Perioperative Changes of Plasma Endothelin—1 in Patients Undergoing Coronary Artery bypass Grafting and the Effect of Nitroglycerin

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Short- and Long-term Therapeutic Efficacies of Intravenous Transplantation of Bone Marrow Stem Cells on Cardiac Function in Rats with Acute Myocardial Infarction：A Meta-analysis of Randomized Controlled Trials

Objective To investigate the short- and long-term therapeutic efficacies of intravenous trans- plantation of bone marrow stem cells (MSCs) in rats with experimental myocardial infarction by meta- analysis. Methods Randomized controlled trials were systematically searched from PubMed, Science Citation Index (SCI), Chinese journal full-text database (CJFD) up to December 2014. While the experimental groups (MSCs groups) were injected MSCs intravenously, the control groups were injected Delubecco’s minimum essential medium (DMEM) or phosphate buffered saline (PBS).Subgroup analysis for each outcome measure was performed for the observing time point after the transplantation of MSCs. Weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated for outcome parameters including ejection fraction (EF) and fractional shortening (FS), which were measured by echocardiogram after intravenous injection and analyzed by RevMan 5.2 and STATA 12.0. Results Data from 9 studies (190 rats)were included in the meta-analysis. As compared to the control groups, the cardiac function of the experimental groups were not improved at day 7 (EF: WMD=0.08, 95%CI?1.32 to 1.16,P>0.01; FS: WMD=?0.12, 95%CI?0.90 to 0.65,P>0.01) until at day 14 after MSCs’ transplantation (EF: WMD=10.79, 95%CI 9.16 to 12.42,P<0.01; FS: WMD=11.34, 95%CI 10.44 to 12.23, P<0.01), and it lasted 4 weeks or more after transplantation of MSCs (EF: WMD=13.94, 95%CI 12.24 to 15.64,P<0.01; FS: WMD=9.64, 95%CI 7.98 to 11.31,P<0.01). Conclusion The therapeutic efficacies of MSCs in rats with myocardid infarction become increasing apparent as time advances since 2 weeks after injection.     

参附注射液对脱泵下冠状动脉旁路移植术患者的心肌保护作用

目的探讨参附注射液对脱泵下冠状动脉旁路移植(OPCABG)术患者的心肌保护作用.方法选择择期行OPCABG术的患者48例,随机分为对照组和治疗组,对照组常规行OPCABG术,治疗组于麻醉后开始应用参附注射液1 mL/kg加入生理盐水250 mL静脉滴注,术后连续应用1周.2组分别于麻醉后(T1)、术后4 h(T2)、24 h(T3)、48 h(T4)、72 h(T5)抽血查血清肌酸磷酸激酶(CK)和肌酸磷酸激酶同工酶(CK-MB).结果治疗组术后各时点血清CK及CK-MB均低于对照组,有统计学上的显著性差异(P＜0.05).结论参附注射液可以减少OPCABG患者术中的心肌损伤,具有明显的心肌保护作用.     

非体外循环冠脉搭桥术的心肌保护作用

目的 :比较非体外循环冠脉搭桥手术 (OPCAB)和体外循环冠脉搭桥手术 (CABG)围术期心肌损伤程度 ,探讨OPCAB的心肌保护效果。方法 :5 0例病人分为两组 ,A组 2 0例 ,为CABG组 ,B组 30例 ,为OPCAB组。分别于麻醉诱导后、手术结束后即刻、术后 2 4h、72h、16 8h取静脉血标本 ,分别测定心肌肌钙蛋白I水平和CK MB活性 ;另外记录围手术期各项临床指标。结果 :OPCAB组术后辅助呼吸时间较体外组短 (P <0 .0 1) ,而且房颤的发生率较低 (P <0 .0 5 )。CABG组与OPCAB组cTnI、CK MB的术前水平相似 ,而术后即刻、术后 2 4h、72h均较OPCAB组明显升高 (P <0 .0 5或 0 .0 1)。结论 :与CABG相比 ,OPCAB的心肌损伤较轻 ,心肌保护效果较好。     

