体外循环中血浆内皮素的变化

观察体外循环心内直视手术病人不同时间（术前１天、术中不同时点，术后１、３、７天）血浆内皮素水平。结果表明，体外循环开始后血浆内皮素持续升高至术前２倍，直至体外循环结束。提示内皮素是心脏手术病人一个新的加压指标，术中选用保护剂可能有益。     

体外循环后凝血系统的变化

体外循环(CPB)对凝血系统有多方面影响。本文旨在通过测定APTT、PT和ACT等指标来了解CPB后凝血系统的变化,对防治心内直视手术后出血可能有一定的临床意义。资料与方法择期心脏瓣膜替换病人33例,术前没有抗凝治疗,出凝血检查和肝肾功能正常。麻醉采用静脉芬太尼和安氟醚吸入,CPB用Sarns机,膜式氧合器。预充液为乳酸林格氏液1500ml、706代血浆500ml和各种电解质,肝素化剂量400U/kg,CPB中ACT>480秒,其它资料见     

高原犬体外循环后肺功能的变化

为了研究在高原缺氧情况下体外循环前后肺功能的变化，为临床开展体外循环提供经验，我们对犬体外循环前后的肺功能进行了以下检测，现报道如下。一、对象与方法１．一般资料　实验地海拔３６５８米，大气压为６４．８～６５．５ｋＰａ，大气中氧分压为１３．１～１３．４ｋＰａ，仅为海平面氧分压的６４．２９％。本地健康成年杂种犬６０条，雌雄不拘，体重９～２３ｋｇ，平均（１４．７±４．１）ｋｇ，均在全麻下经右胸前外侧切口做单纯开胸手术。非体外循环组２０条犬，手术时间３５～７２分钟，平均（４１±１６）分钟。体外循环组（４…     

非体外循环紧急转为体外循环冠状动脉旁路移植术的分析

目的了解导致非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,off-pumpCABG)紧急转为体外循环冠状动脉旁路移植术(on-pump coronary artery bypass grafting,on-pump CABG)的临床的原因,为手术方法的选择提供借鉴。方法回顾分析2002年1月～2006年5月期间546例冠心病患者行off-pumpCABG的临床资料,对术中需紧急转为体外循环下完成手术的患者(off-pump转on-pump组,24例)与同期顺利完成off-pump CABG患者(off-pump组,522例)进行对比分析,并行logistic多因素分析。结果在行off-pump CABG中,24例患者因心室颤动或血流动力学不稳定需紧急改变术式。Off-pump转on-pump组患者中死亡4例,死亡率为16.7%(4/24),明显高于off-pump组[16.7%vs.2.7%(14/522),P<0.001]。多因素logistic回归分析结果提示急性心肌梗死(OR=3.142,P=0.004)、急诊CABG(OR=1.571,P=0.011)和右冠状动脉狭窄≤90%(OR=1.922,P=0.024)为off-pump转为on-pump的危险因素。结论Off-pump紧急转为on-pump时死亡率明显增高,对同时合并有右冠状动脉狭窄≤90%、急性心肌梗死和急诊CABG等高危因素行off-pump CABG时,要做好体外循环的准备。     

围体外循环期应激激素变化及胰岛素抵抗研究

体外循环（ＣＰＢ）心脏手术中强烈的创伤刺激可引起严重的应激反应，此时机体主要通过激素的浓度变化来调节机体的代谢反应，而组织对胰岛素敏感程度的变化可能是激素和代谢调节之间的关键环节。资料和方法　２０例病人包括先天性心脏病组（Ｉ组）１０例，风湿性心脏病组（ＩＩ组）１０例。均无糖尿病，未服用相关药物，亦无其它内分泌病史。ＣＰＢ全部采用Ｓａｒｎｓ体外循环机和西京８７型鼓泡式氧合器，中度低温、血液稀释、中高流量。心内操作结束后，依次开放主动脉和上、下腔静脉，整个手术过程不用外源性胰岛素。所有病人分别在麻醉…     

体外循环下血糖和游离脂肪酸变化的临床研究

测定２６例心内直视手术病人血浆糖（Ｇｌｕｃｏｓｅ），游离脂肪酸（ＦＦＡ）、肾上腺素（Ｅ）、去甲肾上腺素（ＮＥ）的变化，发现体外循环（ＣＰＢ）中Ｇｌｕｃｏｓｅ显著性升高，持续至术后翌展；ＦＦＡ在肝素化后显著增高，而转流中一直处于低水平状态，术后２小时复又升高，术后第１天恢复正常。同时观察到围手术期ＮＥ、Ｅ显著升高。文中探讨了Ｇｌｕｃｏｓｅ、ＦＦＡ变化的机理，并就其变化的临床意义进行了讨论。     

