体外循环心脏手术对甲状腺激素代谢的影响

目的 观察体外循环心脏手术前后甲状腺激素的变化,研究春对甲状腺激素代谢的影响。方法 用放射免疫法测定３０例体外循环心脏手术患者术前、术中、术后血浆甲状腺激素激素和促状腺激素的浓度。结果 三碘甲状腺原氨酸（Ｔ３）、甲状腺 素（Ｔ４）、游离三碘甲状腺原氨酸（ＦＴ３）术中降低,术后２ｈＴ４恢复正常。Ｔ３、ＦＴ３呈下降低趋势,术后２４ｈ降至最低。ＦＴ４手术前后差异无显著性,ｒＴ３术后２４ｈ明显升高。ＴＳＨ     

心脏手术对甲状腺功能的影响

目的观察心脏手术前后甲状腺激素的变化，研究心脏手术对甲状腺功能的影响。方法用放射免疫法测定心脏手术前后患者血中甲状腺激素的含量，观察心脏手术中体外循环（ＣＰＢ）时间的长短对甲状腺激素变化的影响。结果从ＣＰＢ开始至术后Ｔ３、Ｔ４、ＦＴ３均明显降低，Ｔ３、Ｔ４在转流至最低温度时达到极点，分别降至０．３８±０．０４ｎｍｏｌ／Ｌ与５３．０±３．３ｎｍｏｌ／Ｌ，而术后５天仍明显低于术前水平（Ｐ＜０．０５）。ｒＴ３在ＣＰＢ期间稍下降，术后即迅速上升，２天后达到高峰，较术前上升了约３倍（Ｐ＜０．０１），并持续保持在较高水平。ＴＳＨ与ＦＴ４于手术前后均无差别。分组研究表明，手术时间，尤其是ＣＰＢ时间的长短对甲状腺功能的影响并不重要。结论心脏手术可对甲状腺功能造成严重的影响，使患者术后处于低Ｔ３综合征状态；而异常的甲状腺功能对术后心脏功能可能产生不利的影响     

体外循环心脏手术的节约用血措施

体外循环心脏手术的节约用血措施毕叔同邓硕曾李再男王小雷叶晓青黄小蝶为了减少输血传播疾病，特别是两型肝炎或艾滋病的感染机会，我院自１９９４年７月开始采取一系列节约用血措施，以减少手术病人的用血量，收到显著效果。资料与方法我院１９９３～１９９４年收治的择...     

抑肽酶在体外循环心脏手术中的应用

抑肽酶在体外循环心脏手术中的应用姜胜利综述朱朗标李佳春李功宋审校医用抑肽酶是从牛肺里提取的一种蛋白酶抑制剂，属于多肽类，分子量６０００，由１６种氨基酸组成，以丝氨酸残基为激活点抑制蛋白酶［１］。其生物半衰期小于２小时。抑肽酶几乎完全在肾溶酶体内代谢。...     

抑肽酶对体外循环心脏手术患者细胞因子的影响

目的 观察不同剂量抑肽酶对体外循环心肺转流（CPB）期间促炎细胞因子TNF-α、IL-6和抗炎细胞因子IL-10血浆浓度的影响及作用差异。方法 32例瓣膜置换术病人随机分为三组：对照组、小剂量抑肽酶组和大剂量抑肽酶组。分别于CPB前、CPB结束、停CPB后2小时取桡动脉血测定TNF-α、IL-6、IL-10血浆水平。结果 于CPB结束、停CPB后2小时,大剂量组TNF-α、IL-6血浆水平低于相应点小剂量组,而IL-10血浆水平高于小剂量组。结论 大剂量抑肽酶较小剂量抑肽酶能更有效地抑制TNF-α、IL-6释放、促进IL-10释放,对其抗炎性能有益,抑肽酶的抗炎作用存在量效关系。     

