原位心脏移植手术的体外循环管理

目的总结探讨同种原位心脏移植手术体外循环管理的经验和方法.方法回顾分析2003年4月至今昆明医科大学附属延安医7例终末期心脏病患者的同种原位心脏移植手术.采用浅中低温、轻中度血液稀释、中高流量CPB体外循环,注重供体心肌保护,应用常规超滤与改良超滤技术,行多指标监测和临床观察.结果7例患者体外循环过程平稳,手术过程顺利.例1、例2和例5患者生存至今,已分别存活10 a、9 a和5 a;例3患者术后存活1 a;例4和例6患者死于移植术后右心衰、急性排斥反应;例7患者死于停机困难、严重低心排.结论进行良好的体外循环管理,合理选择供体心脏保护技术,减轻再灌注损伤和积极保护心肺功能是原位心脏移植手术体外循环管理的关键.     

原位同种异体心脏移植术的循环管理

目的:探讨原位同种异体心脏移植术的循环管理的特点和方法.方法:3例终末期扩张型心肌病行原位心脏移植术患者,术前均经强心、利尿、扩血管及营养支持治疗.麻醉方法采用气管插管静吸复合全麻,在体外循环下行心脏移植术.诱导前置入Swan-Ganz导管监测各项血流动力学指标,并针对性地使用心血管活性药物.结果:3例患者麻醉手术中血流动力学平稳.1例患者康复出院,1例患者因肺部感染术后15 d死于心肺衰竭,1例患者因难治性右心衰竭于术后2 d死亡.结论:选择应用合适的心血管药物维持血流动力学稳定是手术成功的重要保障,如何治疗肺动脉高压避免右心衰竭尤为关键.     

10例同种异体原位心脏移植手术的麻醉处理

目的 研究同种异体原位心脏移植手术的麻醉处理.方法 对10例同种异体原位心脏移植患者,术前均予以强心、利尿、营养心肌、改善肝功能、降低肺动脉压等治疗.麻醉诱导选用依托咪酯0.1～0.2 mg/kg、氯胺酮30～50 mg,芬太尼8～15 μg/kg,罗库溴胺1 mg/kg,利多卡因0.5～1 mg.麻醉维持以芬太尼为主的静吸复合麻醉,应用漂浮导管连续心排(CCO)和混合静脉血氧饱和度(SvO2)监测血流动力学指标,根据血流动力学的监测变化及时使用异丙基肾上腺素、前列腺素E1等血管活性药物.结果 10例患者围术期血流动力学平稳,全部患者术后2～4 h清醒,6～36 h拔出气管插管,恢复良好.结论 术前重视心肺、肝肾等重要脏器功能维护,合理使用麻醉药物和血管活性药物,加强监测,维持术中的血流动力学稳定,是原位心脏移植手术麻醉管理的关键.     

同种异体原位心脏移植10例应用体会

10例终末期心脏病患者进行同种异体心脏移植手术,均为男性,其中8例为扩张型心肌病,1例为限制型心肌病,1例为心脏恶性肿瘤.手术方法全部采用双腔静脉法行原位心脏移植.术后均采用环孢素A+骁悉+泼尼松口服联合抗免疫治疗.结果显示术后9例存活,手术成功率为90%(9/10).随访2～94个月,其中有1例失随访,4例患者死亡.余5例生活全部自理,恢复正常的生活,最长存活患者术后存活期已超过7年,存活患者术后死亡的主要原因包括急性排斥反应和感染.     

原位心脏移植治疗终末期心脏病的临床效果

目的 分析同种异体原位心脏移植治疗终末期心脏病患者的效果.方法 回顾性收集郑州大学第一附属医院心血管外科13例同种异体原位心脏移植患者的临床资料,分析供心获取与保护、受者术前评估与维持治疗、感染的预防与治疗、免疫抑制剂的应用、术后并发症的治疗等情况.结果 13例心脏移植手术,供心冷缺血时间10～360(200.8±38...     

