Use of A heparin-coated circuit for extracorporeal circulation with selective cerebral perfusion

The use of selective cerebral perfusion with a heparin-coated extracorporeal circuit has not been reported. We developed a unique extracorporeal circulation system that can be used for selective cerebral perfusion based on an existing heparin-coated circuit with a centrifugal pump for general open-heart surgery and a heparin-coated oxygenator without venous drainage by gravity. Between July 1994 and December 1999, this system was used for 12 patients undergoing surgery for true aortic arch aneurysm. The dose of heparin used was reduced to maintain minimum activated clotting time above 300 sec during extracorporeal circulation. One patient suffered a stroke, and one patient had transient postoperative neurologic deficit. One patient died suddenly of ventricular arrhythmia on the 11th postoperative day. The circuit remained thrombus-free. Selective cerebral perfusion with a heparin-coated bypass circuit was safe and very easy to perform after a simple modification of a standard circuit for open-heart surgery.     

Heparin-coated circuits prevent renal dysfunction after open heart surgery

We examined whether heparin-coated (HC) circuits can improve the operative results in patients with chronic renal insufficiency. SUBJECTS AND METHODS: Elective cardiac surgery was performed in 24 patients with a serum creatinine (Cr) level of at least 1.5 mg/dl. Uncoated circuits were used in 12 patients, and HC circuits were used in 12 patients. The results of surgery were compared between the two groups. RESULTS: The mean preoperative Cr concentration was significantly higher in the HC group (2.3 vs 1.8 mg/dl). The heparin doses, protamine dose, and activated clotting times were significantly lower in the HC group. The mean blood loss was also less, although this difference was not significant. The postoperative increase in the Cr level was small in the HC group (2.3-->2.5 mg/dl) compared to that in the noncoated group (1.8-->2.3 mg/dl). Postoperative dialysis was not required in the 5 patients in the HC group with a preoperative Cr clearance less than 20 ml/min. CONCLUSION: HC circuits and low-dose heparin can be used to maintain renal function after cardiopulmonary bypass, even in patients with severe kidney disease.     

体外循环管路的生物学评价

体外循环管路主要用于心肺手术和血液透析,属于三类医疗器械。本文通过细胞毒性试验、热原试验、致敏试验、皮内反应试验、急性全身毒性试验和溶血试验对某体外循环管路产品进行了生物学评价。结果显示其具有良好的生物相容性。     

应用护理敏感质量指标提升血液透析质量

目的探讨护理敏感质量指标在血液透析护理质量持续改进中的应用效果。方法通过德尔菲法确定血液透析敏感指标共计11项,并于2017年4月—9月应用在血液透析质量评估中,运用SPSS 20.0统计软件对收集的指标数据进行分析。结果11项血液透析护理敏感质量指标中,护患比符合国家标准,透析中急性并发症发生率、透析超滤达标率、透析充分性达标率、门诊透析患者急诊透析率和内瘘并发症发生率等5项指标第三季度与第二季度相比,差异有统计学意义( P＜0.05),体外循环凝血发生率、体外循环失血发生率、假性动脉瘤发生率、透析患者     

体外循环心脏手术后胃肠道并发症的综合治疗探究

目的通过观察体外循环心脏手术后胃肠道并发症的临床特征、危险因素、早期诊断、综合治疗以及预后干预措施,探讨体外循环心脏手术后胃肠道并发症的综合治疗措施。方法回顾我院2002年2月²013年10月收治的56例体外循环心脏手术(心脏瓣膜置换术32例,冠状动脉搭桥14例,心脏瓣膜置换术+冠状动脉搭桥术5例,大血管手术3例,先心病矫治术2例)术后发生胃肠道并发症的患者临床资料,分析胃粘膜保护机制削弱、损伤因素作用增强及机体的神经内分泌功能失调三方面在体外循环心脏术后胃肠道并发症的发生、发展、转归中的作用,总结体外循环心脏手术后胃肠道并发症的综合干预措施。结果 1例原有消化溃疡病史,因大量出血,死于休克;其余55例患者均痊愈出院。对55例患者进行为期12013年10月收治的56例体外循环心脏手术(心脏瓣膜置换术32例,冠状动脉搭桥14例,心脏瓣膜置换术+冠状动脉搭桥术5例,大血管手术3例,先心病矫治术2例)术后发生胃肠道并发症的患者临床资料,分析胃粘膜保护机制削弱、损伤因素作用增强及机体的神经内分泌功能失调三方面在体外循环心脏术后胃肠道并发症的发生、发展、转归中的作用,总结体外循环心脏手术后胃肠道并发症的综合干预措施。结果 1例原有消化溃疡病史,因大量出血,死于休克;其余55例患者均痊愈出院。对55例患者进行为期1⁵年的随访,均无复发和死亡情况。结论体外循环心脏手术后胃肠道并发症病死率高,对术前有胃肠道病史、术前心功能差等高危患者术前可采取必要的预防措施,术后对并发症早期诊断、早期采取综合干预措施,可以提高生率,达到很好的治疗效果。     

