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近红外光谱(NIRS)方法监测体外循环手术中的脑组织氧饱和度
体外循环是将人体上下腔静脉的血液引入体外循环机并在其中氧合成动脉血,然后输入人体的主动脉,因此体外循环代替了人体的心肺功能.临床心脏和大血管的手术需要体外循环的支持,从而医生可以对患者的上述组织进行手术操作.人体的脑组织对缺氧非常敏感,据统计,在脑损伤致死的病例中,以缺氧缺血为病因的占90%以上.长时间的体外循环可以导致患者脑组织缺氧缺血等病理改变,从而引发术中和术后的神经系统并发症,对病人的术后恢复产生非常不利的影响.所以在体外循环中,实时监测患者脑组织的氧合状况,并根据其变化实时合理地调节有关的生理参数,例如体温、血液灌注流量、血液的pH值、血液的O2分压和CO2分压等,以达到保护脑组织,防止脑缺氧的目的,具有非常重要的意义.
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急诊体外循环在心肺复苏中的应用
近年来由于体外循环(cardio-pulmonary bypass,CPB)技术的发展和有关设备的更新,不仅使CPB技术成为心脏大血管手术的安全辅助方法,同时也在抢救和治疗危重病人中取得良好临床效果;特别是对于心搏骤停者的心肺脑复苏,显示了其独特的价值.本院1989年1月至2001年5月应用急诊体外循环(emergency cardiopulmonary bypass,ECPB)抢救心搏骤停病人8例,现总结报道如下.
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急诊体外循环在普胸外科中的临床应用
急诊体外循环技术(emergency cardiopulmonary bypass,ECPB)应用于临床,近年来报道已有明显增加,特别在心血管危重病例方面,但对应用于非心脏手术中出现的意外,如普胸病例术中大出血、呼吸道窒息、心肺复苏等,则鲜有报道.本文报告我院及苏州大学附一院心胸外科10年间应用急诊体外循环救治6例普胸外科危重患者的体会,探讨ECPB在普胸外科开展的条件、指征及救治措施.
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大鼠体外循环后血浆二胺氧化酶与小肠黏膜基质蛋白变化的相关性研究
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中国心脏瓣膜外科的发展与现状
Heart valve surgery in China dates back to 4 to 5 decades ago. In 1954, the first closed mitral commissurotomy was successfully performed in a patient with mitral stenosis. In 1960, with the advent of transventricular dilator and by the route of left ventricle, the efficacy of mitral commissurotomy was improved. The procedure was rapidly adopted by many centers in this country[1]. In 1958, the first open heart surgery using cardiopulmonary bypass was performed in China. This was an epoch-making event, which opened up a new era in the field of cardiac surgery in China. Thereafter, in cities like Beijing and Shanghai, direct repairs of mitral lesions under CPB were made with good results. In 1965, the development of the first totally home-made ball valve prosthesis and its successful application in mitral valve replacement was another landmark in the history of heart valve surgery in China. In 1976, aortic valve replacement with glutaraldehyde-preserved bovine pericardial valve prosthesis was carried out successfully. The next year, the first porcine aortic valve prosthesis was produced and introduced to clinical use, which greatly accelerated the progress of heart valve surgery in China. During the last 2 decades, heart valve surgery and its techniques have been widely applied throughout China.
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体外循环下急诊心外科手术13例
随着体外循环(Cardiopulmonary Bypass,CPB)技术在心血管外科中的常规应用及对其理论的深入研究,逐渐认识到CPB对机体和器官具有良好的保护作用.在各种危重病心搏骤停时,应用急诊体外循环技术(Emergency Cardiopulmonary Bypass,ECPB)行心肺复苏;心血管手术后病情恶化采用ECPB支持可争取时间,做进一步抢救治疗;在保证介入治疗安全及抢救介入治疗以外等方面ECPB都发挥了重要作用[1,2].本文回顾分析我院应用ECPB治疗13例心胸外科危重患者的情况,探讨ECPB在心胸外科开展的条件、方法及临床应用指征.
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Purpose and Methods Open-heart surgery with the use of cardiopulmonary bypass (CPB) is associated with an inflammatory cascade which contributes to the development of postoperative complications including multiple organ failure. To provide an update on the subject, we briefly review the recent English-language literature.Results During CPB, various factors have been recognized to induce a complex inflammatory response. Based on an enhanced understanding of the underlying mechanisms, therapeutic strategies have been developed to reduce this inflammatory reaction and its subsequent damaging effects. Off-pump coronary artery bypass grafting may result in less inflammatory injury as compared with the conventional maneuver, which can in turn, diminish the incidence of cardiac, renal, or neurological dysfunction. It is also clear that improving the biocompatibility of CPB materials can lead to a better patient recovery. Inasmuch as the pathophysiology involved appears to be multifactorial, it is unlikely that a single intervention could achieve the desired goal. Both pharmacologic strategies, such as steroid pretreatment, and modification of mechanical devices, such as the use of heparin-coated CPB circuits, could have important clinical implications. The balance between pro- and anti-inflammatory responses may be crucial in limiting the extent of inflammatory injury. Conclusions To date, the concept of organ protection should no longer be limited to the individual organ. Instead, investigations must be extended to focus on a systemic level.
