中低温持续逆行灌注心脏手术的临床研究(附200例报告)

目的:评价在中低温持续逆灌心肌保护下行心脏直视手术的临床效果.方法:常规建立体外循环,放置左心引流管,转机后阻断上、下腔静脉,阻断升主动脉并经冠状静脉窦持续逆行灌注氧合机血,不使用心脏停搏液,鼻咽温度降至中低温(26～27℃),心脏自主纤颤下行直视手术,心脏手术完毕复温至36～37℃后即可停机.结果:全组中有108例(54%)自行复跳,其余除颤1次者68例,除颤2次者18例,除颤3次者6例.早期死亡7例,死亡原因为低心排综合征5例,心脏破裂l例,肾功能衰竭1例.其余均治愈出院.结论:中低温持续逆灌法有良好的心肌保护作用,适用于大部分心脏手术.     

主动脉灌注分流逆灌心脏跳动中主动脉瓣置换术的研究

目的 :探讨简化主动脉灌注分流逆灌心脏跳动中主动脉瓣置换术的操作 ,以获得良好的心脏保护效果。方法 :主动脉灌注管接“Y”接头 ,分一条管 (2 0 cm)灌注升主动脉 ;另接一条管 (30 cm )与逆行灌注管相接 ,经冠状静脉窦逆行灌注。升主动脉阻断时便开始逆行灌注 ,不灌注心脏停跳液 ,平均动脉压 (MAP)维持在 5 .5～ 6 .5 k Pa之间 ,鼻咽温度控制在 (32± 1)℃左右 ,放置左房管作左心吸引。结果 :术后应用硝普钠、硝酸甘油控制 MAP维持在 9.5～ 10 .5 k Pa之间 ,多巴胺用量 5 μg/ kg· min- 1以下。本组 86例术后无低心排量综合征和严重心律失常 ,心肌保护效果良好。术后 7d急性肾衰死亡 1例 ,大量渗血输血后肾衰死亡 1例 ,肺部感染死亡 1例 ,住院手术病死率 3.4 8%。结论 :主动脉灌注分流逆灌心脏跳动中主动脉瓣膜置换术 ,能维持逆灌所需的灌注压 ,有良好的心肌保护效果 ,简化了操作程序 ,临床上应用方便。     

冠状静脉窦逆行灌注在夹层动脉瘤手术中的应用

目的 总结15例经冠状静脉窦逆行灌注心肌停搏液体外循环下胸主动脉夹层动脉瘤手术临床经验,探讨改善心肌保护的方法.方法 15例夹层动脉瘤手术其中9例升主动脉+全弓置换+降主动脉支架象鼻术,4例Bentall+全弓置换+降主动脉支架象鼻术,2例Bentall+二尖瓣置换或成形.均经冠状静脉窦逆行灌注心肌停搏液体外循环下手术.结果 无手术死亡,复跳顺利,脱机顺利,术后1例出现肾功能不全,1例出现低心排,经矫正后恢复,均顺利康复.结论 对复杂胸主动脉夹层动脉瘤患者,采用经冠状静脉窦逆行灌注心肌停搏液进行心肌保护,取得良好效果.     

持续心肌逆行灌注下双瓣膜置换加改良迷宫术的临床应用

目的探讨采用中低温体外循环经冠状静脉窦持续逆行灌注自体氧合机血的方法,进行双瓣膜置换术加改良迷宫术的临床效果。方法全组27例均在低温体外循环心内直视下施行手术。鼻咽温度降至中低温（26—27℃）维持,术中阻断升主动脉并经冠状静脉窦持续逆行灌注,通过压力和容量控制的冠状静脉窦灌注氧合机血,不使用心脏停搏液;完成心内主要操作后复温,心脏手术完毕即可停机。结果27例全部存活,术中出血量少,未发生严重的房室传导阻滞及脑栓塞。随访4—26个月,其中22例维持窦性心律,心房颤动复发3例,偶发房扑2例,经服用乙胺碘呋酮后恢复窦性心律。结论中低温体外循环经冠状静脉窦持续逆行灌注下的双瓣膜置换加改良迷宫术操作简单,疗效确切,历时缩短,安全性高。     

低温体外循环心肌逆行灌注下双瓣膜置换术的临床研究

目的:评价浅低温心脏不停跳法及中低温室颤法于冠状静脉窦逆行灌注下双瓣膜置换手术的临床效果.方法:将63例患者分为中低温(26～27℃)室颤性停搏组(31例)及浅低温(32±1)℃心脏不停跳组(32例),常规插管建立体外循环,转机后阻断上、下腔静脉并降温,阻断升主动脉并经冠状静脉窦持续逆行灌注氧合机血,不使用心脏停搏液;于心内直视下行双瓣膜置换手术.结果:浅低温组手术死亡1例,中低温组死亡1例.两组术中转机时间、术后呼吸机辅助时间、强心药物的使用及心律失常的发生情况等在统计学上均无显著差异.结论:浅低温心脏不停跳及中低温室颤性停搏下心内直视手术都具有较好的心肌保护效果,但中低温下手术更有利于心内的操作,对血液的保护效果更优,可推荐成为一种安全、可行的心肌保护方法.     

