Objective To explore the safety and efficacy of regional citrate anticoagulation in hemoperfusion combined with continuous renal replacement therapy (CRRT). Methods Patients who underwent continuous veno-venous hemodiafiltration tandem hemoperfusion between January 2021 and March 2022 in West China Hospital of Sichuan University were retrospectively enrolled. All patients received double-lumen catheter indwelling through internal jugular vein or femoral vein for vascular access, and were treated with Prismaflex V8.0 CRRT machine, extracorporeal circulation line ST150, and disposable hemoperperfusion device HA380. Four percent sodium citrate was pumped from the arterial end at the rate of 180-200 mL/h. The blood pump rate was 130-150 mL/min, the ratio of dialysis fluid to the dose of replacement fluid was 1∶1, the amount of CRRT treatment agent was 20-35 mL/(kg·h), replacement fluid was added by post-dilution method, and the treatment time of hemoperfusion was 8-10 h. The dialysis treatment completion rate, the cardiopulmonary bypass life, the incidence of coagulation events, and the levels of procalcitonin, C-reactive protein, interleukin-6, etc. were observed. Results A total of 143 cases of treatment were completed in 75 patients, among them, 119 cases were successfully completed and the completion rate of hemoperfusion treatment was 83.2%. The average life of hemoperfusion devices was (8.5±1.5) h. Bleeding or blood clotting occurred in 18.9% of the treatment (27/143), 13 cases had CRRT extracorporeal circulation coagulation, 11 cases had hemoperfusion device coagulation, and 3 cases had gastrointestinal bleeding. The ionic calcium levels after the filter of 93 cases of treatment were maintained around 0.25-0.35 mmol/L, and the peripheral calcium levels were maintained around 1.0-1.1 mmol/L. Compared with that at 0 h, the procalcitonin decreased significantly 72 h after hemoperfusion treatment (P=0.014), while there was no significant change in interleukin-6 or C-reactive protein after 72 h treatment (P>0.05). None of the patients experienced anaphylaxis during treatment. Conclusion In CRRT combined with hemoperfusion, the use of regional citrate anticoagulation results in good cardiopulmonary bypass life, inflammatory mediators clearance, and a lower risk of bleeding.
Objective To explore how to integrate the various sources of information in designing an evidence-based nursing care plan for preventing gastrointestinal hemorrhage (GIH) after pancreaticoduodenectomy (PD). Method Papers and references about prevention of GIH after PD were searched between September and October 2015, and an evidence-based nursing care plan was drawn up and implemented from November 2015 to January 2016. Results A total of 79 papers were found and of which 17 were aviliable. Thirty-nine patients were cared on the basis of the effective project, of whom one was dignosed with GIH on the 3rd postoperative day and the rate of post-PD hemorrhage was 2.6%. All patients were diacharged on the 6th or 7th postoperative day. Conclusion Exploring evidences under the guidance of scientific method and applying them to clinical nursing can prevent post-PD hemorrhage and improve life quality of patients.
Stroke with hereditary cerebral small vessel diseases is a rare disease. Its clinical manifestations include early-onset ischemic lacunar or hemorrhagic stroke with high disability. Its typical imaging markers include lacunes, white matter hyperintensities, microbleeds, intracerebral hemorrhages located in deep or lobe of brain, crotical microinfarcts, and enlarged perivascular spaces. As the clinical and neuroimaging signs and symptoms of hereditary cerebral small vessel diseases often overlap with sporadic cerebral small vessel diseases, it is hard to diagnose. This article summarizes the clinical features, importance of obtaining valuable family history, genetic diagnosis, and management of stroke with hereditary cerebral small vessel disease to improve its accuracy diagnosis.