Histamine-related reactions in patients with byssinosis

The purpose of the study was to analyze the mechanism of histamine action in histamine-dependent reactions of neutrophils and lymphocytes in patients with byssinosis and chronic asthmatic bronchitis under cotton and flax dust effect. The appraisal of histamine content in blood serum, receptor/histamine distribution of lymphocyte and neutrophil subpopulations (rosette-forming double and triple reactions), determination of histamine modeling effect on lymphocyte-neutrophil cooperation in the inhibition reaction of leukocyte migration revealed that under cotton dust effect neutrophils and the complement system were involved into the histamine liberation process in byssinosis patients, lymphocytes were most likely not involved into the process. Flax dust-affected histamine reactions were not so distinct: lymphocyte and neutrophil reactivity in byssinosis patients did not exceed the standards. Patients with chronic asthmatic bronchitis had high blood concentration of histamine and experienced some changes in cells' migration characteristics. It was assumed that primarily nonimmune mechanisms of histamine liberation and activation of the complement system were involved into byssinosis pathological process in patients exposed to cotton and flax dust effect. In patients with chronic asthmatic bronchitis there occurred all 3 activation mechanisms of biologically active substances, i.e., allergic and nonantigenic ways of histamine liberation and activation of the complement system.     

体外循环的管理及质量控制

体外循环技术自应用于临床以来，极大地促进了心血管外科的发展，但体外循环并发症发生率仍然很高，与体外循环有关的意外亦时有发生。体外循环的管理及质量控制在一定程度上可以减轻或避免体外循环的不良预后。本文探讨了体外循环管理及质量控制工作的理论基础及重要性，并分析了影响体外循环工作质量的原因，总结了提高体外循环工作质量的对策，对医院建院后体外循环工作进行了总结。     

心脏辅助与替代装置中血泵的控制及监测方法

用体外循环实现心肺转流是顺利完成心脏手术的先决条件．而血泵则是体外循环装置中的关键部件．其流量与压力等流体机械参数的控制和检测对保证心脏手术的顺利进行至关重要。该文综述了基于流量,压力、心率、心室功和血流辅助指数的几种血泵控制方法．并介绍了血泵流量与压力的直接和间接测量的方法。最后．结合血泵系统的研究现状．从血泵控制和检测方法等方面探讨了今后可能的研究发展方向。     

密闭的体外循环系统在手术室内保存期限的试验研究

目的评估手术室"干备"密闭的体外循环环路不受细菌污染时限。方法严格无菌条件下连接5套密闭的体外循环环路,存放于万级层流手术室内,分别在连接后即刻、24、48、72、96、120、144、168 h时,于环路的膜式氧合器储血罐心内吸引连接处内侧、静脉总干连接处内侧和膜式氧合器动脉出口内侧,使用无菌棉签取样,同时做手术间的空气细菌培养;所有标本在细菌室做细菌培养,观察其菌落生长情况。结果所有时间点的空气培养均为阴性,5套体外循环管路分别在连接后即刻、24、48、72、96 h时各处标本均未观察到菌落生长,120 h时其中一套体外循环环路的膜肺动脉出口处,取样标本中培养出革兰阳性球菌菌落,144 h和168 h各个标本亦未培养出菌落。结论 "干备"体外循环环路存放于万级层流手术室条件下,3 d内是安全的。     

尿NGAL在体外循环术后急性肾损伤早期诊断中的意义

目的 探讨尿中性粒细胞明胶酶相关脂质运载蛋白（Neutrophil gelatinase-associated lipocalin,NGAL）在体外循环术后急性肾损伤（Acute kidney injury,AKI）早期诊断中的价值与意义.方法 选择120例进行体外循环手术的先天性心脏病患者,体外循环结束后第一个12 h内每2小时采集尿样及血样1次,此后3 d内每12小时采集1次,采用ELISA方法对尿样中NGAL进行定量分析,同时在相应时间点检测血清肌酐水平,血清肌酐比基线水平增加50%以上为发生AKI的标准.结果 术后3 d内有21例发生不同程度AKI,发生率17.5%,AKI组尿NGAL在体外循环术后2 h即显著上升,以术后2～6 h最为显著,而血清肌酐多数在体外循环术后24 h才开始上升,AKI组与无AKI组血肌酐差异有统计学意义（P＜0.05）,ROC分析表明术后2 h的尿NGAL在Cutoff值为100 ng/mg Cr时,其诊断AKI的敏感性和特异性分别为92%和91%.结论 尿NGAL可以作为体外循环术后AKI早期诊断的预测指标.     

