先心病术后早期外周血管阻力变化及其影响因素

目的 探索先心病术后早期外周血管阻力（SVR）变化情况及其影响因素。 方法 随机连续纳入2020年10月～2020年12月中国医学科学院阜外医院小儿外科术后恢复室接诊患儿,共纳入80例,分为非体外循环组19例,体外循环组61例。为更好的研究SVR在不同疾病中的情况,体外循环组分为非紫绀型先心病组（40例）及紫绀型组（21例）两个亚组。记录返回PICU即刻的SVR等血流动力学参数及相关术前术中数据等,总结分析SVR情况及其影响因素。 结果 与非体外循环组相比较,体外循环组的体质量、身高、术前血氧饱和度、术后血氧饱和度的数值均下降（均P<0.05）;与非紫绀型先心病组相比较,紫绀型先心病组术前的血氧饱和度下降、术后血氧饱和度下降、CPB时间增加、术后LVEF值下降（均P<0.05）。体外循环组患儿术后SVRI较非体外循环组患儿明显减低[（1357±299 ）vs. （1129±330）,P<0.01],进一步比较体外循环各亚组与非体外循环组的SVRI,非紫绀型先心病患儿术后SVRI较非体外循环组无明显差异,而紫绀型先心病术后患儿SVRI明显减低(P<0.01)。体外循环组组内比较,紫绀型先心病患儿术后SVRI较非紫绀型患儿显著减低(P<0.01),同时紫绀型先心病患儿术后CI较非紫绀型患儿显著升高(P<0.01),紫绀组患儿术后SVV虽较非紫绀型患儿升高,但没有明显统计学差异。回归分析示术后SVRI与体质量呈正相关（r=25.079,P<0.05）,与体外循环时间呈负相关（r=?2.831,P<0.05）。 结论 非紫绀型先天性心脏病术后外周血管阻力可维持基本正常水平,紫绀型先心病患儿术后外周血管阻力会明显下降,甚至可能会增加发生血管麻痹综合征的风险。体外循环术后患儿SVRI主要受体质量和体外循环时间影响,体质量越低、体外循环时间越长,术后其外周血管阻力可能会越低。     

先天性心脏病患儿体外循环心内直视术后的丙型肝炎初查(摘要)

先天性心脏病患儿体外循环心内直视术后的丙型肝炎初查（摘要）陈莹黄惠民缪慧萍沈霞胡洁⒇先天性心脏病患儿在体外循环心内直视术中，由于失血、出血过多，往往需要多次输血，致使输血后肝炎发病率明显增加。近年来发现，输血后肝炎中，丙型肝炎占８０％～９０％，而国内...     

先天性心脏病相关肺动脉高压患儿术后急性肾损伤影响因素分析

目的 探讨先天性心脏病相关肺动脉高压（congenital heart disease associated with pulmonary arterial hypertension, CHD-PAH）患儿在体外循环术后早期发生急性肾损伤（acute kidney injury, AKI）的影响因素。 方法 2016年6月至2020年12月于我科在体外循环（cardiopulmonary bypass, CPB）下行心脏手术的3岁以下患儿,所有患儿均诊断为CHD-PAH,共纳入299例患儿,根据术后是否发生AKI分为AKI组（n=62）和非AKI组(n=237),收集围术期资料进行统计学分析。 结果 单因素Logistic回归分析结果显示包括年龄、身高、体质量、肺部感染、术前血清肌酐SCr值、术中CPB时间、主动脉阻闭时间（aortic occlusion time, ACT）、CHD 手术风险调整-1评分与术后AKI发生密切相关（P<0.05）,多因素Logistic回归分析结果显示年龄、术前肺部感染、术前SCr值、ACT是AKI发生的独立危险因素（P<0.05）;AKI组患儿术后并发症包括二次插管、肾脏替代治疗和血液感染明显高于 非AKI组（P<0.05）,术后机械通气时间、ICU停留时间、总住院时间明显延长和死亡率明显增高（P<0.05）。 结论 低年龄、术前低SCr值、术前存在肺部感染和长ACT是术后AKI发生的独立危险因素,对高危人群制定积极预防措施,可能是减少术后AKI发生,改善临床预后的有效途径。     