体外循环过程中心肌腺苷酸环化酶活性变化

建立体外循环实验模型，观测狗左室心肌腺苷酸环化酶（ＡＣ）活性改变。结果显示：心脏停搏缺血４５分钟，心肌ＡＣ活性明显减低；停搏缺血１５０分钟，此酶活性进一步降低。停机１２０分钟后，停搏４５分钟的心脏心肌ＡＣ活性恢复，而停搏１５０分钟的心脏心肌ＡＣ活性仍明显低于正常对照。结论：体外循环过程心肌缺血可致伤ＡＣ催化单位，缺血时间延长此损伤加重，复灌过程心肌ＡＣ活性恢复情况与其损伤程度有关，这可能成为术后心脏低排的一个重要原因。     

Heparin-coated Cardiopulmonary Bypass Circuits in Coronary Bypass Surgery

Abstract: Cardiopulmonary bypass (CPB) is a nonphysiologic environment for an organism. The damage of blood components may also lead to organ dysfunction, sometimes recognized as postperfusion syndrome. One possible way to diminish the risk of these complications would be to reduce the thorombogenicity and to improve the biocompatibility of the artificial surfaces by using a heparin-coated CPB circuit. In this study, we compared a heparin-coated CPB circuit with a noncoated CPB circuit in terms of biocompatibility in 20 patients undergoing elective coronary bypass surgery. We employed a Dura-flo II (n = 10) as a heparin-coated CPB circuit and a Univox IC (n = 10) as control subjects. Ten patients (Group C) were operated on using the heparin-coated CPB circuit. A total of 10 patients were given heparin in a reduced dose (2.0 mg/kg), and additional heparin was given if the activated clotting time (ACT) was below 400 s. The control group also included 10 patients (Group NC), who were operated on with noncoated devices. They received 2.5 mg/kg of heparin, and additional heparin was given if the ACT was below 450 s. All patients had normal coagulation parameters and did not receive blood transfusion. We measured complement activation levels (C3a, C4a), platelet count, thrombin-antithrombin III complex levels, D-dimer levels, and ACT during CPB and respiratory index postoperatively. The concentration of C3a in group NC was significantly higher than that in group C. Platelet reduction in group NC was significantly greater than that in group C. There were no significant differences in the remaining parameters between the 2 groups. We concluded that heparin-coated CPB circuits improved biocompatibility by reducing complement activation and platelet consumption and enabled us to reduce the dose of heparin required for systemic heparinization.     

心肺转流术在犬心肺脑复苏中的应用

目的：观察犬在高钾停搏10分钟后行心肺转流术（CPB）复苏,并与常规心肺复苏（CPR）比较其自主循环恢复和脑复苏的效果。方法：将杂种家犬12只,以10％KCl静脉给药致心脏停搏（CA）10分钟后随机分为两组,每组6只。组1;用常规CPR法复苏;组2：用自行研制的心肺转流装置复苏。两组于CA前、CA10分钟,复苏后5分钟、10分钟和30分钟监测平均动脉压（MAP）、心率（HR)、心脏复跳时间、瞳孔大小、72小时存活率和动静脉血气并计算脑氧摄取率（CEO2)脑氧耗量（Ca-jvO2)。结果：组1中6只犬仅2只在CPR后10分钟、15分钟恢复自主心跳,但不稳定,并在60分钟内死亡;组2均于CPB后6－10分钟恢复自主心跳,CPB10分钟后MAP＞80mmHg,明显高于组1（P＜0．05）,其自主循环恢复率为100％,明显大于组1（P＜0．05）。两组CEO2和Ca-jvO2在CA10分钟、复苏后5分钟和10分钟均明显升高（P＜0．05）,且复苏后5分钟、10分钟和30分钟时组1明显高于组2（P＜0．05）。组2犬的瞳孔于复苏后第9－19分钟开始缩小,30分钟后恢复至正常,全组均存活72小时以上,72小时存活率为100％,明显高于组1（P＜0．05）。结论：CA10分钟后,用CPB复苏其自主循环恢复明显优于常规CPR,并有益于脑复苏。     

Hydration before Cardiopulmonary Bypass

A generous fluid regimen before cardiopulmonary bypass (6% of body weight) combined with a vasodilator (nitroprusside) was described recently. The present study deals with central haemodynamics, pulmonary oxygenation, glomerular filtration rate and the use of blood products before and after bypass in patients given crystalloid fluid corresponding to 3% of b.w. before bypass combined with nitroglycerin in a close that kept pulmonary artery pressure at a constant level. Ten patients with aortic stenosis and/or incompetence were studied. Cardiac output (thermodilution), heart rate, blood pressures, arterial oxygen tension (Pao₂) at an inspired oxygen concentration of 30%, the concentration of oxygen in blood and endogenous creatinine clearance were measured. After the induction of neurolept anaesthesia, cardiac index, stroke volume, systemic and pulmonary vascular resistance, pulmonary arteriovenous oxygen difference. Pao₂ (Fio₂ = 0.3) and glomerular filtration rate were within normal limits. Neither hydration nor the bypass procedure itself caused any change in these parameters. The patients tolerated cannulation of the large vessels well without hypotensive episodes. When compared with a similar group of eight patients treated with a restrictive fluid regimen (0.21 before bypass), no significant differences in the above-mentioned parameters were found.