Objective: To observe the liver function changes and to analyze the risk factors in patients at peri-operative period of cardiopulmonary bypass surgery.
Methods: A total of 108 patients with cardiopulmonary bypass surgery were observed for their liver function at prior and 1, 2, 3, 6 days post-operation, the related risk factors for lever damage were studied by uni- and multivariate regression analysis.
Results: Compared with pre-operative indexes,① at 1, 2, 3 and 6 days post-operation, aspartate aminotransferase (AST), direct bilirubin (DBIL) were increased, serum albumin (ALB), cholinesterase (CHE) were decreased, and at 1, 2, 3 days post-operation, total bilirubin (TBIL) was increased, at 1, 2, 3 days post-operation, alkaline phosphatase (ALP) was decreased, while it increased at 6 days post-operation, allP<0.05;② glutamyl endopeptidase (GGT) was decreased at 1, 2 days post-operation, while it increased at 6 days post-operation,P<0.05;③glutamate pyruvate transaminase (GPT) was increased at 6 days after operation,P<0.05. Univariate regression analysis indicated that cardiothoracic ratio ≥ 0.56 (P<0.05, OR=2.900, 95% CI: 1.206~6.976), cardiopulmonary bypass time (P<0.05, OR=1.042, 95%CI: 1.017~1.068), aortic clamping time (P<0.05, OR=1.041, 95% CI: 1.012~1.070) and lactic acid level at 1 day after operation (P<0.05, OR=1.518, 95% CI: 1.182-1.948) were related to post-operative damage of liver function. Multivariate regression analysis presented that cardiopulmonary bypass time (P<0.05, OR=1.033, 95% CI: 1.007-1.059) and lactic acid level at 1 day after operation (P<0.05, OR=1.340, 95% CI: 1.028-1.745) were the independent risk factors for post-operative damage of liver function.
Conclusion: Multiterm of liver function could be damaged at the early stage after cardiopulmonary bypass surgery; cardiopulmonary bypass time and lactic acid level at 1 day after operation were the independent risk factors for peri-operative damage of liver function in relevant patients.

Objective To investigate the effect and safety of Tongqiaoxingnao soup applied in elder severe craniocerebral injury stasis resistance qing qiao patients.Methods 40 cases with severe craniocerebral injury stasis resistance qing qiao were enrolled in the study,and they were divided into two groups randomly,each group had 20 cases.Patients in the monotherapy group received routine western medicine treatment,while the combination group was added the treatment of Tongqiaoxingnao soup,200mL per day for 4 weeks.GCS scores and the persistent time of coma were analyzed.After treatment for 4,8,14 days of intracranial pressure and cerebral edema were recorded and analyzed,the total effective rate and the incidence of adverse reactions were compared between two groups.Results GCS score of the combination group was (13.7 ±4.2)points,and it was obviously higher than the monotherapy (9.2 ±3.5)points (t =2.86,P <0.05).The coma duration of the combination group was (6.5 ±1.4)d,and it was obviously shorter than the monotherapy group (10.2 ±2.5 )d (t =2.86,P <0.05 ).The amount of intracranial pressure increased of combination group were 10 cases and 8 cases,which were significantly less than the monotherapy after 8 and 14 days with 16 cases and 15 cases (χ2 =3.96,5.01,all P <0.05).Total effective rate of combination treatment group was 75.0%,which was significantly higher than 40.0% of monotherapy group (χ2 =5.01,P <0.05).The occurrence of adverse reactions such as bleeding,electrolyte imbalance,hypoxemia,and the acid -base imbalance had no significant differences between the two groups (P >0.05 ).Conclusion Tongqiaoxingnao soup applied in elder severe craniocerebral injury stasis resistance qing qiao patients has clinical curative effect,can shorten the coma time,reduce intracranial pressure and relieve cerebral edema,and has high security,it is worthy of populari-zation and application.

Objective To study the effects of acute coronary comprehensive syndrome with PCI therapy after secondary HIT-Ⅱ give sulphur of liver fondaparinux therapy clinical comprehensive effect.MethodsDecimation in 66 patients with acute coronary syndrome after PCI patients was applied on the basis of drug therapy and postoperative anticoagulation.Study group (33 cases) in the postoperative secondary HIT Ⅱ after being diagnosed with stop heparin and give sulphur of fondaparinux, bleeding in the coagulation indexes, within 30 days event and 6months heart vascular pieces efficacy evaluation.ResultsThe use of heparin before.The index of blood coagulation in study group were normal, confirmed HIT Ⅱ when the index change significantly (P<0.05) and the discontinuation of heparin 24h, 3d, 7d indexes compared at diagnosis were restored (P<0.05) and 14 days of heparin to stop with the use of heparin levels.The patients in the study group, the incidence of bleeding events was 9.1%, compared to 15.2% in the control group no significant difference.The patients in the study group of adverse cardiovascular events occurred rate was 12.1%, compared to 18.2% in the control group no significant difference.ConclusionAcute coronary syndrome after PCI HIT-Ⅱ to grant the sulphur of fondaparinux treatment had no significant effect on blood coagulation function and safety.

