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肺动脉灌注行肺保护的研究现状
随着体外循环(cardiopulmonary bypass,CPB)心肌保护技术的明显进步,心内直视手术的安全性显著提高,但CPB后仍存在不同程度的肺损伤,尤其在需要长时间CPB支持或术前合并肺动脉、肺静脉高压等状态下,术后肺部并发症明显增多,逐渐成为影响患者预后的关键因素,因此,CPB时的肺保护方法研究是目前心脏外科的重要研究方向之一.CPB期间采用肺动脉灌注保护液方法行肺保护,针对性强,实验和临床应用研究已取得一些进展.
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6%羟乙基淀粉急性等容血液稀释对体外循环心内直视手术患者氧合和肺水肿的影响
体外循环(CPB)心脏直视手术中因大量失血常需要进行异体输血,急性等容血液稀释(ANH)能够减少手术出血,降低异体输血率已得到国内外许多学者的认可[1-3].但有研究表明[4],血液稀释在心脏外科手术CPB过程中,不但不能降低老年、婴儿和新生儿患者的病死率,而且能够引起血管活性物质释放、免疫反应和炎症反应.
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川芎嗪对小儿体外循环围术期细胞因子IL-6和IL-8的影响
小儿心脏手术需要体外循环(cardiopulmonary bypass,CPB),而麻醉、手术创伤和CPB都会引起细胞和体液的各种级联炎症反应,从而导致急性全身炎症反应.
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体外循环术后ICU患者并发精神障碍20例原因分析及护理干预
近年来,随着体外循环(cardiopulmonarybypass,CPB)和心脏手术技术的不断发展,心脏手术后死亡率显著下降,但术后神经系统并发症居高不下,尤其是术后精神障碍等成为主要并发症之一,我院自2007年1月~2009年1月共实施CPB心脏直视手术990例,其中20例术后出现精神障碍.
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奥拉西坦对CPB心脏手术患者脑损伤保护作用的观察
体外循环(CPB)下心脏手术患者术后易出现程度不同的神经精神系统症状,如苏醒延迟、大面积脑梗死等.奥拉西坦是一种新型神经营养药,目前国内将其用于CPB手术的有关报道较少.2008年1月~2009年6月,我们观察了CPB手术转机期间使用奥拉西坦对患者脑损伤特异性生化指标的影响,现报告如下.
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心内直视手术体外循环前后血浆cTnI变化及意义
2007年9~11月,我们观察了20例心内直视手术患者体外循环(CPB)血浆心肌肌钙蛋白I(cTnI)水平变化,现报告如下.
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银杏叶提取物对脑微空气栓塞损伤的保护作用
近年来,体外循环(CPB)心脏手术后死亡率显著下降,但术后神经系统并发症仍不少见,严重影响患者的生活质量[1].本研究旨在观察兔脑微空气栓塞对缺血脑组织bcl-2表达和血清S100β蛋白的影响以及银杏叶提取物对两者干预作用,探讨药物干预对脑组织的保护机制,为体外循环脑保护提供实验依据.
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7例心脏手术的配合与体会
心脏手术在整个外科手术中具有尖端、复杂、危险的特性[1],大多手术是体外循环( CPB)辅助下直视完成.心脏手术难度风险大、技术要求高、责任心强、操作程序复杂,需要多方面的配合、协作才能完成,各组操作质量与患者生命息息相关,配合的熟练程度与手术成功有着重要关系,因此护士在工作中必须积极主动、熟练到位、分秒必争、抓住重点、尽心尽职,才能保证手术的顺利进行和成功.
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体外循环围术期自体输血的临床应用进展
一些发达国家约有50%的心脏手术采取了自体输血技术,通过采取ABD和其它综合节血措施,85%左右的主动脉手术可以不输异体血[1].临床上自体输血有三种主要方式:保存式、稀释式和回收式.本文就CPB围术期自体输血的临床应用情况综述如下.
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尿肾损伤因子1在心脏体外循环术后急性肾损伤早期诊断的价值
急性肾损伤(AKI)是心脏体外循环(CPB)术后常见的严重并发症,肾损伤分子1(KIM-1)比Scr能更早诊断缺血性AKI.本研究探讨尿KIM-1在CPB术后诊断AKI的价值.