常温体外循环心脏手术的钾离子平衡

作者对连续２６例常温体外循环心脏手术患者的术中、术后钾离子动态变化进行了分阶段观察分析，发现体外循环过程中钾离子随持续灌注的温氧合血心停搏液大量进入体内，复苏时血浆钾显著增高；术后第１日早７时前补钾量较低温体外循环后同期明显为少；体外循环过程钾离子向细胞内转移显著；自手术当日晚６时始钾离子开始向细胞外转移，至术后第２日早７时钾离子出入达到平衡。复苏时的高钾血症常使心脏复跳延迟，但心脏自动复跳率却很高（９６％）。作者还就高钾血症的预防提出了几条措施。     

体外循环心脏手术中应用抑肽酶的副作用

抑肽酶是从牛肺中提取的非特异性丝氨酸蛋白酶抑制剂,可抑制内源性凝血系统、纤溶系统,保护血小板的数量和功能,显著地减少术中、术后出血及输血量。抑肽酶自６０年代开始用于心血管外科,给药途径和剂量最初多不一致,近来倾向于大剂量———麻醉诱导后静脉注入２×１０６ＫＩＵ,预充液内加入２×１０６ＫＩＵ,５×１０５ＫＩＵｈ术中持续静脉滴注;小剂量———用药途径同上,量减半;仅在预充液内加入２×１０６ＫＩＵ〔１〕。但人们在应用中逐渐发现它有许多副作用,有些还相当严重,现将其副作用综述如下。过敏反应抑肽酶是一种…     

心内直视手术对甲状腺激素代谢的影响及其临床意义

为了解体外循环心脏直视手术对甲状腺激素代谢的影响并探讨其临床意义。作者选择２１例心脏直视手术病人，用放免法分别于术前、术中、术后２、２４小时测定其血浆Ｔ３、Ｔ４、游离Ｔ３（ＦＴ３）、游离Ｔ４（ＦＴ４）、反Ｔ３（ｒＴ３）及促甲状腺激素ＴＳＨ的含量。结果发现Ｔ４、ＦＴ４术中降低，术后２小时恢复正常（Ｐ＜０．０５）。Ｔ３、ＦＴ３呈下降趋势，术后２４小时降至最低（Ｐ＜０．０１）。ｒＴ３进行性升高。ＴＳＨ术中一过性升高。结论：甲状腺激素在ＣＰＢ时变化为术中低Ｔ３、Ｔ４综合征，术后为低Ｔ３综合征。提示ＣＰＢ后Ｔ３补充治疗有利于病人康复及某些术后难治性心功能不全的处理。     

大剂量抑肽酶对体外循环心内直视手术病人心肌的保护作用

目的：观察体外循环（ＣＰＢ）心内直视手术中使用大剂量抑肽酶对心肌保护的影响。方法：１２０例心脏瓣膜置换手术病人,随机分成两组：Ａ组（抑肽酶组,ｎ＝６０）,Ｂ组（对照组,ｎ＝６０）,ＡＢ两组均在主动脉阻断后行冷晶体停跳,至开放关作末次温血灌注。     

鱼精蛋白个体化使用减少心脏直视手术后患者出血的研究

目的比较个体化与按体重给予鱼精蛋白对体外循环(CPB)手术后患者出血和输血量的影响,以减少CPB后出血并发症的发生。方法40例拟在CPB下行择期心脏手术的成年患者随机分为两组,实验组:根据肝素-鱼精蛋白滴定法结果给予鱼精蛋白;对照组:术前给予肝素,按1∶1的比例给予鱼精蛋白。记录术后1 h、2 h和24 h的胸腔引流量和输血量。结果实验组鱼精蛋白用量明显大于对照组(P0.05),而胸腔引流量(出血量)于术后1 h(180±83 ml vs.285±156 ml,P=0.012)、2 h(74±31 ml vs.114±44 ml,P=0.002)、24 h(465±167 ml vs.645±207 ml,P=0.004)和红细胞悬液输入量(0.15±0.27 Uvs.0.80±0.96 U,P=0.018)均少于对照组。结论与目前临床上使用的根据CPB前肝素用量给予鱼精蛋白的方法比较,滴定法指导的个体化给予鱼精蛋白能减少CPB后患者的胸腔引流量(出血量)和红细胞输入量。     

