心外膜脂肪组织厚度对冠状动脉搭桥术后患者预后的预测价值

目的探讨心外膜脂肪组织厚度对冠状动脉搭桥术后患者预后的预测价值。方法采用回顾性分析,纳入2016年4月至2019年3月于首都医科大学附属北京同仁医院行冠状动脉搭桥术的76例患者的临床资料,术后随访3个月,根据不良事件发生情况分为预后不良组7例和预后良好组69例。收集基线资料及相关实验室检查指标,应用超声测量患者的心外膜脂肪组织厚度,绘制受试者工作曲线评估心外膜脂肪组织厚度对冠状动脉搭桥术后患者预后的预测价值。结果术后3个月随访时出现不良事件7例,发生率为9.21%。两组患者美国纽约心脏病学会(NYHA)分级、心外膜脂肪组织厚度、血管狭窄数目、糖化血红蛋白和尿酸水平差异均有显著性(P<0.05)。logistic多因素回归分析结果显示入院时NYHA分级较高、血管狭窄数目较多和心外膜脂肪组织厚度较高均是冠状动脉搭桥术后患者预后不良的独立危险因素;绘制受试者工作特征曲线分析结果显示曲线下的面积为0.658,95%CI为0.536~0.779,P=0.017,最佳临界值为7.32mm,其预测冠心病患者冠状动脉搭桥术后预后不良灵敏度为65.9%,特异性为58.8%。结论心外膜脂肪组织厚度增高是冠心病患者冠状动脉搭桥术后不良事件发生的独立危险因素,具有一定的预测价值。     

深低温停循环时不同脑保护方法对猪大脑组织含水率的影响

目的:观察试验用小型猪脑海马头部组织含水率,揭示深低温停循环时不同脑保护方法对脑水肿的影响。方法:①实验于1998-10/2000-02在解放军总医院动物实验中心完成。选用北京农业大学实验用小型猪16头。随机将猪分为4组:深低温停循环组,顺行脑灌注组,逆行脑灌注组,逆行脑灌注+尼莫地平组,每组4头。②鼻咽温降至18℃时分别给予如下处理90min:深低温停循环组通过上、下腔静脉放血至氧合器的静脉储血罐,冰袋敷头;顺行脑灌注组阻断降主动脉,通过主动脉弓灌注头臂三支血管,维持灌注压在50mmHg(1mmHg=0.133kPa)左右;逆行脑灌注组阻断降主动脉,结扎奇静脉,通过上腔静脉逆行灌注,维持灌注压在25mmHg左右;逆行脑灌注+尼莫地平组在体外循环开始10min内经氧合器的标本口加入尼莫地平注射液,其他操作同顺行脑灌注组。③复温120min至鼻咽温36℃。取左侧海马头部组织称湿质量,于110℃烘箱内干燥24h,测干质量,计算组织含水率。④多组比较采用单因素完全随机设计方差分析。结果:小型猪16只均进入结果分析。大脑组织含水率:逆行脑灌注组明显高于深低温停循环组、顺行脑灌注组和逆行脑灌注+尼莫地平组[(83.60±0.68)%,(81.52±1.16)%,(81.04±0.59)%,(80.92±0.74)%,F=9.22,P=0.0019],而深低温停循环组、顺行脑灌注组、逆行脑灌注+尼莫地平组间差异不明显(P>0.05)。结论:①逆行脑灌注加重深低温停循环后的脑水肿,脑水肿可能是深低温停循环后神经功能障碍的一原因。②尼莫地平在深低温停循环时有降低逆行脑灌注引起的脑水肿的作用。     

体外循环前后胎盘生长因子及其受体的变化

目的:观察体外循环(CPB)下心脏手术中心肌组织胎盘生长因子(PlGF)及其受体(Flt-1)蛋白表达与血浆浓度变化。方法:于CPB开始及CPB结束即刻取右房组织,应用免疫组织化学法检测PlGF和Flt-1蛋白表达。于麻醉后、主动脉阻断即刻、主动脉开放后10min,术后2h、4h、24h、3d采血,ELISA法检测血浆PlGF和Flt-1的浓度。结果:CPB前后心肌均有PlGF和Flt-1蛋白表达,其表达主要位于心肌细胞,CPB后表达明显增强(P<0.05)。其血浆蛋白浓度在CPB中明显升高,主动脉阻断即刻及主动脉开放后10min明显高于其他各点(P<0.05),而2点间差异无统计学意义(P>0.05),PlGF峰值出现在主动脉阻断即刻,Flt-1峰值出现在主动脉开放后10min。回到ICU后2h即降至麻醉后水平。血浆峰值浓度与心肌蛋白表达强度无明显相关性。结论:CPB下心脏手术导致心肌PlGF和Flt-1蛋白表达增强,血浆浓度短暂升高。CPB可能是导致血浆浓度升高的主要原因,心脏的缺血再灌注不是产生它们的主要原因,心肌不是其主要来源。     

