Symmetry静脉-主动脉吻合器在不停跳搭桥手术中的应用

白20世纪60年代冠状动脉搭桥手术兴起以来,血管吻合一直采用连续缝合的方法,使用血管吻合器的报道较少。本组资料总结应用Symmetry吻合器（St．Jude Medical）行静脉-主动脉吻合的经验,现报道如下。     

使用Symmetry近端吻合器行冠状动脉搭桥术的术中及中期血管造影结果

本研究的目的是调查在用大隐静脉行冠状动脉旁路移植时,用自动吻合器或传统缝合技术施行近端吻合移植血管的开放率。我们用一段胸廓内动脉及一段或多段大隐静脉作为移植血管,对46例未行体外循环的患者施行冠状动脉搭桥术。对其中23例患者使用Sym-metry吻合器(StJude M edical公司,StPaul,明尼苏达)将移植血管与动脉吻合,其余23例用升主动脉部分钳夹及缝合法吻合。术中行通过时间血流仪测定及血管造影来研究移植血管状况,必要时进行校正。术后3～5个月重复作血管造影。术中移植血管开放率两组间无差异。随访期血管造影表明移植的胸廓内动…     

静脉移植对内皮细胞功能影响的研究进展

尽管血管内介入治疗在临床上广泛运用,但是冠状动脉旁路移植术(CABG)仍然是治疗左主干和三支病变冠状动脉粥样硬化性心脏病的主要方法.大隐静脉是CABG中最常使用的血管之一,但其移植后再狭窄率高,10年通畅率约为50%,是影响CABG效果的重要因素[1].移植静脉重塑过程包括早期血栓形成、新生内膜形成和动脉粥样硬化均与内皮细胞功能密切相关.内皮细胞直接暴露于血管最里层,除了提供屏障作用外,还具有调节血管舒张、炎症反应、趋化因子和细胞因子释放等生理功能.静脉移植可引起内皮损伤,进而导致移植静脉重塑失败.本文综述静脉移植过程中缺血、保存液、血流动力学改变和相关细胞因子对内皮细胞功能影响的研究进展.     

防止大隐静脉移植物痉挛和保护内皮的方法

完整的血管内皮是血流与内皮下高浓度凝血酶原之间的物理屏障。此外,内皮细胞以各种机制强有力地抑制血小板的附着,如产生前列环素及通过纤维蛋白溶酶原激活剂防止纤维蛋白沉积。血管痉挛亦可引起内膜的损伤,因此,在取大隐静脉移植物时需要保护血管内皮。方法是在取大隐静脉切皮前经皮注射37℃含盐酸罂粟碱(60mg/500ml)的平衡盐液浸润静脉周围,约用     

Symmetry主动脉吻合器在OPCAB术中的应用

目的:总结非体外循环心脏不停跳冠状动脉旁路移植术(Off-pump coronary artery bypass grafting,OPCAB)中使用Symmetry主动脉吻合器的近期效果.方法:2002年9月-2004年9月,585例冠心病患者行OPCAB,其中497例使用大隐静永移植物,应用Symmetry主动脉吻合器25例.结果:使用吻合器35个,近端吻合口(1.4±0.2)个/例,成功率97.14%(34/35),吻合失败弃用1个,1个吻合口漏血需手工修补.吻合器安装时间(4.3±1.5)分钟,吻合口完成时间均在10S以内,手术时间(3.2±0.4)小时.手术死亡率4%(1/25),无围手术期心肌梗死、脑卒中并发症,出血二次开胸1例,但非吻合口出血.术后总引流量(592±224)ml,输血率44%(11/25).术后住院(9.8±1.6)天.结论:Symmertry主动脉吻合器可安全有效地应用于OPCAB术,近期临床效果满意.可缩短吻合时间和手术时间,避免主动脉钳夹,降低中风并发症.     

