0 .082-0 .850 ,P=0 .026) .Conclusion Elevated ADP-mediated platelet aggrega-tion inhibition rate increases the risk of pocket hematoma in patients after antiarrhythmia control device placement .

Objective To investigate the incidence of pocket hematoma after electrophysiological device (EPD) placements in patients with dual anti-platelet (DAP) and low molecular weight heparin (LMWH) bridging.Methods One hundred and seventy-three patients with dual antiplatelet drug received the pacemaker implantation and enrolled in this prospective observational analysis.Eighty-seven patients received continue DAP therapy,86 patients replaced DAP drugs with enoxaparin bridging.The adenosine phosphate-mediated platelet aggregation and the ratio platelet aggregation induced by the arachidonic acid (AA) were tested before operation.The incidence of pocket hematoma was investigated.Results Incidence of pocket hematoma in continuing DAP group was lower than that of discontinue dual AP therapy with (LMWH) bridging therapy group (3.4％ vs 16.3 ％,x2 =11.73,P =0.003).Patients with LMWH bridging were 5.102 fold more likely to develop pocket hematoma than DAP individuals.A multiple Logistic regression analysis revealed that LMWH was an independent risk factor for the development of pocket hematoma (P =0.025).Conclusion Continuing dual anti-platelet therapy does not increase the risk of pocket hematoma after antiarrhythmic device placement.

Aim. The elderly are the major population receiving the implantation of a permanent pacemaker (PPM). Infection is a devastating complication. The present study is to verify the relationship between age and PPM implantation infection.Methods. All patients (162 adult and 292 elder patients) received the implantation of PPM. Subcutaneous tissue samples solution was collected in three time points, the first sample was got at skin incision, and the second sample was got when the PPM had been implanted. And the third sample was got after 0.9% NaCl quick rinse. And the tissue solutions were cultured. If culture results are positive, it is considered as evidence of the presence of bacteria in pocket in operation of PPM implantation.Results. The data demonstrated that compared with that in the adult patients, subcutaneous bacterial survival rate was higher significantly in the elderly.Staphylococcus epidermidisis the major bacterial strain. The rinse decreased subcutaneous bacterial survival rates in the adult group.Conclusion. With the age increasing, PPM implantation might be easier to result in infection. Simple rinse can prevent implantation infection significantly. However, age alleviated the protective effects of rinse. Therefore, we should pay more attention to post implantation infection in the elderly.

OBJECTIVES:To explore a method of surface electrocardiogram for assessing cardiac dysfunction in patients with old myocardial infarction. METHODS:1000 patients with old myocardial infarction in Anzhen hospital were analyzed retrospectively. The planar QRS-T angle was calculated automatically according to QRS-wave and T-wave vectors by the electrocardiogram machine. RESULTS:Among these 1000 patients, 822 (82.2%) were male and 178 (17.8%) were female, the mean age was 59.3±10.5 years (34~89 years). The average planar QRS-T angle was 88.5±50.6°. The planar QRS-T angle and LVEF was negative correlation (r=-0.406, p<0.01), the lower the LVEF, the better the relationship with planar QRS-T angle. QRS-T angle>90° had optimal sensitivity and specificity (76%, 74%) in diagnosis of cardiac dysfunction. CONCLUSION:The planar QRS-T angle and LVEF of patients with old myocardial infarction is negative correlation, the larger the planar QRS-T angle, the lower the LVEF. The planar QRS-T angle may be an easier and more feasible index for assessing cardiac dysfunction in patients with old myocardial infarction.

OBJECTIVE To investigate the species of bacteria in pocket of permanent pacemaker(PPM) and the influencing factors so as to take the effective measures and reduce the incidence of infections.METHODS The clinical data of 444 cases of patients who underwent the PPM surgery between Mar 2008 and Mar 2011 were collected,and the general information was collected;then the bacterial culture was carried out at three time points in each surgery,the first sample was taken when skin incision and separation caused subcutaneous pocket,the second sample was taken when the leads were set in place and tested satisfactorily,and the third one was taken after rinse with 30ml iodophor,normal saline or antibiotics.RESULTS The average age of the patients was(66.22±12.50) years old,78.8% of all patients were the first time of implantation,20.3% were the second time,0.9% were the third time.The positive rate of the bacterial culture of the first sample was 6.5%,the second sample 8.5%,and the third sample 4.1%;the difference in the positive rate(less than 9.5%) of bacterial culture at the first sample or the second sample between the less than 44-year-old group and other age groups(17.9%;25.9%) was statistically significant.CONCLUSION There are certain chances that certain degree of bacterial infections would occur during PPM implantation procedure,and the Staphylococcus epidermidis is the predominant species in the pocket.Rinsing with normal saline,antibiotics or povidone-iodine can significantly reduce the bacterial infections.