替奈普酶的纤溶特性及临床应用评价

有关纤溶治疗的历史可追溯到1933年,当时发现溶血性链球菌肉汤培养基的滤出液可溶解纤维血凝块,其后链激酶开始用于纤维性胸膜渗出液、胸腔积血等,     

高功率CO2激光心肌打孔机的研制及临床应用

目的：研制用于激光心肌打孔血运重建术（TMLR）的高功率CO2激光治疗仪，并对其生物学效应及临床应用效果进行评价。方法：采用激光合成方法研制产生大功率CO2激光的心脏打孔机，分别在有机玻璃块，犬离体心脏和活体心肌缺血模型上进行激光心肌打孔实验，以检验合成光束的生物物理特性，选择安全有效的激光心肌打孔参数。在此基础上，使用该仪器为65例冠心病病人行TMLR手术并观察效果。结果：在有机玻璃和离体猪心打孔显示孔道孔径，深度可以满足TMLR的使用要求，使用该仪器在犬缺血心肌打孔形成透壁孔道，1周年镜下可见孔道通畅，65例接受TMLR手术患者，3例分别于术后第3天、第4天及第8天因呼吸衰竭、心力衰竭及心律失常死亡，其余病人均顺利院，随访6－30个月，50例患者心绞痛明显减轻，其中37例较术前减少2级，15例减少1级，7例变化不明显，失访5例，26例术后行心肌放射性核素断层扫描，有21例心肌的孔区域的血流灌注比前术前明显增加。结论：合成高功率CO2心脏激光打孔机治疗仪在TMLR的动物实验及临床应用中安全有效。     

保留冠状动脉的猪心螺旋形心室肌带的解剖

Objective Based on the Helical Ventricular Myocardial Band (HVMB) theory proposed by Torrent-Guasp,the ventricular myocardial hand extends from the root of the pulmonary artery to the root of the aorta with two helical coils.This new theory is considered as a revolutionary concept for further understanding the global, three-dimensional and functional architecture of the ven- tricular myocardium. No repot had described techniques for disecting HVMB while keepin～ the integrity of the coronmy artery sys- tern. We explored techniques for dissecting HVMB in swine.Methads 33 fresh swine hearts were randomly divided intoll groups, 3 bearts in each. 160% barium sulfate (type I)suspmmion was injected into the coronary artery system. The coronary arteries were li- gated. The strial tissue was removed following puuing the hearts in boiling water then cooling for several hours. The superficial coro- nary vessels and fat tissue around the atrio-ventricular taxi inter-ventricular sulcus we～'e preserved. Some branches of the left anterior descending artery, distal segment, of posterior descending branch, and middle and distal segment of obtuse marginal branches were mu- tilated appropriately. HVMB dissection was completed with fingers in accordnce with Torrent Guasp' s technique. Results A contin- ued bundle of muscle, originated at the root of pulmonary artery and ended at the root of aorta, was unwrapped along the major dire- tion of the cardiac muscle fiber in all of the 33 hearts with spating of the coronary artery. The swine hearts' ventricular myocandium was cumosed of two loops, with basal loop firm the root of the pulmonart artery to the anterior papillary muscle and apical from the beginning of the anterior papillary muscle to the root tithe aorta. Each loop consisted of two segments: the right segment-coincid- ing with the right ventricular free wall and the left segment-coinciding with the basal d the left ventricular free wall. Posterior papillary muscle, which belongs to the descendant segment, denmrcated the border between the descendent and the ascendant of the HVMB's apical loop. Conclusion Although controversies about the theory of the HVMB remain, we have dissected the HVMB in the swine hearts' ventricular myocardium successfully with sparing of the coronary artery systems. This dissection procedure provides technical information for the studies of associated diseases based on the theory of HVMB.     