抑肽酶在体外循环术中的应用

１０１例各种心脏直视手术病例在体外循环中应用抑肽酶，另以同期５２例心脏直视手术病例作为对照，研究大剂量抑肽酶在心脏直视手术中的作用，用药组转流结束后创面较对照组干燥，手术止血时间缩短，术中失血减少，术后２４小时出血量减少约５０％（用药组３１６±１１４ｍｌ，对照组５９８±１９７ｍｌ）；库血输入量抑肽酶组亦比对照组用量少（用药组４６８±１４８ｍｌ，对照组７８３±１２２ｍｌ）。大剂量抑肽酶在体外循环中的应用是安全有效的，它明显减少术中、术后的出血及库血用量。     

Effect of the Neutrophil Elastase Inhibitor Sivelestat on Perioperative Inflammatory Response After Pediatric Heart Surgery With Cardiopulmonary Bypass: A Prospective Randomized Study

Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. The neutrophil elastase inhibitor sivelestat is known to suppress this systemic inflammatory response, which can eventually result in acute organ failure. The prophylactic effect of sivelestat on acute lung injury, especially in pediatric cardiac surgery, remains unclear. This prospective double‐blind, randomized study evaluated the perioperative prophylactic effect of sivelestat in patients undergoing elective pediatric open heart surgery with CPB. Thirty consecutive patients, weighing 5–10 kg and undergoing open heart surgery with CPB, were assigned to sivelestat (n = 15) or control (n = 15) groups. From CPB initiation to 24 h after surgery, patients in the sivelestat group received a continuous intravenous infusion of 0.2 mg/kg/h sivelestat, whereas patients in the control group received the same volume of 0.9% saline. Blood samples were collected, and levels of interleukin (IL)‐6, IL‐8, tumor necrosis factor alpha, polymorphonuclear elastase (PMN‐E), C‐reactive protein (CRP), as well as the white blood cell (WBC) count, platelet count, and neutrophil count (NC) were measured. PMN‐E levels, IL‐8 levels, WBC count, NC, and CRP levels were significantly lower, and platelet count was significantly higher in the sivelestat group, according to repeated two‐way analysis of variance. The activated coagulation time was significantly shorter in the sivelestat group, similarly, blood loss was significantly less in the sivelestat group. In conclusion, Sivelestat attenuates perioperative inflammatory response and clinical outcomes in patients undergoing pediatric heart surgery with CPB.     

Heparin-Coated Equipment Reduces Complement Activation during Cardiopulmonary Bypass in the Pig

Complement activation was studied during cardiopulmonary bypass (CPB) in the pig. One group of animals was perfused for 2 h using a standard extracorporeal circuit including a hollow fiber membrane oxygenator with full systemic heparinization. Another group was treated in the same way, except that bypass was performed through a heparin-coated CPB circuit (Carmeda Bio-Active Surface, CBAS) and systemic heparinization was reduced by 75%. It was found that complement activation during CPB, measured as changes in the ratio C3d/C3, was significantly less in the CBAS group, most probably reflecting a better biocompatibility.     

小儿体外循环采用中度低温低流量灌注技术的临床研究

目的研究先天性心脏病患儿体外循环手术中采用中度低温合并低流量灌注技术的可行性。方法３０例手术患儿体外循环降温至肛温２５．６±０．８４℃，食管温度２４．１±１．３２℃，鼓膜温度２３．８±１．４１℃，维持流量１．２３±０．０９Ｌ／ｍｉｎｍ２，转流时间９５．４±３４．６分钟，主动脉阻断时间５１．４±２０．２分钟，低流量维持时间４５．７±２２．４分钟。结果低流量灌注时静脉血氧饱和度均在８０％以上，除１例外，其余均无缺氧酸中毒的血气表现，血乳酸值也未升高，术后恢复良好。结论中度低温体外循环选用低流量灌注可满足机体代谢的需要，有利于减少长时间高流量灌注的不良反应。     