Objective To establish a hemorrhagic retinal detachment (HRD) model for the study of the damage and treatment of HRD.Methods Fourteen rabbits (28 eyes) were divided into the HRD (12 eyes) and control (16 eyes) group randomly. Autologous anticoagulated blood (0.2 ml) was transvitreally injected into the rab bits′subretinal space with a special glass micropipette in HRD group （12 eyes ）; while 0.2 ml saline with or without heparin sodium （2.5 U/ml） was respectively injected into subretinal space respectively of the rabbits in heparin saline control group (6 eyes) and saline control group (3 eyes); furthermore, another 2 control groups, i.e.,pseudo injection group (3 eyes, single retinal puncturing without subretinal injection) and normal group (4 eyes of 2 normal rabbits) were also set. The conditions of the occurrence and representation of the retinal detachment (RD) were observed and analysed by means of ophthalmoscopy, optical coherence tomography (OCT) and ultrasound A and (or) B scan examinations in the subsequent 28 days after the operation.Results After the operation, HRD occurred in all eyes of the rabbits in HRD group. The area of HRD extended from 10 to 12 disc diameter(DD). The obvious elevation of RD maintained to 14 days, and the residual subretinal hemorrhage was still observed till 28 days. The obvious RD of the rabbits in hepar in saline and saline control group was only kept for no more than 12 hours. The retinal puncture hole in pseudo injection group disappeared 2 days after the operation, and there was no change in retina of rabbits in normal control group.Conclusion It is convenient, practical and effective to establish a HRD model by means of transvitreal subretinal injection of autologous anticoagulated blood. (Chin J Ocul Fundus Dis，2003，19：175-178)
Objective To test the effects of large amount of blood in the vitreous on electrophysiological examination. Methods The reductions of transmission of flash light through a serial dilution and depth of whole blood were measured.An experimental model of vitreous hemorrhage in rabbits was established by injecting 0.5ml autologous uncoagulated whole blood into the vitreous cavities after compression with an expanding perfluoropropane gas bubble.Pars plana vitrectomy was performed to clear the blood clots 2 weeks after blood injection.Ganzfeld and bright-flash electroretinography were performed through six-week observation period. Results Blood reduced remarkably the transmission of reduced remarkably the transmission of bright-flash light.Massive vitreous hemorrhage had a dense filtering effect and extinguished the Ganzfeld but not the bright-flash electrotetinogram.About 3.5log units higher of the intensities of bright- flash light than that of conventional method could stimulate the responses of ERG-B waves in blood injected eyes.Slow recovery of Ganzfeld ERG-b waves after vitrectomy were noted within 2 weeks (Plt;0.05),AND ERG-b wave reached at 80-90% of normal level during the third week. Conclusion The ERG-b waves,which become undetectable because of absorption of the dense opacities of the absorption of the dense opacities of the vitreous in eyes with a large amount of vitreous hemorrhage,can be recorded in bright-flash light conditions with nearly nearly normal amplitudes.This result indicates that functions of retina were not severely damaged by the large amount of vitreous hemorrhage. The injection of large amount of blood into vitreous cavities may cause a transient reduction of the amplitudes of ERG-b waves. (Chin J Ocul Fundus Dis,1998,14:104-107)
ObjectivesTo systematically review the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 23 RCTs involving 1 560 patients were included. The results of meta-analysis showed that, compared with the blank control or placebo, the addition of plasminogen activator urokinase after puncture and drainage could improve the clinical efficacy (RR=1.36, 95%CI 1.26 to 1.47, P<0.000 01), shorten removal time of hematoma (MD=−3.37, 95%CI −3.89 to −2.85, P<0.000 01), reduce postoperative re-bleeding rate (Peto OR=0.30, 95%CI 0.18 to 0.51, P<0.000 01), reduce the incidence of intracranial infection (Peto OR=0.47, 95%CI 0.25 to 0.87, P=0.02), and reduce mortality (Peto OR=0.45, 95%CI 0.27 to 0.76, P=0.003). The differences were statistically significant between two groups.ConclusionsCurrent evidence shows that the combination with urokinase can improve curative effect of hypertension cerebral hemorrhage patients with external ventricular drainage. In reducing hemorrhage, intracranial infection and mortality, urokinase also has great curative effect. