ABSTRACT
OBJECTIVE: To observe the changes of shock index (SI) and diastolic blood pressure (DBP) in postpartum hemorrhage patients, and the explore their relationship with postpartum hemorrhage and the clinical significance of early warning of hemorrhage risk. METHODS: 402 patients with postpartum hemorrhage (within 24 hours after delivery, the amount of bleeding in vaginal delivery ≥ 500 mL, and the amount of bleeding in caesarean delivery ≥ 1 000 mL) admitted to the obstetrics ward of Affiliated Hospital of Hangzhou Normal University from January 2014 to December 2017 were selected as the objective group and 416 without complications during delivery were selected as the control group in the same hospital at the same period. Clinical data in the two groups before and after childbirth was collected, including age, pregnancy week, 24-hour blood loss, and hemoglobin (Hb), whole blood cell parameters, heart rate (HR), systolic blood pressure (SBP), DBP, SI, blood urea nitrogen (BUN), serum creatinine (SCr) within 24 hours before and after delivery, and postpartum 24 hours and prenatal DBP difference (ΔDBP). The differences of indicators were compared between the two groups. Pearson method was used to analyze the correlation between the postpartum DBP and SI in the objective group. Ordinal regression model was used to analyze the early warning risk factors of each index to postpartum hemorrhage. RESULTS: Compared with the control group, older age (years: 29.29±5.01 vs. 28.05±4.46), more pregnancies (times: 2.68±1.42 vs. 2.33±1.28), shorter gestation weeks (weeks: 38.33±3.57 vs. 39.05±1.40), more 24-hour blood loss (mL: 726.57±467.66 vs. 244.49±50.25) in the objective group were significant differences (all P < 0.01). Postpartum hemorrhage patients were successfully hemostatic, no maternal and perinatal death was found in the two groups. Compared with the control group, DBP was significantly decreased at 24 hours after delivery in the objective group [mmHg (1 mmHg = 0.133 kPa): 71.19±12.55 vs. 75.68±8.96, P < 0.05], and ΔDBP was significantly increased (mmHg: 5.39±3.93 vs. 0.67±0.33, P < 0.01). In addition, compared with the control group, SI and HR were significantly increased in the objective group [SI: 0.80±0.15 vs. 0.72±0.11, HR (bpm): 91.56±13.37 vs. 82.96±11.76, both P < 0.05], Hb, red blood cell count (RBC), platelet count (PLT) and SBP were significantly decreased [Hb (g/L): 91.30±13.41 vs. 112.30±13.41, RBC (×1012/L): 3.74±0.38 vs. 4.59±0.45, PLT (×109/L): 173.02±59.08 vs. 182.09±54.76, SBP (mmHg): 115.13±9.27 vs. 117.94±11.66, all P<0.05]. Correlation analysis showed that postpartum DBP was negatively correlated with SI, 24-hour blood loss, ΔDBP, BUN and SCr (r value was -0.419, -0.268, -0.490, -0.108, -0.163, respectively, all P < 0.05), and positively correlated with SBP, Hb and RBC (r value was 0.739, 0.125, 0.096, respectively, all P < 0.05). It was shown by Ordinal regression analysis that the risk of postpartum hemorrhage was significantly increased when ΔDBP ≥ 9.32 mmHg [relative risk (RR) = 2.64, 95% confidence interval (95%CI) = 1.94-3.34, P = 0.000], SI ≥ 0.95 (RR = 1.78, 95%CI = 1.01-2.55, P = 0.000), DBP ≤ 59.64 mmHg (RR = 0.86, 95%CI = 0.31-1.41, P = 0.000), SBP ≤ 105.86 mmHg (RR = 0.63, 95%CI = 0.18-1.07, P = 0.000), Hb ≤ 77.89 g/L (RR = 1.68, 95%CI = 0.99-2.38, P = 0.000), and ΔDBP ≥ 9.32 mmHg was the most effective early warning effect. CONCLUSIONS: Combined with clinical manifestations of patients with postpartum hemorrhage, SI and DBP can be used as an important reference indicator for the observation of postpartum hemorrhage conditions. ΔDBP ≥ 9.32 mmHg can be used as the risk factors of the patient with postpartum hemorrhage.
Subject(s)
Blood Pressure , Postpartum Hemorrhage , Shock/diagnosis , Adult , Case-Control Studies , Female , Humans , Pregnancy , Risk Factors , Young AdultABSTRACT
BACKGROUND: Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide. Platelet activation may play an important role in pathologic progress in lung cancer. In this study, we aimed to clarify the influence of activated platelets on lung cancer generation and growth, and the relationship among these functional and ultrastructural changes of platelets and the severity of pathogenetic condition in these patients with NSCLC. METHODS: One hundred and thirty-six cases of patients with pathologically confirmed NSCLC were included in this study. Fifty-four healthy people were enrolled as controls. The change of ultra microstructure and activity of blood platelets were observed under the transmission and scanning electron microscope. Simultaneous determination of plasma granule membrane protein 140 (GMP-140) was made. RESULTS: Transmission electron microscopy showed remarkable changes of ultra microstructure of platelets in patients with NSCLC, including swelling, increase of a-granules, vesicles, and glycogenosome. Scanning electron microscopy showed many more surface processes and wrinkles on platelets in patients with NSCLC. The reference plasma levels of GMP-140 of healthy controls were (18.2 +/- 2.7) microg/L. The plasma levels of GMP-140 in patients with NSCLC were (47.8 +/- 12.3) microg/L, which were much higher than those of the controls. There was a medium positive correlation between plasma levels of GMP-140 and amount of a-granules (r = 0.514, P < 0.01) and a high positive correlation between plasma levels of GMP-140 and area of platelet (r = 0.84, P < 0.01) in patients with NSCLC. The Kaplan-Meier survival curve analysis showed significant shift to the left in patients with NSCLC whose a-granules per platelet were 19 or more compared to those 18 or less (Log rank statistic, chi(2) = 17.38, P < 0.01). CONCLUSIONS: There are significant activated changes of ultra microstructure and increased activity of blood platelets in patients with NSCLC. These activated platelets may play an important role in the generation and growth of lung cancer. These changes can be used as a diagnostic index of severity, progression, and prognosis of NSCLC.