100例冠状动脉旁路移植术的体外循环经验

总结了100例冠状动脉旁路移植术的体外循环经验。病例特点：3支血管病变多、高龄患者多、合并疾病多和左室功能减退多。人均旁路移植3．42根。体外循环和主动脉阻断的平均时间分别为72和49min全部体外循环获得成功。强调：经主动脉根部顺灌冷停跳液是一种简单、快捷、有效的心肌保护方法。超滤装置使灌注师能更主动地控制体外循环中的液体平衡。同时对合并升主动脉钙化和糖尿病也提出了处理经验。     

七氟醚预处理对体外循环下冠状动脉搭桥术患者心肌保护作用的系统评价

目的用Meta分析的方法评价七氟醚预处理对体外循环下冠状动脉搭桥术患者的心肌保护作用。方法按照制定的检索策略检索PubMed、EMBASE、中国生物医学数据库等及Cochrane图书馆,文献检索时间为1998—2011年。收集有关七氟醚预处理用于冠状动脉搭桥手术患者的临床随机对照研究,筛选出符合纳入标准的文献,利用RevMan4．2软件对纳入研究结果进行Meta分析。结果共检索到符合条件的文献5篇,包含病例294例。Meta分析结果显示,七氟醚组术后血浆心肌肌钙蛋白T峰值浓度较对照组低（加权均数差为-0．21．95％可信区间为-0．33—0．09,P〈0．05）,各研究间存在异质性（P〈O．01）。与对照组比较七氟醚组的术后血浆氨基末端脑钠肽前体峰值浓度低、血浆肌酸激酶同工酶浓度低、心脏指数高、不良心血管事件的发生率低。结论七氟醚预处理可对体外循环下冠状动脉搭桥手术患者有明显的心肌保护作用。     

体外循环下冠状动脉旁路移植手术早期呼吸力学变化

目的研究体外循环(cardiopulmonary bypass,CPB)下冠状动脉旁路移植手术(coronary artery bypass graft-ing,CABG)早期呼吸力学指标的变化。方法以25例全身麻醉、中低温CPB下行单纯CABG术患者为研究对象。测定开胸前、转流前、转流后、关胸后气道峰压、气道阻力及胸肺顺应性等呼吸力学指标。转流前后血气分析,计算肺泡-动脉氧压差(alveolar-arterial oxygen difference,A-aDO2)。结果CPB前后相比,气道峰压[从(16.9±2.8)cmH2O到(17.6±2.7)cmH2O,P<0.01,1 cmH2O=0.098 kPa]及气道阻力[从(7.8±1.6)cmH2O/(L.s)到(8.5±1.7)cmH2O/(L.s),P<0.01]明显升高,胸肺顺应性[从(64.9±7.3)ml/cmH2O到(62.1±6.9)ml/cmH2O,P<0.01]明显降低。A-aDO2在CPB后明显升高,从(159.2±61.0)mmHg到(203.5±25.4)mmHg(P<0.05,1 mmHg=0.133 kPa)。关胸后呼吸力学指标与开胸前相比都有明显的变化,胸肺顺应性降低18%(P<0.01),气道峰压及气道阻力分别升高5%(P<0.01)及10%(P<0.01)。转流时间与CPB前后的A-aDO2的变化率呈正相关关系(r=0.63,P<0.01)。结论CPB下CABG时开胸及体外循环影响早期呼吸力学的变化,而且CPB时间与肺换气功能损伤程度有密切关系。     

冠脉支架置入术与冠脉搭桥术治疗严重冠心病的对比研究——SYNTAX研究

1 文献来源 Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease [J]. N Engl J Med, 2009,360(10):961- 972.     

