儿茶酚胺的临床检测研究进展

儿茶酚胺与部分神经内分泌肿瘤有着密切关系。因此，儿茶酚胺的临床检测对上述疾病的早期预测及后期监测具有重要价值。现有多种检测儿茶酚胺的方法，但因生物样品中儿茶酚胺含量极微、易氧化且存在内源性干扰物，临床上尚缺乏标准化的检测方法。该文简要概述目前儿茶酚胺的检测方法及其优缺点，为儿茶酚胺的临床检测提供一定的参考价值。     

Bleeding from thermistor connector indicates entrapment of pulmonary artery catheter

Several complications of insertion and use of pulmonary artery catheter (PAC), including catheter entrapment, are recognized during or after cardiac surgery. Early detection is very important. We report a case of PAC entrapment because the the catheter was accidentally sutured to the superior vena cava. Bleeding from the thermistor connector was initially detected after surgery because the needle punctured the lumen of thermistor connector. The PAC was removed through re-exploration. Therefore, bleeding from the thermistor connector could early indicate the PAC entrapment. We suggest that abnormal bleeding from the non-injectate lumen ports of PAC should be checked before sternal closure.     

Surgical incision in complete video-assisted mitral valve replacement

Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon's technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision: midclavicular group(M group,n = 50) and parasternal group(P group, n = 30). The clinical data were recorded including: cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow(M Group vs. P Group): cardiopulmonary bypass time(90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 0.05), aortic clamping time(65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 0.05),1st day volume of thoracic drainage after operation 1(75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 0.05), ICU tracheal intubation time(9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 0.05), postoperative days of hospital stay(7.3 ± 2.2 vs. 6.9± 3.2 days, P 0.05). T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.     

主动脉手术后非感染性发热的临床研究

目的研究主动脉手术后非感染性发热的发生率、临床过程、危险因素及其对患者转归的影响。方法回顾性研究2006年1月至2008年1月期间因主动脉瘤或主动脉夹层在北京阜外心血管病医院行手术治疗549例患者的临床资料,在排除术前或术后明确合并感染者、术前发热者(口腔温度≥38℃)、急诊手术者、非发热相关原因死亡者及病历资料不全者后,将最终入选的463例患者按照术后是否发热分为发热组(345例,非感染性发热,最高口温38.0～39.3℃)和无发热组(118例,术后无发热);对两组患者的一般资料、手术资料和术后情况等进行组间比较;对P≤0.001的指标行多元logistic回归分析,以寻找影响术后非感染性发热的预测指标。结果主动脉手术后有74.5%(345/463)的患者出现非感染性发热。手术结束当天和术后第1 d发热组患者最低日体温高于无发热组(P=0.000,0.000);手术结束当天、术后第1 d、2 d、3 d和4 d,发热组患者的最高日体温均高于无发热组(P=0.000,0.000,0.000,0.047,0.018)。单变量分析结果:体重(P=0.000)、手术类型(P=0.000)、术中膀胱温度最低值(P=0.000)、ICU口温(P=0.000)和输血(P=0.000)均为影响术后发热的危险因子;多元logistic回归分析结果:胸主动脉和胸腹主动脉手术(比值比:4.861;95%的可信区间:3.029,5.801;P=0.004),较低的术中膀胱温度最低值(比值比:1.117;95%的可信区间:1.013,1.244;P=0.040)和较高的ICU初始口温(比值比:2.570;95%的可信区间:1.280,5.182;P=0.008)均是术后非感染性发热的预测因子。结论主动脉手术后非感染性发热十分常见,手术部位(胸主动脉或胸腹主动脉)、术中低核心体温及术后短期内体温升高可能是主动脉手术后非感染性发热的危险因素。     

高频超声心动图评价心梗小鼠左室整体功能和节段性室壁运动异常

目的 通过建立小鼠心梗模型,探讨应用超高分辨率超声系统评价心梗小鼠心脏结构及心功能方面的应用价值.方法 25只雄性C57BL/6小鼠随机分为2组,即开胸结扎左冠状动脉前降支建立心梗模型组(n=15)和仅在相同结扎位置穿针,不结扎的方法建立假手术组(n=10).术前3 d和术后1周采用二维、M型、脉冲多普勒(PWD)、组织多普勒(TDI)和EKVTM超声技术对心梗小鼠心脏形态结构、室壁运动以及心功能进行评价.术后1周,取小鼠心脏进行HE染色并观察心肌组织结构.结果 二维超声与HE色染均显示,心梗模型组心肌有明显的梗死区;心梗模型组与假手术组比较,心室明显扩大,室壁明显变薄,心室收缩功能与舒张功能均显著下降(P<0.05);局部室壁运动受阻严重,心室发生重构.结论 采用2D超声心动图联合M型、PWD、TDI以及EKVTM超声心动图观察小鼠心梗模型能够更精准敏感地判断心肌梗死位置和梗死程度,为临床心肌梗死诊断、治疗和预后评估提供了参考价值.     

