婴幼儿体外循环中监测胶渗压及红细胞压积在超滤中的作用

目的:探讨婴幼儿体外循环(CPB)期间超滤的应用及其与胶体渗透压(COP)和红细胞压积(Hct)的相互影响。方法:检测38例体质量10 kg以下先天性心脏病(CHD)患儿CPB中的COP,于转机前对预充液进行常规超滤(CUF)以适当提高COP。CPB中应用CUF,停机后依据COP及Hct加用改良超滤(MUF)。结果:CUF超滤量(407.63±165.11)mL。9例加用MUF,超滤量(88.89±34.06)mL,进一步浓缩血液,提高COP。结论:CUF用于预充液超滤可适当提高其COP,CUF及MUF可在婴幼儿心脏手术中单独或联合应用。综合COP及Hct可以决定超滤方式及超滤量,是否输入红细胞或胶体及输入量。     

零平衡超滤与改良超滤在老年患者心脏手术中的联合应用研究

目的:总结70岁以上老年患者体外循环中联合应用零平衡超滤(ZBUF)与改良超滤(MUF)的经验。方法:70岁以上老年患者98例均在低温体外循环下实施手术,转中依血红蛋白(HGB)水平适当ZBUF,停机后行MUF。结果:98例患者均顺利停机。超滤时间40~100(75.3±11.7)分钟,滤出液800~3000(1650±56.6)m L,停机时HGB压积(HCT):24~35(29.2±1.5)%,HGB水平为7.9~9.0(8.6±0.2)g/L,MUF后HGB水平为9.8~12.5(11.2±1.02)g/L。ICU监护时间平均4~6天,平均:4.8天。结论:ZBUF与MUF的联合应用有利于术后多余水分的排出及炎性介质的滤出,对于老年患者和长时间体外循环者安全有效。     

改良超滤对成人瓣膜置换术早期预后的影响

目的 :了解改良超滤对成人瓣膜置换术早期预后的影响。方法 :10 3例成人瓣膜替换术患者 ,随机分为常规超滤组 (CUF组 ,n =5 5 )和改良超滤组 (MUF组 ,n =4 8)。分别于术中应用常规和改良超滤技术 ,对 2组术后早期的临床资料进行比较分析。结果 :全部病例中心功能Ⅳ级的患者相比 ,MUF组术后即刻心指数 (CI) ,左室每搏功指数 (LVSWI)和每搏指数 (SVI)均明显高于CUF组术后即刻CI(P <0 0 1) ,LVSWI和SVI(P <0 0 5 ) ,其中CI在术后 6h仍显著高于CUF组 (P <0 0 5 ) ,2组间SVR ,PVR ,RVSWI无明显差异。MUF组术后红细胞压积 (HCT)和氧合指数 (OI)均显著高于CUF组 (P <0 0 1) ,术后2 4h尿量明显少于CUF组 (P <0 0 1)。与CUF组相比 ,MUF组的呼吸机辅助通气时间和ICU监护时间均明显缩短 (P <0 0 5 )。结论 :与常规超滤法相比 ,改良超滤可以在术后迅速浓缩血液 ,减轻机体水肿 ,保护心肺功能 ,有利于改善术后早期的预后     

儿童法洛四联症根治术的体外循环管理(附38例报告)

分析38例儿童法洛四联症(TOF)根治术的体外循环(CPB)资料.结果显示本组患儿CPB时间(108.9±23.5)rain,主动脉阻断时间(68.6±23.6)min.主动脉开放后36例(95%)心脏自动复跳.常规应用多巴胺支持撤机,停机顺利.36例采用中低温中低流量灌注,2例采用深低温低流量CPB,CPB中尿量(324.7±268.9)ml.全部应用改良超滤(MUF)共(12.2±2.5)min,滤出液(451.4±90.3)ml,超滤后红细胞压积(HCT)升至35%～40%.术后呼吸机支持时间(25.5±12.5)h,ICU停留时间(2.7±0.6 d),无死亡病例.认为采用适当的血液稀释和胶体液预充、选择与外科手术相配合的灌注方式、应用MUF、注意术中心肌保护是儿童TOF根治术体外循环管理的重点.     

逆行自体血液预充和改良超滤在儿童体外循环中的应用

目的探讨逆行自体血液预充技术(RAP)和改良超滤技术(MUF)联合应用对儿童体外循环的影响.方法40例体外循环手术患儿,随机分为实验组(n=20)和对照组(n=20).实验组联合应用逆行自体血液预充技术和改良超滤技术,对照组不进行上述两项技术.分别记录两组患儿体重,体表面积,体外循环时间及主动脉阻断时间,逆行自体血液预充置换液量,转前、转中、术后红细胞压积,呼吸机使用时间及围手术期临床用血量.结果两组患儿体重,体表面积,体外循环时间及主动脉阻断时间差异无统计学意义(P＞0.05).转前、转中红细胞压积比较差异亦无统计学意义(P＞0.05);实验组可减少预充液量,转后红细胞压积实验组(32.50±3.04)%高于对照组(24.05±1.47)%,差异具有统计学意义(P＜0.05),实验组呼吸机使用时间为(106.50±47.85)min,围手术期临床用血量为(0.15±0.26)U,对照组呼吸机使用时间为(195.75±77.94)min,围手术期临床用血量为(0.78±0.62)U,实验组均少于对照组,差异有极显著性意义(P＜0.01).结论逆行自体血液预充技术和改良超滤技术在儿童体外循环手术中联合应用可以减少临床用血量,降低输血相关风险,促进患儿术后恢复.     