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo observe the effect of retinal hemorrhage on the treatment of retinopathy of prematurity (ROP) by laser photocoagulation.MethodsRetrospective case analysis. Screening and diagnosis of 134 eyes in 67 patients with ROP in Zone Ⅱ Stage 3+ were included in the study. Among them, 32 patients were male and 35 patients were female. The average birth gestational age was 27.80±2.55 weeks. The average birth weight was 1060±320 g. All children underwent binocular indirect ophthalmoscopy and RetCam Ⅲ. Of the 134 eyes, 38 eyes (28%) with anterior, ridge or vitreous hemorrhage (group A); 96 eyes (72%) without hemorrhage. Retinal avascular photocoagulation was performed within 72 hours after diagnosis by intravenous sedative combined with ocular surface anesthesia with 810 nm laser. Follow-up was performed at 1, 4, 8 and 12 weeks after treatment, and then every 6 months thereafter. The same equipment and methods before treatment were used to examine and document the regression and progression of ROP. The number of eyes with lesions after photocoagulation in the two groups was compared by χ2 test. The t-test was used to compare the gestational age and birth weight.ResultsAmong 134 eyes, lesions completely resolved in 125 eyes (93.3%), progressed in 9 eyes (6.7%). In group A, 7 eyes were progressive (18.4%). In group B, 2 eyes were progressive (2.1%). There was a statistically significant difference in the number of eyes with lesions after laser treatment in group A and B (χ2=9.14, P=0.003). There was no significant difference in birth gestational age and birth weight (t=0.85, 0.25; P=0.40, 0.80).ConclusionThe laser photocoagulation is safe and effective in the treatment of ROP. The preretinal, ridge or vitreous hemorrhage is related to the progression of the lesion after laser photocoagulation.
ObjectiveTo observe the efficacy and safety of vitrectomy combined with subretinal injection of alteplase (tPA) and intravitreal injection of Conbercept in the treatment of large area submacular hemorrhage (SMH) secondary to polypoidal choroidal vasculopathy (PCV). MethodsA retrospective clinical study. From January to September 2021, 32 eyes of 32 patients with massive SMH secondary to PCV diagnosed in the Affiliated Eye Hospital of Nanchang University were included in the study. Large SMH was defined as hemorrhage diameter ≥4 optic disc diameter (DD). There were 32 patients (32 eyes), 20 males and 12 females. The mean age was (72.36±8.62) years. All patients had unilateral disease.The duration from onset of symptoms to treatment was (7.21±3.36) days. All patients underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination. BCVA examination was performed using the international standard visual acuity chart, which was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The central macular thickness (CMT) was measured by spectral domain-OCT. The average size of SMH was (6.82±1.53) DD. The logMAR BCVA 1.73±0.44; CMT was (727.96±236.40) μm. All patients were treated with 23G pars plana vitrectomy combined with subretinal injection of tPA and intravitreal injection of Conbercept. At 1, 3, 6 and 12 months after treatment, the same equipment and methods were used for relevant examinations before treatment. The changes of BCVA and CMT, the clearance rate of macular hemorrhage, and the complications during and after surgery were observed. BCVA and CMT before and after treatment were compared by repeated measures analysis of variance. ResultsCompared with before treatment, BCVA gradually increased at 1, 3, 6 and 12 months after treatment, and the differences were statistically significant (F=77.402, P＜0.001). There was no significant difference in BCVA between any two groups at different time points after treatment (P＞0.05). Correlation analysis showed that BCVA at 12 months after treatment was negatively correlated with the course of disease (r=－0.053, P=0.774). One week after treatment, macular hemorrhage was completely cleared in 30 eyes (93.75%, 30/32). The CMT was (458.56±246.21), (356.18±261.46), (345.82±212.38) and (334.64±165.54) μm at 1, 3, 6 and 12 months after treatment, respectively. Compared with before treatment, CMT decreased gradually after treatment, and the difference was statistically significant (F=112.480, P＜0.001). There were statistically significant differences in different follow-up time before and after treatment (P＜0.001). The number of treatments combined with Conbercept during and after surgery was (4.2±1.8) times. At the last follow-up, there was no recurrence of SMH, retinal interlamellar effusion and other complications. Conclusion Subretinal injection of tPA combined with intravitreal injection of Conbercept is safe and effective in the treatment of large SMH secondary to PCV, and it can significantly improve the visual acuity of patients.