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体外循环手术中C3、C4的检测意义
目的了解体外循环(CPB)手术对病人血浆中C3、C4的影响.方法用透射比浊法测定行心脏瓣膜置换术前后病人血浆中C3、C4浓度,并进行比较.结果术前与术后血浆中C3、C4差异有显著性(P<0.05),血浆中C3、C4降低的谷值在CPB末.结论CPB导致术后早期大量补体激活,易引起全身性炎症反应综合征(SIRS),减少补体激活程度可降低炎症反应强度.
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非体外循环下冠状动脉搭桥术后护理
冠状动脉硬化性心脏病是一种常见的心血管疾病,常需手术治疗.0PCAB是国内开展的一种全新的冠心病的外科治疗法,国外自80年代末开展以来,目前欧美发达国家OPCAB作为一种常见的冠脉搭桥术(CABG),有的国家已占有冠脉搭桥术的90%.我院2010年1~3月在非体外循环(CPB)下行6例CABG,取得了满意的疗效.
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心脏手术围术期输血与血液保护策略的研究进展
心脏手术围术期贫血与发病率和死亡率密切相关,输血因此成为心脏手术围术期的常态,但越来越多的研究证实了输血的诸多不良后果.因此,输血是1把双刃剑,目前尚不太清楚在保证患者安全的前提下,如何合理应用这个紧缺资源.本文回顾了贫血与心脏外科手术结果之间的关系、输血相关风险、输血对心脏手术后死亡率和发病率的影响、限制与自由输血策略比较和近年来指南提出的多模式血液保护技术.相信各医院从自己的实际出发、多学科协同贯彻指南的相关建议后,心脏手术围术期输血与血液保护策略会得到进一步优化.
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上腔静脉-右肺动脉连接术的体外循环管理
2008年12月至2009年3月,我科对19例复杂紫绀型先天性心脏病患者施行了上腔静脉-右肺动脉连接术(Glenn手术),现总结体外循环(CPB)管理经验,以减少围术期并发症的发生.
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10kg以下低体重儿心内直视手术的体外循环管理
由于婴幼儿的生理及解剖特点,体外循环(cardiopulmonary bypass,CPB)技术是婴幼儿心脏直视手术术后恢复及减少并发症的关键.2007年3月至2008年6月,我们成功完成10 kg以下低体重儿心内直视手术67例,术后恢复好.现将其CPB的管理特点总结如下.
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Comparative study of the protective effect using hypothermic cardiopulmonary bypass and normothermic cardiopulmonary bypass
Objective To explore the detrimental influence of normothermic and hypothermic cardiopulmonary by-pass during open - heart surgery on immunity function,cytokines and complements. Methods Forty patients with con-genital or rheumatic heart disease were randomized to receive the two strategies: normothermie CPB (study group) andhypothermic CPB (control group) ,20 cases in each group. Venous blood samples were collected at each time points ofpreoperation, end of CPB, day 1,4,7,14 postoperatively to examine the plasma level of IL - 2, TNF - α, C3, C4, IgG,IgM, IgA, CD3, CD4, CD8. Results IL -2 in both groups decreased significantly at day 1,4, and returned to normal atday 7 postoperatively. IL - 2 in control group was significantly lower than that in study group postoperatively. TNF - α intwo groups was all higher at time points of end of CPB,day 1,4 postoperatively;in study group,it returned to normallevel at day 7 postoperatively, whereas in control group, it was still higher at day 7 postoperatively than that before oper-ation ,and returned to normal at day 14 postoperatively. C3 in study group was significantly lower at time points of endof CPB,day 1,7 postoperatively than that in control group;C3 in both groups was all higher at time points of end ofCPB, day 1,4 postoperatively;in study group, it returned to normal level at day 7 postoperatively, whereas in controlgroup,it was still higher at day 7 postoperatively than that before operation and returned to normal at day 14 postopera-tively. CA in study group at time points of end of CPB, day 1 postoperatively was significantly lower than that in controlgroup;C4 in both groups was all lower at time points of end of CPB, day 1,4 postoperatively than that before operation.The results showed that IgA after operation in both groups was significantly lower than that before operation, and re-turned to normal at day 7 postoperatively;IgA in study group at day 1 postoperatively was higher than that in controlgroup. IgG in both group at time points of end of CPB,day 1,4 postoperatively was significantly lower than that beforeoperation. IgG in control group was significantly higher at time points of end of CPB, day 1,4 postoperatively was signifi-cantly higher than that in control group. IgM in study group was significantly lower at time points of end of CPB, day 1,4 postoperatively. In control group, IgM was significantly lower at time points of end of CPB, day 1,4,7 postoperativelyand returned to normal at day 14 postoperatively. IgM in study group was significantly higher at day 1,4 postoperativelythan that in control group. CD3 ,CD4 in both groups decreased significantly at time points of end of CPB,day 1,4,andCD3 ,CD4 in study group and CD3 in control group returned to normal at day 7 postoperatively, CD4 in control groupstill lower than that before operation at day 7 postoperatively, and returned to normal at day 14 postoperatively. CD3,CD4 in control group was significantly lower at time points of end of CPB, day 1,4 than that in study group. CD8 in bothgroups increased significantly at day 1 postoperatively ;there was no significant difference between the two groups. Con-dusions The detrimental influence of open - heart surgery under normothermic CPB on humoral and cellular immunityfunction, cytokines and complements is less than that under hypothermic CPB, so normothermic CPB is beneficial for thepostoperative recovery and anti -inflammation function.
