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The UK guidelines for the use of desmopressin in patients with von Willebrand's disease. Von Willebrand Working Party of the United Kingdom Haemophilia Centre Director's Organization. 血管性血友病患者使用去氨加压素的英国指南。英国血友病中心主任组织冯·维勒布兰德工作组。
Pub Date : 1997-03-01 DOI: 10.1097/00003643-199703001-00004

A document entitled Guidelines for the Diagnosis and Management of von Willebrand's Disease was produced by the von Willebrand Working Party of the United Kingdom Haemophilia Centre Directors' Organization. Under the chairmanship of Dr Beverley Hunt, an independent board of haematologists and anaesthesiologists reviewed the use of a synthetic vasopressin analogue, desmopressin (DDAVP), in the management of patients with von Willebrand's disease. The Advisory Board considered that production of the guidelines was to be applauded, but that the contraindications for DDAVP were imprecisely defined and may thus be misleading. This paper summarizes the Advisory Board's discussion of the suggestions.

联合王国血友病中心主任组织的血管性血友病工作组编写了一份题为《血管性血友病诊断和管理准则》的文件。在Beverley Hunt博士的领导下,一个由血液学家和麻醉学家组成的独立委员会审查了一种合成抗利尿激素类似物去氨加压素(DDAVP)在血管性血友病患者治疗中的应用。咨询委员会认为,指南的制定是值得赞扬的,但DDAVP的禁忌症定义不准确,因此可能具有误导性。本文总结了咨询委员会对这些建议的讨论。
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引用次数: 15
Measurement of blood loss in clinical studies. 临床研究中失血量的测量。
Pub Date : 1997-03-01 DOI: 10.1097/00003643-199703001-00007

Direct measurement of blood loss has poor reliability and poor validity. A formula is proposed for how blood loss may be calculated from pre- and post-operative haemoglobin, taking the influence of any blood transfusions into account.

直接测量失血量的信度和效度较差。在考虑任何输血影响的情况下,提出了一个计算术前和术后血红蛋白失血量的公式。
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引用次数: 29
Desmopressin--a haemostatic drug: state-of-the-art review. 去氨加压素——一种止血药物:最新研究综述。

Desmopressin is a well tolerated and convenient haemostatic drug that can be used in a number of clinical conditions with bleeding diathesis. It has several effects on the haemostatic system, causing endogenous release of coagulation factor VIII, von Willebrand factor, tissue plasminogen activator and also increasing platelet adhesiveness and shortening bleeding time. The effect is virtually immediate and lasts for several hours. Side-effects are few and mostly mild. Desmopressin is suitable for home use in selected patients with bleeding diathesis. The optimal dosage is 0.3 microgram kg-1 intravenously, but the drug may also be administered subcutaneously or intranasally. In addition to the established indications, haemophilia A, von Willebrand's disease and platelet dysfunction, the drug may also be used safely in other patients with unexpected bleeding during or after surgery. The effectiveness of general prophylactic use of desmopressin, in order to diminish surgical blood loss and transfusion requirements, has not been proven, except in patients with known bleeding diathesis caused by congenital or acquired haemostatic disorders, e.g. in those taking aspirin.

去氨加压素是一种耐受性良好、使用方便的止血药物,可用于许多有出血素质的临床情况。它对止血系统有多种作用,引起凝血因子VIII、血管性血液病因子、组织纤溶酶原激活剂的内源性释放,并增加血小板黏附性,缩短出血时间。效果几乎立竿见影,持续数小时。副作用很少,而且大多是轻微的。去氨加压素适合有出血性素质的患者在家中使用。最佳剂量为0.3微克公斤-1静脉注射,但也可皮下或鼻内给药。除了已确定的适应症,血友病A、血管性血友病和血小板功能障碍外,该药也可安全用于手术中或手术后意外出血的其他患者。一般预防性使用去氨加压素以减少手术失血量和输血需求的有效性尚未得到证实,但已知有先天性或获得性止血障碍引起的出血素质的患者(例如服用阿司匹林的患者)除外。
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引用次数: 0
Pharmacological prophylaxis of bleeding in surgical patients treated with aspirin. 阿司匹林治疗外科病人出血的药理学预防。
Pub Date : 1997-03-01 DOI: 10.1097/00003643-199703001-00008

A Medline search and subsequent meta-analysis shows that pre-operative aspirin increases blood loss and transfusion requirements in patients undergoing coronary artery bypass grafting. Both aprotinin and desmopressin are effective in counteracting this. There are almost no data on the effects of bleeding of aspirin, aprotinin and desmopressin in other procedures.