婴幼儿左向右分流型先天性心脏病合并重症肺炎的体外循环管理

目的:探讨婴幼儿左向右分流型先天性心脏病合并重症肺炎的体外循环管理方法。方法:回顾性分析2013年5月至2017年6月我院收治的78例左向右分流型先天性心脏病合并重症肺炎患儿的临床资料,患者均接受急诊或亚急诊手术。术中应用浅低温、进口膜肺进行体外循环,经主动脉根部顺行灌注康斯特保护液(HTK液)进行心肌保护,术中应用常规超滤联合改良超滤技术。结果:体外循环时间为45~68 min,平均(50.24±12.45)min,主动脉阻断时间为10~60 min,平均(23.56±10.68)min。心脏自动复跳76例(97%)。转流结束后改良超滤时间为8~15 min,平均(10.45±3.24)min。术后死亡3例(3.8%)。结论:婴幼儿左向右分流型先天性心脏病合并重症肺炎常危及患儿生命,早期手术可获得理想的治疗效果。体外循环采用常规超滤联合改良超滤技术、合适的膜式氧合器、精确的预充及血液稀释、良好的心肌保护等措施是提高手术成功率的重要保障。     

改良超滤在成人心脏瓣膜置换术中的应用

目的:总结改良超滤在成人心脏瓣膜置换手术的应用,并评价其减少围术期出血的效果及库血应用情况。方法:将100例体外循环(CPB)下心脏瓣膜置换术成人患者,随机分成改良超滤组(MUF组,n=50)及常规超滤组(CUF组,n=50)。检测两组红细胞压积(Hct)和血小板(Plt)在各时段的变化;并对围术期输血量、出血量,呼吸机辅助通气时间和ICU监护时间进行比较。结果:对照组因出血死亡2例,余98例患者痊愈出院,两组患者Hct和血小板在各时段比较无明显异常,MUF组未输入库血率明显高于CUF组[(29/50)与(14/5),P<0.01)]、输库血量及出血量较CUF组明显减少[(2.7±1.2)vs.(4.2±2.2),P<0.05];[(577±281)vs.(901±591)mL,P<0.05)]、MUF组呼吸机辅助通气时间(12.5±4.4)h、ICU监护时间(16.8±6.7)h和CUF组呼吸机辅助通气时间(17±6.9)h、ICU监护时间(22.0±11.1)h比较,明显缩短(P<0.05)。结论:心脏手术体外循环后采取改良超滤,可迅速回输心肺机管道系统的余血,排出体内多余水分,能迅速浓缩血液成分,减少库血的应用及输入量。     

静脉-动脉改良超滤在Stanford A型主动脉夹层手术的应用

目的 探讨静脉-动脉改良超滤(VA-MUF)在Stanford A型主动脉夹层(TAAD)手术中的临床效果.方法 回顾性分析2018年1月至2021年3月南方医科大学南方医院心血管外科接受手术治疗的TAAD患者81例,其中在体外循环(CPB)中应用VA-MUF(MUF组)32例,采用常规超滤(CUF组)49例.记录并比...     

改良超滤联合常规超滤对重症瓣膜病患者瓣膜置换术后肺保护的作用

目的:探讨改良超滤联合常规超滤技术对体外循环瓣膜置换术后肺损伤的改善作用.方法:纳入102例行瓣膜置换术的重症瓣膜病患者,分为常规超滤组(CUF组)和常规超滤联合改良超滤组(CMUF组),两组在体外循环(CPB)中均进行常规超滤,CMUF组在转流结束后进行改良超滤直至机血全部回输体内.分别于诱导后(T1)、常规超滤开始...     

老年人长时间心内直视手术的体外循环管理

目的总结老年人长时间心内直视手术体外循环的管理经验。方法2003年9月至2005年9月老年人长时间体外循环(CPB)心内直视手术36例,其中采用深低温停循环2例、中度低温34例。使用主动脉球囊反搏(IABP)辅助7例,离心泵左心辅助循环4例,应用改良超滤(MUF)8例,心肌保护应用氧合血心肌停搏液。根据病情选用顺灌、逆灌、桥灌及顺灌逆灌间断灌注的灌注方法。实施血液保护、脑保护、心肌保护、肺保护、肾保护。结果1例冠状动脉移植合并室壁瘤切除术患者,术后因多脏器功能衰竭死亡,其余均顺利康复出院。结论体外循环中采用综合性措施是老年人长时间心内直视手术成功的保证。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.