ObjectiveTo investigate the relationship between optic disc hemorrhage and localized retinal never fiber layer defects (RNFLDs) in norma l tension glaucoma.MethodsIn 83 patients with normal-tension glaucoma, the cumulative frequency and quadrantal distribution of optic disc hemorrhages were retrospectively analyzed. The neighboring relation between optic disc hemorrhages and RNFLDs in a same quadrant and the changes of correspondin gretinal never fiber layer (RNFL) after the occurrence of optic disc hemorrhages were observed by tridimensional photochromy of ocular fundus.Results(1) The occurrences and distribution of optic disc hemorrhages: 29of83(34.94%) patients (33 eyes) had totally 58 occurrences, including 39 in infer iotemporal area, 14 in superiotemporal area, and 5 in other area. (2) The relati onship of neighborhood between optic disc hemorrhages and RNFLDs: in the availab le tridimensional photochrome, 23 occurrences in 15 patients (16 eyes) were foun d with cuneiform RNFLDs in the same quadrant, in which 22 was near the border of cuneiform RNFLDs. (3) The changes of corresponding retinal never fiber layer (R NFL) after the occurrence of optic disc hemorrhages: the photochromes of 24 occurrences in 20 patients (21 eyes) were kept well in the initial and the 2-year follow-up periods, while the changes of RNFL were found in each region correspon ding to the 19 occurrences (in inferiotemporal or superiotemporal area) in the initial photochrome, including 7 cuneiform defects with various sizes, and 12 developed localized RNFLDs next to the initial hemorrhages in the optic disc. No obvious localized RNFL corresponding to the other 5 occurrences (1 in inferiotempo ral, 1 in superiotemporal, and 3 in other areas) were found in the follow up period.ConclusionOptic disc hemorrhages in normal-tension glaucoma occur mostly in inferiotemporal area, and secondly in superiotemporal area of optic disc, and the appearance of optic disc hemorrhages may suggest that the localized RNFLDS would develop in the associated regions.(Chin J Ocul Fundus Dis，2004，20：339-342)
ObjectiveTo compare the keyhole approach and traditional craniotomy in the treatment of basal ganglia region hypertension cerebral hemorrhage postoperative epileptic curative effect comparison keyhole approach and traditional craniotomy in the treatment of basal ganglia region the curative effect of hypertensive cerebral hemorrhage postoperative epilepsy. MethodsCollected cases of basal ganglia region admitted in department of neurosurgery our hospital from September 2006 to March 2015, 108 cases of hypertensive cerebral hemorrhage patients, randomly divided into two groups:keyhole approach group (58 cases) and conventional surgery group (50 cases).Two groups of patients with perioperative all use the same management scheme, using statistical methods to analyze clinical data of two groups of patients, such as age, sex, blood loss, postoperative epilepsy, drug efficacy and the incidence of adverse drug reactions, etc. ResultsPostoperative follow-up of 2 years, keyhole approach group 12 cases sufferred postoperative seizure, 1 case of patients with status epilepticus, no death occurred; a total of 10 cases of mono-antiepileptic drug(AEDs) therapy effectively, and 7 cases present adverse drug reactions; Traditional surgical postoperative seizures 22 cases, 9 cases occurred status epilepticus, and five died as a result, only five were effective for single therapy, and 15 cases with adverse drug reactions.Statistical results suggest the incidence of postoperative epilepsy, the incidence of severe epilepsy, prognosis, single drug control and adverse drug reactions between the tuo groups have significant difference (P < 0.05). ConclusionCompared with traditional craniotomy for removal of hematoma, keyhole approach greatly reduce the incidnce of basal ganglia region hypertension cerebral hemorrhage postoperative complications, severe epilepsy and adverse reaction of AEDs.Therefore, keyhole approach in the treatment of basal ganglia region hypertension cerebral hemorrhage is an admirable way of treatment.