Medline搜索和随后的荟萃分析显示,术前阿司匹林会增加冠状动脉旁路移植术患者的失血量和输血需求。抑酶蛋白和去氨加压素都能有效地对抗这种情况。几乎没有关于阿司匹林、抑肽酶和去氨加压素在其他手术中对出血的影响的数据。
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引用次数: 24
Desmopressin and bleeding during invasive surgery. 有创手术中的去氨加压素和出血。
Pub Date : 1997-03-01 DOI: 10.1097/00003643-199703001-00009

Peri-operative bleeding is associated with invasive surgery and has traditionally been compensated for by blood transfusion. Concerns about the risk of transfusion-transmitted disease have led to an increasing interest in synthetic haemostatic agents. Desmopressin (1-deamino-8-D-arginine vasopressin), a synthetic analogue of vasopressin, has been shown to be of benefit in the peri-operative management of von Willebrand's disease or mild haemophilia A. This paper addresses the role of desmopressin and bleeding during invasive surgery, particularly during cardiopulmonary bypass. Clinical trials using desmopressin in open cardiac surgery indicate that it may reduce blood loss in those with an excessive bleeding tendency. However, it is difficult to identify this group pre-operatively.

围手术期出血与侵入性手术有关,传统上通过输血来补偿。对输血传播疾病风险的担忧导致对合成止血剂的兴趣日益增加。去氨加压素(1-去氨基-8- d -精氨酸加压素)是加压素的合成类似物,已被证明在血管性血友病或a型轻度血友病的围手术期治疗中有益。本文讨论了去氨加压素和有创手术中出血的作用,特别是在体外循环期间。在心脏直视手术中使用去氨加压素的临床试验表明,它可以减少那些有过度出血倾向的患者的失血量。然而,术前很难确定这一组。
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引用次数: 13
Guidelines for the diagnosis and management of von Willebrand's disease. 血管性血友病的诊断和治疗指南。
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引用次数: 0
Strategies to reduce the need for peri-operative blood transfusion. 减少围手术期输血需求的策略。
Pub Date : 1997-03-01 DOI: 10.1097/00003643-199703001-00006

Therapeutic regimens involving the transfusion of blood components are a matter of debate, not only with regard to patients' safety, but also with regard to cost-effectiveness. The following different measures to reduce the use of blood components and their efficacy are discussed: autologous transfusion, including predonation, isovolaemic haemodilution and peri-operative retransfusion; toleration of a lower haematocrit; and measures to reduce blood loss. In particular, a combination of these methods may be most effective at reducing transfusion needs.

