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Objective To observe the effects of acute normovolemic hemodilution(ANH) plus tranexamic acid on blood loss and blood transfusion in patients with total knee replacement.Methods 98 cases of patients with total knee replacement were divided into ANH group and combination group by computer randomization,49 cases in each group.ANH was performed in ANH group,and ANH plus tranexamic acid was given in combination group.The changes of hemoglobin(Hb),red blood cells deposited(Hct),platelet count(PLT) were observed before and after autologous blood transfusion in two group.The changes of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),D-dimer were observed at preoperative and postoperative in two group.The amount of blood loss and allogeneic blood infusion,the urine volume and the postoperative flow volume were recorded in two groups.Results The average levels of Hb,Hct after autologous blood transfusion in combination group were higher than those in ANH group,the differences were statistically significant(P<0.05).The average level of D-dimer at postoperative in combination group were higher than that in ANH group,the difference was statistically significant(P<0.05).The amounts of blood loss and allogeneic blood infusion,the postoperative flow volume were lower than those in ANH group,the differences were statistically significant(P<0.05).Conclusion The joint application of ANH and tranexamic acid can effectively reduce the amounts of blood loss and allogeneic blood infusion in patients with total knee replacement,and has a certain clinical value.
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Objective To investigate the value of high-sensitivity C-reactive protein (hs-CRP) combined with high-sensitivity cardiac troponin T (hs-cTnT) for prognosis of patients with acute coronary syndrome (ACS).Methods One hundred and eighteen patients with ACS were selected from July 2011 to December 2012.According to the clinical feature,they were divided into unstable angina pectoris (UAP) group (38 cases),non ST segment elevation myocardial infarction (NSTEMI) group (38 cases) and ST segment elevation myocardial infarction (STEMI) group(42 cases).They were followed up for 3 months,and the incidence of cardiovascular events and cardiac death was observed.Twenty healthy people were selected as control group.Results The serum level of hs-CRP on admission in UAP group,STEMI group,NSTEMI group was higher than that in control group,and NSTEMI group was highest.And there was significant difference between NSTEMI group and STEMI group,and also between NSTEMI group and control group (P ＜ 0.05).The serum level of hs-cTnI was increased in STEMI group and NSTEMI group.The increased degree in STEMI group was higher than that in NSTEMI group,and there was significant difference (P ＜0.05).The incidence of cardiovascular events and cardiac death within 3 months after discharge in patients with the serum level of hs-CRP ≥ 3 mg/L on admission in UAP group and NSTEMI group,STEMI group was 6/11,40.0％ (12/30),46.4％ (13/28),which was higher than that in patients with the serum level of hs-CRP ＜ 3 mg/L[11.1％(3/27),3/8,5/14],and there was significant difference(P＜ 0.05).The incidence of cardiovascular events and cardiac death within 3 months after discharge in patients with the serum level of hs-cTnT≥ 1.0 μ g/L on admission in NSTEMI group and STEMI group was 16.7％(5/30) and 18.4％(7/38),which was higher than that in patients with the serum level of hs-cTnT ＜ 1.0 μ g/L (1/8,1/4),and there was significant difference (P ＜ 0.05).Conclusion Significantly increased hs-CRP is an important predictor of poor prognosis of ACS patients.hs-CRP combined with hs-cTnT is helpful in early identification of high-risk patients.Giving intensive treatment to these patients in time and monitoring closely after discharge can reduce the happening of cardiovascular events.
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Objective To investigate the effects of telmisartan on the expression of angiotensin converting enzyme2 (ACE2) mRNA in monocyte-derived macrophages of hypertensive patients companied with diabetes.Methods 62 essential hypertensive patients companied with diabetes were randomly divided into two groups:regular treatment group,and telmisartan group.Then the content of ACE and ACE2 in serum was detected by ELISA,and the expression of ACE mRNA and ACE2 mRNA in monocyte-derived macrophages of patients was detected by RT-PCR before and after having been treated.Results (1) After having been treated for 4 weeks and 12 weeks,the blood pressure of the patients in two groups were decreased significantly,Comparing with regular group,telmisartan group seemed to have more obvious therapeutic effect (P ＜ 0.05) ; (2) After having been treated for 12 weeks,glycosylated hemoglobin diseased in both group,but there was no significant difference between the two group (P ＞ 0.05) ; (3) In telmisartan group,the content of ACE2 in serum was increased after having been treated for 12 weeks than that in regular treatment group,[(23.9 ± 8.2) U/L vs (16.3 ± 8.9) U/L,P ＜ 0.05] ; and the expression of ACE2 mRNA in monocyte-derived macrophages in telmisartan group was obviously increased after 12 weeks comparing with regular treatment group (0.73 ±0.06 vs 0.51 ±0.04,P ＜0.01).Conclusion The role of telmisartan in decreasing blood pressure and it's advantage to the metabolism of glucose are partly related with the up-regulation of ACE2 mRNA.