体外循环下处理动脉导管未闭手术32例分析

目的探讨体外循环下(CPB)处理动脉导管未闭(PDA)的外科治疗经验。方法回顾性分析本院1994年10月～2011年10月在体外循环下处理32例PDA的临床特点、手术方式及转归。结果术后1例患者出现灌注肺,1例患者重度肺动脉高压导致右心功能不全,1例出现肺动脉高压危象,其余患者均康复出院,复查动脉导管无再通。结论合并心内畸形的PDA,术前诊断及术中探查是关键,心内直视手术前处理好PDA,可减少术后并发症。对单纯PDA应严格掌握体外循环下手术的适应症。绝大多数PDA均可进行心包内游离,充分显露是手术的关键。结合心包内分离及经肺动脉切口处理PDA,可明显缩短CPB时间,减少术后并发症,缩短术后康复时间。     

乌司他丁、立芷雪对体外循环心脏手术患者的血液保护作用

目的探讨乌司他丁和立芷雪对体外循环心脏直视手术的血液保护的作用。方法选择180例体外循环心脏直视手术病人,随机分为乌司他丁组(U组)、立芷雪组(L组)和对照组(C组);每组各60例,乌司他丁30万U、立芷雪3 kU分别以生理盐水溶解稀释至20 ml,对照组为20 ml生理盐水,分别于麻醉后经静脉用微量泵30 min泵入。分别于麻醉后(T1)、体外循环转机30 min(T2)、手术结束时(T3)、手术结束后24 h(T4)4个时点自桡动脉取血,测定血红蛋白浓度、血小板计数、并记录术后胸腔引流量。结果三组血浆血红蛋白浓度、血小板计数于T2、T3、T4时明显下降,乌司他丁组和立芷雪组手术结束时血红蛋白浓度、血小板计数明显高于对照组,术后胸腔引流量也少于对照组。乌司他丁组和立芷雪组相比,各指标差异无显著性意义。结论在体外循环心脏直视手术期间血液纤溶系统亢进,血小板功能受损,乌司他丁可抑制纤溶系统的过度激活,保护了血小板的功能,具有和立芷雪相似的血液保护作用。     

双瓣置换术中肺动脉灌注低温改良LPD液的肺保护作用

目的探讨双瓣置换术中，肺动脉灌注低温改良LPD液对肺损伤的保护作用。方法24例需实施双瓣置换术的风心病患者，对照组14例和灌注组10例，灌注组常规完成手术＋肺动脉灌注低温改良LPD液，对照组常规完成手术，未行肺动脉灌注。术前、停CPB时、停CPB后1、2、6、12h六个时间点监测两组病例的氧合指数，术前、停CPB时、停CPB后6、12h四个时间点检测血浆IL石、IL-10的水平。结果与对照组相比，灌注组术后氧合指数明显改善，IL-6表达降低，IL-10表达增加。结论CPB中肺动脉灌注低温改良LPD液能减轻双瓣置换术后肺损伤，改善肺功能。     

体外循环下治疗布-加综合征合并下腔静脉血栓形成

目的总结在体外循环辅助下,经右房切口治疗合并下腔静脉血栓形成的布-加氏综合征的治疗经验。方法回顾我院自2002年9月至2010年7月共计49例在体外循环辅助下．经右心房切口治疗合并下腔静脉血栓的布加氏综合征的临床病例和随访资料。结果全组病人均成功的在体外循环辅助下完成经右房切口下腔静脉狭窄段扩张及血栓取出术。术中在手指破膜后再使用3．0×4．0cm球囊进行扩张。围手术期病人无死亡,无急性肺检塞等严重并发症的发生。术后随访0^-36个月,所有病人术后症状明显缓解,腹水及下肢水肿减轻至消失。1例病人术后1年后出现再狭窄,经股静脉行下腔静脉球囊扩张后好转。全组病人术后随访未见有血栓形成。结论在体外循环下,经右房切口对于合并下腔静脉血栓的布-加氏综合征是一种安全有效的治疗方法．     

体外循环下治疗布-加综合征合并下腔静脉血栓形成(附49例病例报告)