原位心脏移植56例的临床经验

目的　总结分析复旦大学器官移植中心 5 6例原位心脏移植的临床经验。方法　 2 0 0 0年 5月至 2 0 0 3年 12月连续为 5 6例患者行原位心脏移植术 ,包括扩张型心肌病 4 7例 ,终末期瓣膜性心肌病 2例 ,终末期缺血性心肌病 2例 ,原发性心脏恶性肿瘤 2例 ,复杂先天性心脏病 1例 ,肌营养不良性心肌病 1例 ,恶性心律失常 1例。手术按标准法行原位心脏移植手术 19例 ,双腔静脉吻合法移植手术 37例。术后抗排斥反应治疗采用环孢素 泼尼松 霉酚酸酯三联方案。结果　手术死亡1例 ,死因为第 5次手术术后渗血不止。所有存活病例获完整随访 ,在平均 12 .4个月的随访中 ,术后1年内死亡 5例 ,1年存活率 91% ,其中死于肾功能衰竭 1例 ,慢性右心衰 1例 ,急性排斥反应 2例 ,车祸 1例。 1例术后 3年 2个月死于移植物冠状动脉硬化。存活病例心功能恢复至ⅠⅡ级。结论通过选择适当的受体病例 ,保护良好的心肌 ,采用双腔静脉吻合技术 ,加强术后监测与预防多种并发症 ,心脏移植可获得满意的早中期疗效。     

心脏移植中右心功能不全的预防和处理

目的:探讨心脏移植手术中造成右心功能不全的原因及其防治方法.方法:11例实施同种异体原位心脏移植手术病人监测围手术期肺动脉压力、肺循环阻力、中心静脉压和右心功能.预防性给予前列腺素E1,术后吸入NO.结果:本组病例无死亡,11例病人术中肺动脉压力有所下降,中心静脉压均有不同程度升高,1例病人出现右心功能不全表现.结论:术前正确评估肺动脉压力和右心功能,采取综合措施积极有效地降低肺动脉压,减轻右心负荷是避免或减轻右心功能不全的关键.     

滇南小耳猪原位心肺联合移植的麻醉管理

目的探讨滇南小耳猪同种原位心肺联合移植手术麻醉管理的有效方法.方法 2009年1月至2010年3月对14只实验用封闭群滇南小耳猪进行心肺联合移植的实验研究.基础麻醉下插管静吸复合麻醉维持,常规体外循环下实施心肺联合移植手术,行多指标监测和临床观察.结果麻醉过程平稳,供心保护好,7例手术成功,6例成功复跳,获得短期存活,达到研究目的.结论合理选择麻醉方法和药物,及时发现并处理围术期常见并发症,减轻再灌注损伤和积极保护心肺功能是成功进行小耳猪原位心肺联合移植手术麻醉的关键.     

同种异体原位心脏移植(附6例报告)

目的　探讨心脏移植术过程中术式 ,心肌保护 ,术后并发症等相关问题。方法　对 6例实施原位心脏移植患者的临床资料进行分析、总结 ,得出相关数据 ,经统计学处理。结果　 6例患者中 ,移植方法采用标准法 4例 ,双腔法 1例 ,全心脏法 1例。供心平均热缺血时间为 (10 5± 1 8)ｍｉｎ ,冷缺血时间为 (4 9± 14.7)ｍｉｎ。存活时间分别为 8年、7年、5年、3 5年、2年、0 5年。结论　充分的术前准备 ,适当的术式选择 ,良好的心肌保护 ,术后右心衰竭的预防与治疗是心脏移植成功的关键。同种异体原位心脏移植(附6例报告)@孙晨光 @夏求明 @李…     

原位心脏移植43例

目的 探讨43例同种异体原位心脏移植的初步经验和体会。方法 自1995年8月至2003年5月福建医科大学附属协和医院心外科共为43例终末期心脏病患者实施了原位心脏移植。对这些患者的手术效果及其影响因素进行回顾性总结。结果 术后早期死亡7例,分别死于急性右心功能衰竭(5例)、感染(1例)和急性肾功能衰竭(1例),死亡率为16．3％;晚期死亡5例,分别死于急性排斥反应(2例)、感染(2例)和心律失常(1例)。长期生存的患者生活质量良好。结论 心脏移植是治疗终末期心脏病的有效方法。低肺血管阻力受体的选择和合理的免疫抑制治疗方案的府用是心脏移植成功的关键。     

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.