冠状动脉搭桥术212例

目的：总结成人冠状动脉搭桥术（CABG）的临床经验。方法：2002年4月至2010年2月共施行CABG术212例,同期行心脏瓣膜20例,升主动脉带瓣管道置换6例,室壁瘤切除8例,房间隔缺损（ASD）修补术2例,粘液摘除术1例,冠状动脉支架置入术（PTCA）后再狭窄、堵塞35例,冠状动脉支架置入术致心脏破裂修补术4例。结果：本组住院死亡9例（4.2%）,死亡原因包括：急性心梗行支架置入术后低心排在主动脉球囊反博仍无效下急诊搭桥术2例（1%,2/5）,肾功能衰竭2例（1.5%）,严重心律失常1例（1.5%）,严重肺部感染致败血症,多器官功能衰竭2例（0.4%）。随访147（69.3%,147/212）例,随访时间6个月至7年,死亡3例,原因均为严重心律失常。大多数患者心功能和生活质量明显改善,心功能（NYHA）Ⅰ级95例,Ⅱ级65例,Ⅲ级41例9例,Ⅳ级2例。结论：CABG手术随着手术和术后治疗经验的成熟,其安全性越来越大,已成为冠心病患者较为安全、可靠的治疗方法;但由于心脏介入手术的普及,由其并发症而需急诊搭桥的病例有所增加,这部分手术死亡率较择期手术高。     

体外循环和非体外循环冠状动脉旁路移植术疗效对比的Meta分析

Background  The growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is emerging, but the role of off-pump coronary artery bypass (OPCAB) in clinical practice remains controversial. The purpose of this study was to assess differences in the incidences of stroke, atrial fibrillation (AF), and myocardial infarction (MI) between OPCAB and conventional coronary artery bypass grafting (CCABG) by meta-analyses of randomized clinical trials.

Methods  A literature search for the period before March 2010 supplemented with manual bibliographic review was performed for all Chinese or English publications in Medline, the Science Citation Index Expanded, the Cochrane Central Register of Controlled Trials (CENTRAL) and CBMdisc. A systematic overview (meta-analyses) of randomized clinical trials was conducted to evaluate the differences between OPCAB and CCABG in the incidences of stroke, AF, and MI. The meta-analysis was performed using RevMan 5 software.

Results  Forty-three randomized clinical trials were selected for meta-analysis after screening a total of 356 references, with 8104 patients in the OPCAB group and 8724 cases in the CCABG group. The meta-analyses of these trials showed no significant difference between OPCAB and CCABG in the incidences of stroke (odds ratio (OR)=0.80, 95% confidence interval (CI)=0.52–1.22, P=0.30) and MI (OR=0.73, 95%CI=0.52–1.02, P=0.06). However, we found a significantly reduced risk of AF (OR=0.65, 95%CI = 0.52–0.82, P=0.0002) in off-pump patients.

Conclusions  Our meta-analyses suggest that OPCAB reduces the risk of postoperative AF compared with CCABG, but there is no significant difference in the incidences of stroke and MI between OPCAB and CCABG.

     

冠脉支架置入术与冠脉搭桥术治疗严重冠心病的对比研究——SYNTAX研究

1文献来源 Serruys PW, Morice MC, Kappetein AP, et al.Percutaneous coronary intervention versus coronaryartery bypass grafting for severe coronary artery disease [J]. N Engl J Med, 2009,360 （10） ：961 - 972.     

高龄患者冠状动脉旁路移植术体外循环中的心肌保护

目的观察高龄（≥70岁）冠心病患者冠状动脉旁路移植术（CABG）中的心肌保护的临床效果。方法总结我院近1年高龄（≥70岁）冠心病患者体外循环下行CABG20例，包括介入治疗术后3例（心内支架术后急诊搭桥1例），体外循环中运用冷血停搏液顺灌-冷血持续逆灌-开升主动脉前温血顺灌的心肌保护方法。结果全组20例患者心脏自动复跳16例，占80％；电击复律4例，占20％。术后胸骨感染1例，围术期死亡1例，其余患者均痊愈出院。结论高龄（≥70岁）患者体外循环下行CABG，体外循环中运用冷血停搏液顺灌-冷血持续逆灌-开升主动脉前温血顺灌为有效的心肌保护方法，自动复跳率高。