浅低温心脏不停跳心内直视手术194例临床报告

目的 :探讨心脏不停跳心内直视手术的临床意义和价值。方法 :并行循环 ,阻断上下腔静脉而不阻断升主动脉 ,不使用心脏停搏液 ;逆行灌注者 ,阻断升主动脉后经冠状静脉窦逆行持续灌注机器氧合血 ,鼻咽温维持在 33℃± 1℃ ,在心脏空跳条件下完成心内直视手术。结果 :心脏手术完毕即可停机 ,术后血液动力学平稳 ,多巴胺用量很少。低心排发生率 1 .0 % ,血尿发生率 3.8%。无 1例发生空气栓塞。早期死亡率 2 .5 % (5 / 1 94 )。结论 :心脏不停跳法是一种较接近生理状态的心肌保护方法 ,获得较理想的心肌保护和临床效果 ,可应用于绝大部分心内直视手术     

体外循环心脏直视手术氧合血停跳液灌注心肌保护2834例总结

自 198 9年 1月至 1999年 5月 ,应用氧合血停跳灌注行心肌保护 2 834例 ,男性 16 2 7例 ,女性 12 0 7例 ;年龄 7天～ 74岁 ,体重 3～ 91kg;体外循环时间 2 3～ 6 47m in,主动脉阻断时间 12～ 30 1m in,转流温度2 4～ 32℃ ,一些主动脉瘤患者温度降至 2 0℃以下。氧合血灌注量 50～ 30 0 0 m l。灌注方法 :冠状静脉窦逆行灌注 56例 ,持续温血灌注 2 5例 ,持续冷血灌注 30例 ,持续不停跳温血灌注 3例 ,余均为间断冷血停跳液灌注。开放升主动脉钳夹后 ,心脏自动恢复心律者 2 4 4 6例 ,自复率 87% ,手术死亡 117例 ,死亡率 4 %。转流中尿量50～ 12 0 0 m l,平均 ( 382 .35± 2 85.4 7) m l。氧合血停跳液灌注应根据不同病情、手术需要以及操作人员的熟练程度 ,采用不同方法 ,以达最佳保护效果。     

心脏瓣膜病合并冠心病的外科治疗

目的 通过１例手术的体会结合复习文献，探讨心脏瓣膜病合并冠心病的外科治疗。方法 手术在低温体外循环下进行，冷停搏液灌注心脏停搏后改用冠状静脉窦温氧合血持续逆行灌注。病变主动脉瓣切除后替换人工心瓣膜。采用大隐静脉作为移植物行主动脉冠状动脉搭桥。结果 本例术后恢复顺利，效果良好。结论 心脏瓣膜病合并冠心病术前明确诊断非常重要，同时行瓣膜置换及搭桥术效果良好，但应注意手术方法、心肌保护及药物的应用。     

冠状静脉窦逆行灌注心肌保护方法在重症瓣膜置换术中的应用

目的总结我院重症瓣膜置换术中应用顺灌加逆灌心肌保护方法的临床效果。方法 10例重症瓣膜置换患者,常规建立体外循环,升主动脉阻断后首先从主动脉根部或左、右冠脉开口顺行灌注心脏停跳液,心脏停跳效果不满意,加经冠状静脉窦逆行灌注心脏停跳液。结果心脏跳动停止后开放升主动脉后自动复跳率90%,术后均无低心排发生。结论经主动脉根部或左、右冠状动脉开口顺行灌注心脏停跳液,心肌保护效果不好时,可加经冠状静脉窦逆行灌注心脏停跳液行心肌保护,取得良好效果。     

中低温不阻断心肌血流在法乐四联症根治术中的应用(附22例报告)

目的评价法乐四联症(TOF)根治术中采用中低温体外循环(CPB)不阻断心肌血流心肌保护方法的临床效果。方法常规建立CPB,放置左心引流管,转机后阻断上、下腔静脉,阻断升主动脉并经冠状静脉窦持续逆行灌注氧合机血,不使用心脏停搏液,鼻咽温度降至中低温(26℃～27℃)后在心脏自主纤颤下行心内直视手术,经右室流出道及(或)主肺动脉切口,术中行右室流出道疏通,补片修补室间隔缺损(VSD),补片加宽右室流出道,必要时跨环补片,心脏手术完毕复温至36℃～37℃后即可停机。结果全部手术均无死亡,无低心排综合征(LOS)及严重心律失常发生。结论中低温室颤性停搏下行TOF根治术具有良好的心肌保护效果,有利于心内手术的操作,减少手术负损伤。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…