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乌司他丁后处理及其联合预处理对体外循环下心脏瓣膜置换术患者心肌细胞凋亡的影响
Objective To evaluate the effects of ulinastatin postconditioning and combination of ulinastatin preconditioning and postconditioning on myocardial apoptosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Eighty New York Heart Association (NYHA) class Ⅱ or Ⅲ patients of both sexes,aged 21-59 years,scheduled for cardiac valve replacement with CPB,were randomly divided into four groups (n =20 each):normal saline control group (group C),ulinastatin preconditioning group (group U1),ulinastatin postconditioning group (group U2) and ulinastatin preconditioning plus postconditioning group (group U3).In group U1,uinastatin 20000 U/kg was infused via the central vein at 500-1000 U·kg-1 · min-1 after endotracheal intubation until 10 minutes before blocking the ascending aorta.In group U2,ulinastatin 10000 U/kg was infused via the aortic root at 4000-5000 U· kg-1 · min-1 at 5-7 minutes before opening the aorta.In group U3,ulinastatin preconditioning and postconditioning were performed as described in groups U1 and U2.In group C,the same volume of normal saline was infused instead of ulinastatin.Blood samples were taken from the radial artery at 10 minutes before blocking the ascending aorta,40 minutes after blocking the ascending aorta,45 minutes after opening the aorta and at the end of operation for determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α) and soluble tumor necrosis factor receptor 1 (sTNF-R1).Myocardial tissues were obtained from the right atrial appendage at 45 minutes after opening the aorta for determination of the expression of TNF-α,bcl-2,bax,caspase-3,and apoptosis.The bcl-2/bax ratio and apoptotic index were calculated.Results Plasma concentrations of TNF-α and sTNF-R1 and the expression of TNF-α,bax,caspase-3 and apoptotic index were lower and the expression of bcl-2 and bcl-2/bax ratio were higher in groups U1,U2 and U3 than in group C and they were lower in group U3 than in groups U1 and U2 (P < 0.05).Conclusion Ulinastatin postconditioning can inhibit myocardial apoptosis in patients undergoing cardiac valve replacement with CPB,and the efficacy of combination of ulinastatin preconditioning and postconditioning is stronger than that of ulinastatin postconditioning.The mechanism is involved in balancing the expression of bax and bcl-2 and down-regulating the expression of TNF-α and its receptor.
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体外循环机在宫外孕手术自体血回输中的临床应用
近年来,随着输血技术的改进,常规的输血工作从理论上、观念上以及技术上都发生着重大的变革.目前临床用血日益增多,血源日趋紧张;另外,异体输血可带来不良反应(如输血反应等)和血源性传染病(如肝炎、艾滋病等),因此,自体血回输越来越受到重视,同时更受到病人、家属、术者的认可和接受.我院于1997年开始,对宫外孕大出血手术病人运用国产体外循环机进行术中血液回输,效果较满意.现报告如下.
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肿瘤坏死因子在体外循环中的研究进展
体外循环(cardiopulmonary bypass,CPB)引起的全身炎症反应的研究是目前国内外心脏外科领域内研究的一个热点问题.
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浅低温体外循环冠脉搭桥手术中病人脑氧合的变化
心肺转流(CPB)体外循环心脏手术病人,术后中枢神经系统并发症高达2%~5%,其发生与脑栓塞及脑氧合失调有关.颈静脉球血氧饱和度可反映脑代谢的变化,常作为一种检测脑氧合平衡的指标[1].因此我们观察了浅低温CPB冠脉搭桥手术中SjvO2及相关指标的变化,以探讨脑氧合的变化规律.
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CPB的冠脉手术病人主要麻醉方法的选择影响术后ICU住院时间
研究背景:挥发性麻醉药在冠脉手术期间可以保护心肌.本研究旨在和全凭静脉麻醉相比较,说明挥发性麻醉药的应用与ICU住院天数和总住院天数(LOS)减少有关.
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体外循环期间全身炎性反应综合征与多脏器损伤关系的研究进展
八十年代初Kirllin[1]提出体外循环(cardiopulmonary bypass,CPB)期间,循环血液中多种细胞成分与非生物相容性的人工材料进行界面接触时可以激活人体内的补体活性颗粒样物质并产生大量氧自由基成分,由这诸多种因素引发全身性炎症反应综合征(systemic inflammatory response syndrome,SIRS),造成组织器官损害。近年来分子免疫研究证实[2],SIRS也是导致全身多脏器功能衰竭的重要因素,在一系列炎性瀑布启动过程中,已知有多种免疫分子参与。就其研究进展综述如下。1 CPB诱发全身炎性反应综合征的病理生理机制1.1 炎性瀑布的激活1.1.1 炎性细胞因子的激活:CPB期间血液内细胞成分与人工材料的持续性接触,使T淋巴细胞、巨噬细胞、血管内皮细胞、纤维母细胞等,受内原性刺激产生旁分泌(paracrine)和自分泌(autocrine)出的小分子(小于80kD)糖蛋白即细胞因子。细胞因子的mRNA分子不稳定,一旦合成即很快分泌出来,转录与激活作用十分短暂,而且呈自限过程。当刺激停止,合成也随即停止。
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体外循环心肌保护的研究近况
传统的体外循环心肌保护是指心脏直视手术中心脏停跳下的心肌保护,即停跳液对心肌的保护.它是体外循环下心脏手术的重要措施之一,心肌保护效果的好坏直接影响到术后心功能的恢复.自从本世纪五十年代提出心脏停搏液技术以来,停搏液的配制、温度和灌注方法均得到很大的改进和完善,本文就这些方面作一综述.
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A metabolic profile of plasma samples from patients undergoing heart surgery with the use of cardiopulmonary bypass (CPB) and concurrent administration of tranexamic acid was determined. Direct immersion solid phase microextraction (DI-SPME), a new sampling and sample preparation tool for metabolomics, was used in this study for the first time to investigate clinical samples. The results showed alteration of diverse compounds involved in different biochemical pathways. The most significant contribution in changes induced by surgery and applied pharmacotherapy was noticed in metabolic profile of lysophospholipids, triacylglycerols, mediators of platelet aggregation, and linoleic acid metabolites. Two cases of individual response to treatment were also reported.