婴幼儿体外循环后V—AMUF与A—VMUF的应用比较

目的 比较婴幼儿体外循环后静脉-动脉方向改良超滤（V—AMUF）与动脉-静脉方向改良超滤（A．VMUF）的临床应用效果。方法将40例先天性心脏病（先心病）患儿随机分成对照组和实验组,各20例。对照组体外循环后应用A．VMUF;实验组体外循环后应用V—AMUF,观察患儿的鼻咽温（T）、动脉收缩压、红细胞压积（HCT）、血浆白蛋白、炎症介质浓度、超滤时间、肺功能以及术后恢复情况。结果与对照组比较,实验组超滤期间T、动脉收缩压稳定,超滤结束后血浆肿瘤坏死因子（TNF）水平下降,肺功能损害减轻,患儿术后恢复时间缩短（P均〈0．05）;超滤结束时两组血浆IL-5水平均下降,两组比较,P〉0．05;两组超滤结束后较转流结束时HCT和白蛋白浓度均明显升高,两组比较,P〉0．05;实验组超滤速度快于对照组,超滤时间和手术时间较对照组缩短（P均〈0．05）。结论相对A．VMUF而言,体外循环后采用V—AMUF,可快速地浓缩血液,排除部分炎症介质,缩短手术时间,有利于患儿T、动脉收缩压的稳定,减轻重要脏器组织水肿和损伤,促进术后恢复,提高手术治疗效果。     

热休克蛋白72和诱导型一氧化氮合酶基因在体外循环术前后先天性心脏病患儿心肌的表达及其作用

目的研究热休克蛋白72(HSP72)和诱导型一氧化氮合酶(iNOS)在慢性缺氧型及非缺氧型先天性心脏病患儿体外循环术(CPB)前后的表达及其相关性;探讨HSP72和一氧化氮(NO)对缺血缺氧心肌的作用。方法在已确诊先天性心脏病(房间隔缺损、室间隔缺损、法洛四联症)住院患儿中,随机抽取18例分为慢性缺氧组[动脉氧饱和度(SaO2)<85%]及非缺氧组(SaO2>95%),每组9例。两组分别于CPB中主动脉交叉钳夹(ACC)前、CPB结束时收集患儿心肌标本保存在液氮中。试验采用半定量逆转录聚合酶链式反应(RT-PCR)技术测定心肌细胞中HSP72和iNOSmRNA的相对含量,比较两组心肌CPB前后HSP72和iNOSmRNA水平,并分析其临床意义。结果①与CPB术前相比,非缺氧组及慢性缺氧组HSP72mRNA水平均明显增高(P<0.05);CPB术前及术后,慢性缺氧组HSP72mRNA水平均明显高于非缺氧组(P<0.05)。②与CPB前相比,非缺氧组iNOSmRNA水平明显增高(P<0.05),而慢性缺氧组iNOSmRNA水平无明显变化(P=0.795);CPB术前及术后,慢性缺氧组iNOSmRNA水平均明显高于非缺氧组(P<0.05)。结论缺血应激上调了非缺氧型先天性心脏病患儿心肌组织HSP72、iNOS及慢性缺氧型先天性心脏病患儿心肌组织HSP72的基因表达,慢性缺氧应激也上调了慢性缺氧型先天性心脏病患儿心肌组织HSP72、iNOS的基因     

异氟醚预处理对婴幼儿体外循环后心肌的保护作用

目的观察异氟醚预处理对体外循环下婴幼儿心内直视手术心肌的保护作用。方法将100例先天性心脏病患儿,随机分为预处理组和对照组,观察两组转机时间、主动脉阻断时间、心脏复跳情况、循环情况。分别于麻醉后、体外循环主动脉开放后15min、4h、24h时间点取血样,检测血清降钙素基因相关肽（CGRP）、内皮素（ET）、心房钠尿肽（ANP）、心肌钙蛋白（cTnI）的变化。结果两组转机时间、主动脉阻断时间、开放至复跳时间无显著差异,预处理组的自动复跳率、复跳后低血压发生率及术后24h低血压发生率均优于对照组（P<0.05）。主动脉开放15min后,CGRP和ANP在两组患者均显著增高（P<0.01）,但预处理组明显高于对照组（P<0.05）;ET和cTnI在主动脉开放后也显著上升（P<0.01）,但预处理组上升幅度明显低于对照组（P<0.05）。结论异氟醚预处理能减少心肌的缺血/再灌注损伤,促进体外循环后心功能恢复。     