七氟烷缺血后处理对离体大鼠心肌细胞的保护作用

目的观察七氟烷缺血后处理对离体大鼠心肌细胞凋亡的影响。方法20只♂Wistar大鼠随机分为缺血对照组(A组)和七氟烷缺血后处理组(B组),每组10例。两组离体鼠心均用Langendorff离体心脏灌注模型,以改良Kreb-Henseleit液灌流平衡20min后,停灌40min,再灌注60min。B组在复灌时以平衡有1.0Mac的七氟烷灌注液灌注15min。以Powerlab Chart 5软件动态监测左室展压(LVDP)、左室压力变化最大速率(±dp/dtmax),心率(HR)。计量平衡20min、复灌15min和复灌60min的冠状动脉灌注流量(CF)。以2,3,5-氯三苯四唑染色(TTC)染色心肌切片,并以Image J 1.37软件计算心肌梗死面积。TUNEL法检测染色凋亡细胞,尼康高倍光学显微镜(Nikon Eclipse,E400,日本)视野拍照并存档,以Leica Qwin Plus V3软件分析,计算凋亡指数(AI)。结果和A组比,B组复灌后的LVDP、±dp/dtmax、CF和HR均明显升高(P<0.05);B组复灌后心梗面积明显减小且AI明显降低(P<0.05)。和基础值比,复灌15min以及复灌60min的LVDP、±dp/dtmax、CF和HR均显著降低(P<0.05)。结论七氟烷缺血后处理抑制离体大鼠心肌的细胞凋亡,提示对缺血再灌注(I/R)心肌具有心肌保护作用。     

血液稀释对脑氧供需平衡的影响研究进展

血液稀释已是患者围术期循环管理与血液保护的重要组成部分,但是它也有着不可忽视的问题:脑氧供需的平衡.血液稀释后可造成急性稀释性贫血,虽然通过增加脑血量、脑氧摄取率可以维持基本的脑氧需求,但是在一些特殊手术,如颅脑手术、心脏手术中,血液稀释的代偿机制会受到一定的影响,并且在这些手术中,患者大脑所面临的的缺氧风险也较普通手...     

Transesophageal echocardiography as a quality control tool in thoracoscopic cardiac surgery:4-years' experience

Background The utilization value of intraoperative transesophageal echocardiography in cardiac surgery is more and more important. However,the role of intraoperative transesophageal echocardiography on quality control during thoracoscopic cardiac surgery has not been comprehensively studied. Methods A retrospective study of transesophageal echocardiography application on patients underwent thoracoscopic cardiac surgery from2012 to 2015 was conducted in a single cardiovascular center. General anesthesia and peripheral cardiopulmonary bypass were standardized for all patients. All procedures were performed through 3 holes made in the right chest wall. Transesophageal echocardiography monitoring was routinely utilized in each patient. Results A total of 1387 patients underwent thoracoscopic cardiac surgery were involved in the study. The mean age of patients was 42.8±15.3 years with a female predominance(60.6%). The most common procedures were mitral valve replacement(n=507,36.6%),atrial septal defect repair(n=425,30.6%),and mitral valve plasty(n=294,21.2%). Other main procedures included correction of partial anomalous pulmonary venous connection,cor triatriatum,ventricular septal defect or partial atrioventricular canal,removal of left or right atrial myxoma,and tricuspid valve plasty or replacement. Transesophageal echocardiography monitoring was useful at every stage of surgery without any major associated complications. Forty-four patients(3.2%)required surgical re-interventions immediately following transesophageal echocardiography evaluation. The reasons included unsatisfactory valve plasty,paravalvular leak,prosthetic dysfunction and residual shunting. The incidence of surgical re-intervention,as well as the mortality,decreased annually with increased surgical volume. Conclusions Intraoperative transesophageal echocardiography plays an important role in the quality control of thoracoscopic cardiac surgery.[S Chin J Cardiol 2019;20(2):69-78]     

肢体远隔缺血预处理对胸腔镜体外循环心脏手术的肺保护作用

目的:探讨肢体远隔缺血预处理对胸腔镜体外循环心脏手术的肺保护作用及其机制。方法 :胸腔镜体外循环心脏手术患者81例,ASAⅡ～Ⅲ级,随机分为试验组(给予肢体远隔缺血预处理,n=41)和对照组(不给予肢体远隔缺血预处理,n=40)。采集患者术中及术后临床指标,分别在手术开始前、手术结束后6、24 h采集桡动脉血检测氧合指数(PaO2/FiO2)、血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及丙二醛(MDA)水平。结果:两组患者术后机械通气时间试验组小于对照组,组内比较术后6、24 h血浆TNF-α、IL-6、MDA水平明显高于手术开始时的水平,术后6、24 h PaO2/FiO2明显低于手术开始时的水平;但是组间比较术后6、24 h血浆TNF-α、IL-6、MDA水平试验组低于对照组,术后6、24 h PaO2/FiO2试验组高于对照组,差异有统计学意义(P<0.05)。结论:肢体远隔缺血预处理对胸腔镜体外循环心脏手术中肺损伤具有一定的保护作用,是一种简单、有效的肺保护方法。     

胸腔镜下体外循环心脏手术的麻醉管理

目的 总结胸腔镜下体外循环心脏手术的麻醉管理经验。方法回顾性分析2011年1月至12月在广东省人民医院行胸腔镜下体外循环心脏手术患者的麻醉及围术期处理的相关资料。结果2011年我院共行胸腔镜辅助小切口或全胸腔镜下体外循环心脏手术85例,其中男30例,女55例,年龄（42．5±15．2）岁。手术类型包括：房间隔缺损修补术20例,同期三尖瓣成形术15例;左心房黏液瘤摘除术7例;二尖瓣成形术8例：二尖瓣置换术50例,同期三尖瓣成形术19例、心房颤动射频消融术5例、房间隔缺损修补术2例及左心房血栓清除术1例。麻醉均采用静吸复合全身麻醉,左侧双腔气管插管单肺通气,经皮上腔静脉插管、股动静脉插管建立外周体外循环,体外循环时间（151．8±63．6）min,心肌血运阻断时间（92．1±43．7）min。全组患者术后并发症8例（9．4％）,死亡1例。结论良好的单肺隔离通气、充分的静脉引流以及完善的术中监测有利于手术的顺利进行,维持血流动力学平稳和避免缺血、缺氧可以减少围术期并发症,是胸腔镜下体外循环心脏手术麻醉管理的重点。