神经纤维瘤(NF)是一种罕见的常染色体显性遗传性疾病,由肿瘤抑制基因NF1突变所致[1].临床特征是患者身体多处出现咖啡色斑,色斑随着年龄增长而增多、增大,瘤体增大的同时伴随疼痛,影响机体正常活动及功能,其发病率为1 ∶4 000～1∶ 3 000,成人外显率接近100％[2].预存式(贮存式)自体输血又称术前自体备血,指在术前一段时间采集患者血液储存备用,虽其技术成熟、输注安全性高,但是目前多数研究仅集中于"稀有血型孕产妇""原发性肝癌"等疾病中[3-4].手术切除是NF患者较好的治疗方式,但瘤体血供丰富,创面大,手术应激性刺激持续时间长,因此,术中失血量极大,血液保障困难[5-6].为了对抗手术风险,本案例中巨大NF患者采取多种方法备足血液制品供术中输注,为分析预存式自体输血的效果,现报道如下.

本研究回顾性分析国内首例行达芬奇机器人手术系统辅助下腹主动脉瘤切除人工血管重建术患者的临床资料，该患者为39岁女性，因检查发现腹主动脉瘤1个月入院，结合患者对微创治疗及远期疗效的综合要求行达芬奇机器人手术系统辅助下腹主动脉瘤切除人工血管重建术。手术时间506 min，术中出血量约为1 200 ml，其中800 ml以自体血回收后回输，完成腹主动脉瘤切除人工血管重建后，腹主动脉人工血管充盈良好，近心端及远心端吻合口吻合良好，无明显渗血，远端髂动脉搏动良好，双侧足背动脉可触及搏动，无术中并发症发生。患者术后住院时间为8 d。患者术后随访半年，患者腹部切口及各戳卡孔愈合良好，腹部搏动性包块消失，生存良好。本研究提示达芬奇机器人手术系统辅助下腹主动脉瘤切除人工血管重建安全可行，近期疗效较好。

Objective To compare the quality and safety of platelet-rich plasma (PRP) by blood bag and monopheresis. Methods A retrospective analysis was performed on 66 patients treated with autologous PRP therapy in the blood transfusion department of First Affiliated Hospital of Army Medical University from July 2019 to August 2021. According to preparation procedure, they were divided into blood bag group (n=30, with 47 times of preparation) and monopheresis group (n=36, with 36 times of preparation). The counts of erythrocytes, leukocytes and platelets and product multiples in the PRP products were detected and compared between the 2 groups. Adverse reactions were recorded and safety was evaluated. Results The preparation time, product volume, product concentration and product multiple were significantly better in the monopheresis group than the blood bag group (P < 0.01). The amount of mixed red blood cells was statistically less in the blood bag group than the apheresis group (P < 0.01). There was no notable difference in the amount of mixed white blood cells between the 2 groups. No adverse reactions were seen in both groups. Conclusion The monopheresis PRP products have higher platelets concentration than those by blood bag and need shorter time of procedure group. Therefore, monopheresis is recommended as first choice and blood bag as the alternative.

目的 探究五芩散联合阿托伐他汀对急性心肌梗死择期经皮冠状动脉介入术(PCI)患者术后造影剂肾病发生率的影响.方法 将110例急性心肌梗死择期行PCI患者随机分为2组,对照组55例给予阿托伐他汀治疗,研究组55例给予五苓散联合阿托伐他汀治疗,2组均术前3d到术后3d持续用药,比较2组术后造影剂肾病发生率,检测2组术前、术后24 h血清肌酐(SCr)、内生肌酐清除率(Ccr)以及α1微球蛋白(α1-MG)水平,观察2组治疗期间不良反应发生情况.结果 研究组造影剂肾病发生率显著低于对照组(P＜0.05).术后24 h研究组SCr、Ccr、α1-MG水平与治疗前比较均无明显变化(P均＞0.05);对照组SCr、α1-MG水平显著高于术前及研究组(P均＜0.05),Ccr显著低于术前及研究组(P均＜0.05);2组不良反应发生率差异无统计学意义(P＞0.05).结论 五苓散联合阿托伐他汀应用于急性心肌梗死择期PCI患者,可显著降低造影剂肾病发生率,保护患者肾功能,安全性高,值得临床推广应用.

Arrhythmia is one of the common cardiovascular complications in maintenance hemodialysis (MHD) patients, and is a critical one especially during dialysis, which is also an important cause for death in MHD patients. Therefore, the management of arrhythmia is of particular importance for MHD patients. This review focused on the treatment and prevention of arrhythmia in MHD patients.

Objective To study the effect of Yinxindamo on coagulation function by observing the change of blood prethrombotic state in the treatment of patients with chronic obstructive pulmonary disease in acute exacerbation state. Methods A total of 103 patients with AECOPD were selected and randomly divided into the control group (48 cases) and the treatment group (55 cases). The control group was treated with oxygen therapy, spasmolysis, asth-marelief, and sputum reduction, and the treatment group was additionally treated with Yinxindamo 25 ml/day, for 14 days. The blood prethrombotic state indicators of the two groups before and after treatment were determined. Results The differences in PT, TT, APTT and FBG before and after the treatment showed no significance in the control group (P>0. 05), but the levels of DD, TAT and PAP had significant difference (P <0. 05). In the treatment group, there were significant differences in PT, APTT, FBG, DD, TAT and PAP before and after the treatment (P<0. 01). Meanwhile, the levels of DD, TAT and PAP improved more significantly in the treatment group than in the control group after the treatment ( P<0. 05 ) . Conclusion The conventional therapy combined with Yingxingdamo can improve the blood prethrombotic state indicators of AECOPD patients.