目的总结在体外循环辅助下,经右房切口治疗合并下腔静脉血栓形成的布-加氏综合征的治疗经验。方法回顾我院自2002年9月至2010年7月共计49例在体外循环辅助下,经右心房切口治疗合并下腔静脉血栓的布加氏综合征的临床病例和随访资料。结果全组病人均成功的在体外循环辅助下完成经右房切口下腔静脉狭窄段扩张及血栓取出术。术中在手指破膜后再使用3.0×4.0cm球囊进行扩张。围手术期病人无死亡,无急性肺栓塞等严重并发症的发生。术后随访0～36个月,所有病人术后症状明显缓解,腹水及下肢水肿减轻至消失。1例病人术后1年后出现再狭窄,经股静脉行下腔静脉球囊扩张后好转。全组病人术后随访未见有血栓形成。结论在体外循环下,经右房切口对于合并下腔静脉血栓的布-加氏综合征是一种安全有效的治疗方法。     

改良超滤和机血快速回输技术在瓣膜替换术中的应用

目的　在瓣膜替换术中应用改良超滤和机血快速回输技术 ,并评价其减少术后出血、降低术后并发症的效果。方法　 148例风湿性心脏瓣膜病病人随机分为两组 ,88例采用改良超滤和机血快速回输技术 (实验组 ) ,与 6 0例常规手术 (对照组 )进行对比 ;比较两组病例术后出血和临床用血情况。结果　实验组停体外循环后红细胞压积明显增高 (P <0 .0 1) ,术后 2 4h出血量和术后库血用量明显减少 (P <0 .0 1) ,不输血病例数量增加。结论　改良超滤和机血快速回输技术能使术后创面渗血明显减少。     

手术联合介入封堵体肺动脉侧支矫治法洛四联症短期效果

目的 评价手术联合介入封堵体肺动脉侧支矫治法洛四联症的临床应用价值.方法 2004年10月至2008年5月,采取手术联合介入封堵大的体肺动脉侧支矫治法洛四联症8例.心血管造影诊断体肺动脉侧支血管25支,行介入封堵20支,其余5支侧支血管较细,未作处理.手术均采用中度低温体外循环下进行,采用涤纶补片修复室间隔缺损,右心室流出道彻底疏通.结果 全组患者无围手术期死亡,无肺部严重渗出、肾衰竭、严重低心排血量综合征等并发症,也无介入封堵相关并发症,发生低氧血症1例,经治疗后恢复正常.术后随访6个月,NYHA心功能分级Ⅰ级7例,Ⅱ级1例.结论 介入封堵体肺动脉侧支与心内矫治手术联合治疗伴有大的体肺动脉侧支的法洛四联症,能减少回心血流量,利于手术操作,进而提高一期根治的成功率.     

Parental Perception of Neonatal Extracorporeal Membrane Oxygenation

The increasing acceptance of extracorporeal membrane oxygenation (ECMO) as a means of supporting neonates with respiratory failure has established this form of cardiopulmonary bypass as an important technology in pediatrics. Although the majority of ECMO graduates survive without major neurological or pulmonary damage, there is a paucity of data regarding family outcomes. The possibility of the child's death combined with the complexity of the procedure can engender high levels of stress for parents. We explored parents' perceptions about their baby's ECMO procedures. Qualitative analysis was used to reduce interview data into major categories with related themes. Results are presented across the psychological dimensions of parental perceptions and include implications for clinical practice.     

The principles of minimal extracorporeal circulation and its uses

The recently introduced minimal extracorporeal circulation system is a remarkable alternative to the conventional heart-lung machine in several cardiosurgical indications. It consists of a centrifugal pump, an oxygenator, a tip-to-tip heparin coated line set and a modified cell saver application. Due to its closed blood-air interaction-free construction and reduced priming volume, the unfavourable effects of perfusion as haemodilution, inflammatory response, locoregional malperfusion, transfusion needs, can be effectively reduced. Our short summary demonstrates the advantages and safety of the system proven over 2000 cases. The potential applications are aortocoronary bypass operations with or without arrest, left heart bypass at thoracal aneurysms, "bridge to recovery" in heart failure or subsequent to reanimation, extracorporeal membrane oxygenation and many more.     

Synthesis and evaluation of 2-tosylamino and 2-tosyliminopyrimidine derivatives as inhibitors of some leukocyte functions

We have studied the potential anti-inflammatory effects of 20 2-tosylamino and 2-tosyliminopyrimidine new derivatives in human neutrophils. We have evaluated their interference with some leukocyte functions and 5-lipoxygenase activity. All the compounds reduced neutrophil degranulation process at concentrations in the microM range. Besides, compounds with a phenolic substitution inhibited leukotriene B(4) biosynthesis in neutrophils and decreased the cell-free 5-lipoxygenase activity. This study demonstrates that 2-tosylamino and 2-tosyliminopyrimidine derivatives can reduce the activation of neutrophil cells which may have relevance for the modulation of the inflammatory response.