经皮内镜下胃造瘘联合肠内营养剂、冰刺激治疗吞咽障碍的疗效分析

目的分析经皮内镜下胃造瘘联合肠内营养、冰刺激在吞咽障碍患者中的疗效。方法选取2017年2月至2019年2月首都医科大学附属北京康复医院收治的吞咽障碍患者68例,以随机数表法分为对照组与试验组,各34例。对照组患者予以鼻胃管喂养联合肠内营养剂、冰刺激治疗;试验组患者予以经皮内镜下胃造瘘联合肠内营养剂、冰刺激治疗。对比治疗前后吞咽功能评分、营养指标、生活质量及并发症发生率。结果治疗前后组间吞咽功能评定量表(SSA)评分均相近(P>0.05);治疗后两组的SSA评分均显著降低(P<0.05)。治疗后两组的血清前白蛋白(PA)、血清白蛋白(ALB)、体质量指数(BMI)均显著增加(P<0.05),且试验组均显著高于对照组(P<0.05)。治疗后两组的生活质量评分(SWAL-QOL)均显著增加(P<0.05),且试验组均显著高于对照组(P<0.05)。试验组的总并发症发生率为5.5%,显著低于对照组的26.5%(P<0.05)。结论经皮内镜下胃造瘘联合肠内营养剂、冰刺激对吞咽障碍患者吞咽功能的疗效与鼻胃管喂养联合肠内营养剂、冰刺激治疗相近,但可有效提高患者的生活质量,并降低并发症发生率。     

体外循环实施万汶预充策略对婴幼儿心脏术后凝血功能及临床转归的影响

摘要 目的：体外循环期间采用人工胶体万汶的预充策略对婴幼儿术后凝血功能及临床转归的影响，评价其能否安全用于婴幼儿，为临床节约血浆提供依据。方法：2017年2月至2017年5月，择期行先天性心脏病矫治术患儿80例。随机将患儿分为血浆组和万汶组，各40例。统计两组患儿性别，年龄，体重，病种，手术切口方式及术前术凝血功能7项检测；术前、术后血浆胶体渗透压；术前、术中、改良超滤后、出院红细胞压积；术前、术后血小板计数；术前、术后的血栓弹力图参数；术后24h引流量，呼吸机使用时间、监护室逗留时间、住院时间、术后血浆使用率、术后血红细胞使用率、术后凝血酶原复合物使用率。结果：两组患儿均痊愈出院。两组患儿24小时胸引量（ml）、术后红细胞使用率（%）、术后血浆使用率（%）、术后血浆使用量（ml）、呼吸机使用时间（h）、凝血酶原复合物使用率（%）、监护室逗留时间（h）、住院时间（d）比较无统计学差异（P>0.05）。两组患儿术前胶体渗透压、术后胶体渗透压组间比较均无统计学差异（P>0.05）。两组患儿术后凝血反应时间（R）、血块形成时间（K）、图像开口夹角（Angle）、最大振幅（MA）、凝血综合指数（CI）与术前比较有统计学差异（P<0.05）。组间比较无统计学差异（P>0.05）。两组患儿术前、术后的血小板（plt）组间、组内比较均无无统计学差异（P>0.05）。两组患儿术中血浆使用量、术中万汶使用量组间比较有统计学差异（P<0.05）。结论：采用万汶替代血浆用于婴幼儿体外循环预充后对术后凝血功能未产生显著不利影响，对临床转归无明显影响，未增加患儿术后并发症。婴幼儿先心病手术中万汶可安全用于体外循环预充。     

新生儿心脏术后合并毛细血管渗漏综合征一例

新生儿先天性心脏病围术期特点不同于其它年龄段,易出现特殊并发症,并可因忽视而影响预后。本例患儿术后合并毛细血管渗漏综合征,抢救治疗成功。报道如下：l临床资料男性,出生后第4天经多普勒超声心动图检查诊断为“法乐三联症,动脉导管未闭”。第6天在低温及体外循环下行根治手术。术前体重s．vkg,术中转机68分钟,体外循环总液量815ml（其中预充全血400ml,白蛋白10s）,术后平均动脉压45mmHg（lmmHg—0·133kPa）。返回小儿术后恢复室时,患儿头面部及全身水肿,并逐渐加重,指压痕（＋＋＋）。X线胸片：两肺野呈渗出性改变。术…     

外源性磷酸肌酸对儿童围术期的心肌保护作用

目的探讨外源性磷酸肌酸（CP）对先天性心脏病患儿体外循环下（CPB）开胸术中心肌保护及术后心肌恢复的作用。方法将63例先天性心脏病患儿随机分为A、B和C组3组,每组21例,心肌灌注液均采用等量含血STH2液,B、C组术中心肌灌注液中加入外源性CP,术后均采用常规极化液治疗,C组术后静脉加用CP。监测术后即刻至术后5 d心肌酶的变化趋势。结果手术结束时血中心肌酶水平明显升高,B、C组间无差异,均明显低于A组（P〈0.05）;术后C组心肌酶水平恢复最快,A组最慢,各组间有统计学差异（P〈0.05）。结论先天性心脏病患者围术期应用CP具有保护心肌和加快损伤心肌修复的作用。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.