尼可地尔及罂粟碱对冠状动脉旁路移植术大隐静脉血管桥血管舒张功能的影响

目的 探讨钾离子通道开放剂（PCOs）尼可地尔（NCR）和罂粟碱对大隐静脉血管桥血管舒张功能的影响。方法 采用器官槽法，研究分别用重碳酸盐缓冲液（KH）、含0．1mmol／LNCR的KH、含1．2mmol／L罂粟碱的KH浸泡大隐静脉血管环1小时，检测三者平衡后引发的血管收缩舒张反应。结果 与单纯浸泡于KH的血管环相比，含0.1mmol／LNCR的KH、含1．2mmol／L罂粟碱的KH中的血管环都能较好地舒张，后二者之间无明显差别。电镜见含罂粟碱溶液浸泡的血管内皮细胞有较重的损伤。结论 尼可地尔和罂粟碱对冠状动脉旁路移植术大隐静脉血管桥都具有良好的舒张功能。罂粟碱损伤血管内皮。     

一种观察血管内皮损伤与自由基关系的新方法——Ⅱ、内皮扫描电镜观察

本研究用离体兔胸主动脉淋浴灌流系统电解Krebs液损伤血管内皮模型,观察了自由基对血管内皮的影响。结果发现,电解性自由基在损伤血管内皮释放EDRF能力的同时,内皮细胞完整性遭破坏,细胞膜凹陷,细胞间隙增宽及部分区域内皮细胞脱落。     

Symmetry主动脉吻合器在OPCAR术中的应用

目的总结非体外循环心脏不停跳冠状动脉旁路移植术(Off-pump coronary artery bypass grafting,OPCAB)中使用Symmetry主动脉吻合器的近期效果.方法2002年9月-2004年9月,585例冠心病患者行OPCAB,其中497例使用大隐静永移植物,应用Symmetry主动脉吻合器25例.结果使用吻合器35个,近端吻合口(1.4±0.2)个/例,成功率97.14%(34/35),吻合失败弃用1个,1个吻合口漏血需手工修补.吻合器安装时间(4.3±1.5)分钟,吻合口完成时间均在10S以内,手术时间(3.2±0.4)小时.手术死亡率4%(1/25),无围手术期心肌梗死、脑卒中并发症,出血二次开胸1例,但非吻合口出血.术后总引流量(592±224)ml,输血率44%(11/25).术后住院(9.8±1.6)天.结论Symmertry主动脉吻合器可安全有效地应用于OPCAB术,近期临床效果满意.可缩短吻合时间和手术时间,避免主动脉钳夹,降低中风并发症.     

蒲黄、丹参对纤维蛋白损伤内皮细胞的保护作用

应用传代培养的牛和人主动脉内皮细胞及原代培养的人脐静脉内皮细胞为实验模型,用1%纤维蛋白的琼脂薄膜复盖于融合成单层的细胞上,观察比较蒲黄、丹参对纤维蛋白损伤牛和人血管内皮细胞的影响。发现牛和人主动脉或脐静脉内皮细胞接触含纤维蛋白的琼脂薄膜后,部分细胞出现收缩移动和细胞间隙增宽,随后大多细胞脱落,少数聚集成团;而加入蒲黄血清或丹参针液的防治组,大部分细胞形态基本正常。加入蒲黄、丹参防治组的培养液中,LDH及ACP含量均明显低于实验对照组。提示蒲黄、丹参均能减轻纤维蛋白凝块对血管内皮的损伤作用。     

主动脉吻合器在冠状动脉搭桥手术中的应用——附32例报告

目的通过对32例冠脉搭桥手术中使用主动脉吻合器进行静脉桥近端吻合的总结,探讨主动脉吻合器的应用价值。方法自2003年3月～2005年10月,该中心在32例冠脉搭桥手术中使用主动脉吻合器(包括St.JudeMedicalSymmetryTM主动脉吻合器和MedtronicSpyderTM近端吻合器)进行静脉桥近端吻合,平均年龄(67.9±5.59)岁。这些患者均在术前或术中被确定为存在不同程度的升主动脉钙化或粥样斑块形成,术中不能钳夹升主动脉侧壁。吻合完成后采用血流测定行血管桥流量测定。结果32例患者共使用主动脉吻合器搭桥68根,均操作顺利,无1例发生近端吻合口漏血。测量血管桥平均流量(23.5±13.0)mL/min。术后无1例患者发生精神神经系统并发症,如中风、失语、意识障碍等。结论主动脉吻合器是一种操作简便、快捷、安全可靠的静脉桥近端吻合装置,由于无须钳夹主动脉和特殊的结构设计,大大减少了主动脉壁斑块脱落导致栓塞的危险性,在搭桥手术中有很大的应用价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.