Objective: To explore the clinical efficacy of thymalfasin on the immune function and inflammatory response in the treatment of patients with severe pneumonia. Methods: From June 2015 to June 2018, 86 patients with severe pneumonia in the Hospital of Zhejiang Provincial General Team of Armed Police were enrolled in the study.According to different treatment methods, they were divided into control group and treatment group, with 43 cases in each group.The control group was treated with cefoperazone/sulbactam sodium on the basis of conventional treatment.The treatment group was treated with thymalfasin on the basis of the treatment of the control group.The expression of monocyte human leukocyte antigen-DR (mHLA-DR), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured before and after treatment.At the same time, CD₄⁺, CD₈⁺, CD₄⁺/CD₈⁺ before and after treatment were examined in the two groups.The efficacy and bacterial clearance rate of the two groups were evaluated.The adverse reactions were recorded. Results: After treatment, the levels of IL-6 and TNF-α in the two groups were significantly lower than those before treatment [treatment group: (44.9±11.8)ng/L, (42.9±13.1)ng/L vs. (86.5±27.9)ng/L, (79.6±28.6)ng/L, control group: (71.5±14.2)ng/L, (65.9±22.6)ng/L vs. (87.1±28.6)ng/L, (78.8±29.1)ng/L, t=9.005, 7.650, 3.203, 2.295, all P<0.05]. The expression level of mHLA-DR in the treatment group after treatment [(44.8±5.7)%] was significantly higher than that before treatment [(27.1±3.4)%, t=17.487, P=0.000]. The changes of the indicators in the treatment group were significantly better than those in the control group (t=9.447, 5.773, 8.725, all P<0.05). After treatment, the CD₄⁺ level of the two groups were higher than those before treatment, and the CD₈⁺ levels of the two groups were significantly lower than those before treatment, the differences were statistically significant(t=3.050, 3.429, 6.965, 13.327, all P<0.05), and the CD₄⁺/CD₈⁺ of the two groups were significantly increased (t=0.370, 3.314, all P<0.05). The indicators of the treatment group were improved more significantly than the control group (t=4.416, 12.355, 3.089, all P<0.05). The bacterial clearance rate of the treatment group was 88.89% (32/36), which was significantly higher than that of the control group [67.65% (23/34), χ²=4.686, P=0.030]. The clinical efficacy of the treatment group was 93.02%(40/43), which was significantly higher than 76.74%(33/43) of the control group (χ²=6.095, P=0.047). The incidence of adverse reactions between the two groups had no statistically significant difference (χ²=0.212, P=0.645). Conclusion Thymalfasin in the treatment of patients with severe pneumonia can improve the immune function, reduce the inflammatory response, improve the bacterial clearance rate and clinical efficacy, and will not increase the adverse reactions, so it is worthy of promoting.

Objective:To analyze the costs and effectiveness of five common screening modes and genetic screening for thalassemia in China in order to find the optimal way and provide evidence for the implementation of thalassemia prevention and control projects in Hunan Province.Methods:From June 2020 to April 2021, 12 971 couples from 14 cities and autonomous prefectures in Hunan Province were selected as the study population. The diagnosis of thalassemia was based on the results of genetic testing. Results of routine blood test and hemoglobin electrophoresis were collected and analyzed. The efficacy of five screening modes, at the cut-off value of <80 fl or 82 fl for the mean corpuscular volume (MCV), was analyzed by positive predictive value, negative predictive value, Jorden index and cost-effectiveness ratio. Sensitivity analysis was used to assess the feasibility of genetic screening at different costs after fixing the costs of routine blood and hemoglobin electrophoresis. The five thalassemia screening models are as follows: Mode 1: The woman had a blood routine test first. If the result was positive, the spouse required a blood routine test. If both results were positive, a thalassemia gene test should be offered to the couple. Mode 2: Both husband and wife were screened by blood routine and hemoglobin electrophoresis. If one or both of them were positive, both would be tested for thalassemia gene. Mode 3: The couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing. Mode 4: The woman was screened by blood routine and hemoglobin electrophoresis. If any one of them was positive, the woman would be tested for thalassemia gene. If the gene test result was positive, the spouse should receive thalassemia gene. Mode 5: Both spouses conducted a blood routine test. If either was positive, both would conduct hemoglobin electrophoresis test. If both were positive, both spouses should receive thalassemia gene testing. Gene testing mode: The woman would be tested for thalassemia, and her spouse would have thalassemia test too if her result was positive.Results:When using MCV<80 fl as the cut-off for diagnosing thalassemia, the Youden indices of the five prenatal screening modes in Hunan Province were 0.551, 0.639, 0.898, 0.555 and 0.356, while when using MCV<82 fl as the cut-off, the Youden indices were 0.549, 0.629, 0.851, 0.548 and 0.356. When the MCV cut-off value was <80 fl, the missed diagnosis rates of the five screening modes were 44.44%, 0.00, 0.00, 18.52% and 62.96%, and the cost-effectiveness ratios were 21 709, 250 939, 76 870, 138 463 and 92 860 yuan (RMB)/couple, respectively. When the price of genetic testing was lower than 55 yuan (RMB), the cost-effectiveness ratio of genetic screening was lower than that of Mode 3.Conclusions:MCV<80 fl can be considered as the positive criteria in blood routine screening for thalassemia in Hunan Province, and the cost-effectiveness ratio of Mode 3 (the couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing) is the best. Genetic screening has certain advantages with the decreasing price.