涉及血液成分输血的治疗方案是一个有争议的问题,不仅涉及到患者的安全,而且涉及到成本效益。本文讨论了以下减少血液成分使用的不同措施及其疗效:自体输血,包括捐献前输血、等容血稀释和围手术期再输血;容忍较低的红细胞压积;以及减少失血的措施。特别是,这些方法的结合可能是最有效的减少输血需求。
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引用次数: 10
Desmopressin--a haemostatic drug: state-of-the-art review. 去氨加压素——一种止血药物:最新研究综述。
Pub Date : 1997-03-01 DOI: 10.1097/00003643-199703001-00002
Desmopressin is a well tolerated and convenient haemostatic drug that can be used in a number of clinical conditions with bleeding diathesis. It has several effects on the haemostatic system, causing endogenous release of coagulation factor VIII, von Willebrand factor, tissue plasminogen activator and also increasing platelet adhesiveness and shortening bleeding time. The effect is virtually immediate and lasts for several hours. Side-effects are few and mostly mild. Desmopressin is suitable for home use in selected patients with bleeding diathesis. The optimal dosage is 0.3 microgram kg-1 intravenously, but the drug may also be administered subcutaneously or intranasally. In addition to the established indications, haemophilia A, von Willebrand's disease and platelet dysfunction, the drug may also be used safely in other patients with unexpected bleeding during or after surgery. The effectiveness of general prophylactic use of desmopressin, in order to diminish surgical blood loss and transfusion requirements, has not been proven, except in patients with known bleeding diathesis caused by congenital or acquired haemostatic disorders, e.g. in those taking aspirin.
去氨加压素是一种耐受性良好、使用方便的止血药物,可用于许多有出血素质的临床情况。它对止血系统有多种作用,引起凝血因子VIII、血管性血液病因子、组织纤溶酶原激活剂的内源性释放,并增加血小板黏附性,缩短出血时间。效果几乎立竿见影,持续数小时。副作用很少,而且大多是轻微的。去氨加压素适合有出血性素质的患者在家中使用。最佳剂量为0.3微克公斤-1静脉注射,但也可皮下或鼻内给药。除了已确定的适应症,血友病A、血管性血友病和血小板功能障碍外,该药也可安全用于手术中或手术后意外出血的其他患者。一般预防性使用去氨加压素以减少手术失血量和输血需求的有效性尚未得到证实,但已知有先天性或获得性止血障碍引起的出血素质的患者(例如服用阿司匹林的患者)除外。
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引用次数: 81
Patient sedation: technical problems and developments. 患者镇静:技术问题和进展。
Pub Date : 1996-07-01 DOI: 10.1097/00003643-199607001-00005

Target-controlled infusion (TCI) systems have dramatically simplified the technique of total intravenous infusion. Systems have been used successfully to provide patient sedation during a variety of surgical procedures. Initial studies indicate that sedation for surgery is achieved rapidly without undue oversedation, and is easily maintained at a constant level. TCI systems have also been used successfully for patient-controlled analgesia (PCA). Using the analgesic alfentanil, good quality post-operative analgesia can be achieved without under- or overdosing. The recent development of using effector-site drug concentrations as a guide to the extent of sedation should allow fine control of patient sedation with TCI systems.

靶控输注(TCI)系统极大地简化了全静脉输注技术。系统已成功地用于在各种外科手术过程中为患者提供镇静。初步研究表明,手术镇静可迅速实现,无需过度镇静,且易于维持在恒定水平。TCI系统也已成功用于患者自控镇痛(PCA)。使用镇痛药阿芬太尼,可以达到良好的术后镇痛质量,而不会过量或不足。使用效应位点药物浓度作为镇静程度的指导的最新发展应该允许使用TCI系统对患者镇静进行精细控制。
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引用次数: 14
Sedation during regional anaesthesia: indications, advantages and methods. 区域麻醉中的镇静:适应证、优点和方法。
Pub Date : 1996-07-01 DOI: 10.1097/00003643-199607001-00002

Patient management is a vital component of regional anaesthesia, and the appropriate method and level of sedation must be chosen for each patient on an individual basis. This may range from simple distraction through pharmacologically induced anxiolysis or hypnosis, to light general anaesthesia by the inhalational or intravenous routes. Intravenous sedation is most widely used and suitable agents include the benzodiazepines, the intravenous induction agents and the opioids. Currently, midazolam and propofol are considered to be the most suitable drugs. Patient safety must never be compromised and pharmacological sedation must be administered by a trained practitioner, with appropriate patient monitoring and provision of supplementary oxygen.

病人管理是区域麻醉的重要组成部分,必须根据每个病人的情况选择适当的方法和镇静水平。这可以是通过药物诱导的抗焦虑或催眠来进行简单的分心,也可以是通过吸入或静脉途径进行轻度全身麻醉。静脉镇静是应用最广泛的药物,适用的药物包括苯二氮卓类药物、静脉诱导剂和阿片类药物。目前,咪达唑仑和异丙酚被认为是最合适的药物。绝不能损害患者的安全,药理镇静必须由训练有素的医生管理,并适当监测患者并提供补充氧气。
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引用次数: 17
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European journal of anaesthesiology. Supplement
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