体外循环致先天性心脏病手术患者血液细胞因子水平的变化

目的探讨体外循环对先天性心脏病手术患者外周血细胞因子水平的影响。方法以先天性心脏病手术患者为研究对象，不需体外循环的心血管手术患者作为对照，酶联免疫吸附法和生物活性法测定手术前、中、后多时间点外周血中细胞因子水平。结果二组患者术中和／或术后白细胞介素－２明显降低（Ｐ＜０．０５）；可溶性白细胞介素－２受体、白细胞介素－６、肿瘤坏死因子－α和白细胞介素－１０明显升高（Ｐ＜０．０５）。结论手术应激和体外循环均是引起先天性心脏病患者术中和／或术后细胞因子水平改变的主要因素。     

Oversaturation Status of Reticuloendothelial System Following Cardiopulmonary Bypass

Abstract: In the past, it was generally believed that the phagocytic function of the reticuloendothelial system (RES) was depressed after cardiopulmonary bypass (CPB), but several investigators reported differing results. Therefore, this study was performed to determine the effect of CPB on RES function, experimentally and clinically. Six dogs undergoing CPB (CPB group) were compared with an identical number of dogs subjected to thoracotomy without CPB (control group). A lipid emulsion test was performed in all dogs before and after the surgical procedure to measure RES phagocytic function. Any ultrastructural changes in Kupffer cells were observed by electron microscopy. In both groups, the RES phagocytic index showed a significant decline after surgery. However, comparison of the 2 groups revealed that there was a significantly greater decrease in the CPB group (p < 0. 05). Electron microscopy of the Kupffer cells showed that the number of phagosomes, especially those containing deformed erythrocytes, increased after CPB. Twenty patients undergoing cardiac surgery requiring CPB (Group A) and 8 patients undergoing pulmonary resection (Group B) were studied. RES phagocytic function was determined 3 days prior to surgery and 3 days postoperatively using the lipid emulsion test. No significant difference was observed in the preoperative phagocytic indices between the 2 groups. The phagocytic function remained almost unchanged in Group A on the third postoperative day, compared with the preoperative value, but it increased significantly in Group B on the third postoperative day, compared with the preoperative value. The intergroup difference was significant on the third postoperative day (p < 0. 01). These findings suggest that phagocytic activities of RES are not depressed but stimulated by CPB and that the phagocytic ability of RES is saturated by formed microparticles after CPB, such as residual of hemolyzed erythrocytes, protein aggregates, and microbubbles, among others. “Depressed RES phagocytic function” after CPB may not be a proper expression of this situation. It should be considered that the status of RES function after CPB is not functionally depressed but functionally oversaturated.     

Phenotypic Alterations in Circulating Monocytes Induced by Open Heart Surgery Using Heparinized and Nonheparinized Cardiopulmonary Bypass Systems

Abstract: In this study of 31 patients with coronary bypass surgery, we used flow cytometry to compare heparin-coated and noncoated cardiopulmonary bypass systems on leukocyte activation. We found significant differences between the groups during bypass, with activation of the complement system, measured as elevated levels of C3a desArg, upregulation of granulocyte β₂ integrin (CD11b). and a loss of circulating monocytes when noncoated systems were used. In both groups an early increase in the monocyte cell surface CD62L expression was obvious while the percentage of human leukocyte antigen (HLA)-DR positive monocytes did not alter. The morning after the operation, leukocytosis was present. together with a highly significant reduction in the monocyte expression of CDllb and HLA-DR, indicating the recruitment to the peripheral blood of cells with altered phenotypes. This alteration in phenotype on potent inflammatory cells may be one part of the impaired function of the immunological system reported after major surgery.