表达谱基因芯片筛选体外循环前后心肌细胞因子的变化

Objestive Systemic inflarmmation may be triggered by injury, hypothermia, ischemia-reperfusion and the contact of the blood with foreign body during cardiopulmonary bypass (CPB). To determine the application values of gene chip technique in the clinical practice and the study of cardiovascular stagery, as well as to provide clues to the study of inflammatory responess during CPB, microarry for gene expression profiles was used to identify the differences in the gene expression of myocardium between pre-and post- CPB. Methods Six adult patients who underwent CPB from March to May in 2003 were involved. Samples of right atrium were col- lected before and at immediate end of CPB. BD AtlasTM cDNA Expression Arrays was used to identify the differences in the gene ex- pression of cytokines. The results were compared with that of semi-quantative RT-PCR. Resellts The mean age of 6 patients (5 males and 1 female) was (32.67± 11.72) years. The baseline heart function was gradeⅡin 3 cases and grade Ⅲ in 3 other cases. The baseline left ventricular ejection fraction(LVEF)was (58.17±7.91)%. The mere duration was (91.67±43.88) minutes for CPB and was (58.67±43.46) minutes for aorta blocking. The minimum nasopharynx/rectal temperture was (29.37±1.90)℃/ (32.15±1.52)℃. Gene expression profiles of cytokines in the myocardium pre- and post-CPB were analysed successfully. The ex- pression of IL-6, IFN-γ,Wnt5a, TNFRSF1B, a member of tumor necrosis factor receptor superfamily, PIGF and MFNG in the myo- cardium were unpregulated after CPB. Conclusion Microarray technique is applicable in the study of cytokines changes dying CPB. cDNA microarray identified pleliminarily the differences in the gene expression between pre- and post-CPB. These genes may be in- valved in inflammation and other psthophysiological responses incuced by CPB. The myocardiym is probably one of the major sources of cytokines during CPB. Further study may be helpful in understanding the llngthe development of inflammation during CPB, and eventually, reducing the post-operative complications.     

P波离散度在心血管疾病中的研究现状

心房颤动是最常见的房性心律失常之一,不仅好发于心脏病患者,而且随着年龄增长,正常人群房颤的发病率也呈增多趋势。P波离散度是近年提出的一种预测房颤和房性心律失常的无创性心电检查方法,是心房非均质性电活动的标志,它的增加与心房颤动的发生和复发相关。测量P波离散度,尤其是将P波离散度与P波最大时限结合观察,对心房颤动的预测具有很高价值。     

重组尿激酶原治疗急性心肌梗死的疗效和安全性评价

目的研究尿激酶原(Pro-UK)对急性ST段抬高心肌梗死患者溶栓的疗效和安全性。方法随机选择2003-02~2004-03间于首都医科大学附属北京同仁医院住院的急性ST段抬高心肌梗死发病6h以内患者,分别给予Pro-UK或尿激酶(UK)。观察主要疗效和安全性指标。结果共入组26例患者,Pro-UK溶栓患者16例,UK溶栓患者10例。溶栓后90min冠脉造影心肌梗死溶栓(TIMI)3级血流率分别为:56·25%(9/16)和70%(7/10)(P=0·683),其中Pro-UK50mg为66·7%(4/6),60mg为75%(3/4);TIMI2/3级血流率分别为:56·25%(9/16)和80%(8/10)(P=0·399)。各种安全性指标两组差异均无显著性。Pro-UK组纤维蛋白原水平较UK组显著高,提示Pro-UK具有高的纤维蛋白特异性。结论Pro-UK溶栓治疗50~60mg安全有效,有待于进一步研究。     

60岁以上患者心脏瓣膜置换术98例临床分析

目的 总结98例老年心脏瓣膜置换术患者的早期临床结果及特点.方法 选择我院2001年1月至2010年12月60岁以上行瓣膜置换术者98例,其中单瓣置换87例(二尖瓣置换58例,主动脉瓣置换29例)、双瓣置换11例,及同期行冠状动脉旁路移植术41例,左室室壁瘤手术2例.对其临床资料进行总结,分析近年老年瓣膜置换的特点.结果 本组共置换心脏瓣膜109枚,其中机械瓣39枚,生物瓣70枚.主动脉内球囊反搏置入5例.院内死亡4例(4.08％),左室破裂1例,室颤1例,出血二次开胸后继发多器官功能衰竭2例.2例(2.04％)病重自动出院,其余痊愈出院.术后早期16例(16.33％)发生并发症,包括精神神经系统并发症2例、二次开胸止血6例、低心排7例、二次插管1例、气管切开2例、严重心律失常1例、切口感染延迟愈合2例、肾功能不全6例及心包大量积液1例.结论 60岁以上瓣膜病患者多合并其他疾病,且术后并发症较多,生物瓣应用逐渐增多,同期行冠状动脉旁路移植术较多,完善的术前检查、充分准备可获得良好的疗效.