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体外循环围术期炎性介质水平改变的临床意义
体外循环(CPB)时血液直接接触非生理性物质表面、非生理性灌注、手术创伤、器官缺血再灌注、内毒素释放等均可触发全身炎症反应综合(SIRS)[1].机体在全身炎症反应发生的同时代偿性抗炎反应也伴随发生,二者相辅相成;促炎、抗炎性细胞因子能调节机体炎症反应和抗炎反应之间的动态平衡,是炎症反应的重要介质[2].我们对本院CPB心脏手术患者围术期血清炎性介质水平进行了动态监测,以探究其在CPB围术期患者监护工作中的指导意义.
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体外循环手术肺保护的研究进展
在体外循环( CPB)手术后,肺部并发症是心脏手术后早期死亡的重要原因之一,据报道,CPB术后因肺部合并症死亡的患者约占CPB术后总死亡率的1/3[1,2].体外循环致肺损伤的机制目前尚不清楚,多数学者认为可能是血液暴露于人工仪器而引起的全身炎症反应[3]、肺缺血—再灌注性损伤[4]、肺表面活性物质减少[5]所致.体外循环激活了补体、中性粒细胞、血小板的内皮细胞等,导致全身性炎症反应综合症发生,而后者在体外循环所致的肺功能不全中起着非常重要的作用,通过观察肺泡-动脉氧差、肺内分流、肺水肿程度、肺顺应性和肺血管阻力等指标,我们可以证明体外循环能造成肺损伤,随着对体外循环引起的炎症性肺损伤机制的深入了解,已有许多对抗体外循环所致的炎症反应的方法,有些措施已在临床应用.针对CPB相关性肺损伤的发生机制,近年来动物实验和临床研究在CPB肺缺血/再灌注损伤保护的研究方面也取得了可喜的进展.
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CBMdisc与CPB数据库生物医学文献收录特点的抽样对比研究
对CBMdisc与CPB数据库生物医学文献收录特点进行抽样对比研究.
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Objective: To investigate the dynamics of plasmacAMP/Cgmp in patients during cardiac surgery, and itsrelationship to traumatic stress.Methods: Sixteen patients, aged 19.31 years ± 10.4years, who underwent an open heart operation withcardiopulmonary bypass (CPB) and hypothermia wereserved as subjects. The arterial plasma concentrations ofcyclic adenosine monophosphate ( Camp ) and cyclicguanosine monophosphate ( Cgmp ) were measured byradioimmunoassay 2 hours before operation, afterheparinization, 20 minutes following CPB, at the end of theoperation, and 24 and 72 hours postoperatively,respectively. The patients' preoperative blood samples wereheparinized and the venous blood samples of 30 healthyblood donors were taken to measure the levels of Camp andcGMP as heparin and normal controls separately.Results: There were no statistical difference amongthe heparin control, preoperative level and normal control.The peak values of Camp and Cgmp occurred during CPBand plasma Camp levels changed synchronously withintensities of operative stimulus to human body. HowevercGMP level was mainly related to the operative stimulus to the heart and CPB. The Camp value was positivelycorrelated with the Cgmp value ( r = 0.6313, P < 0.001 ).Conclusions: Dynamic variation of plasma cyclicribonucleotide can be considered as a reference parameterfor intensity of traumatic stress.