康斯特保护液对婴幼儿心内直视手术心肌保护效果的临床观察

目的 对比康斯特保护液(HTK液)和ST.Thomas液在婴幼儿心内直视手术中对心肌的保护作用.方法 将40例择期行心内直视手术的婴幼儿随机分为两组.HTK组灌注HTK液,ST.Thomas组灌注ST.Thomas液.术中由冠状静脉窦取血,行肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cT-nI)检测.开放升主动脉前取小块右心房心肌组织行超微结构观察.结果 血清CK-MB和cT-nI浓度变化:开放升主动脉后较缺血前两组均明显升高.心肌结构改变:ST.Thomas组可见心肌细胞水肿,片状肌浆凝聚,心肌纤维呈波纹状改变,线粒体轻度肿胀,部分嵴断裂,空泡形成.HTK组超微结构改变较ST.Thomas组轻.结论 HTK液对未成熟心肌有良好的保护作用,可减轻心肌细胞及间质水肿,肌原纤维结构破坏轻,线粒体损伤轻.单次灌注可避免多次灌注所致的心肌细胞水肿和冠脉血管内皮的损伤.     

心肌肽素在体外循环中对心肌保护的临床研究

目的 探讨心肌肽素（CMP）在体外循环中对心肌的保护作用。方法 50例风湿性心脏病患者，随机分成对照组和实验组。对照组经升主动脉根部灌注冷晶体停跳液，实验组在晶体停跳液的基础上加入心肌肽素60mg／L。其它处理两组相同。从心肌酶谱（AST、CK-MB、LDH1）、心肌组织细胞形态学、心肌细胞超微结构等观察对心肌的影响。结果 （1）两组病例心肌酶在升主动脉开放后显著升高，但实验组明显低于对照组，两组间差异有显著性。（2）心肌组织细胞形态学、细胞超微结构观察发现对照组因缺血、缺氧引起的心肌纤维变性、心肌横纹模糊和空泡样变显著，电镜结果显示对照组术后部分心肌纤维溶解断裂，线粒体肿胀明显；而实验组心肌细胞的形态学超微结构损伤轻。结论 心肌肽素加入晶体停跳液中可加强心肌保护，减少心肌酶的释放，心肌细胞超微结构损伤轻，对心肌的保护效果优于单纯晶体停跳液。     

腺苷静脉预处理对缺血/再灌注心肌的保护作用

目的：比较腺苷静脉预处理在体外循环心内直视手术中对缺血/再灌注心肌的保护作用。方法：将在体外循环下行心内直视术非紫绀型先心病及瓣膜病患者30例,随机分为两组（每组15例）。A组：腺苷静脉预处理组;B组：空白对照组;两组其他处理相同。分别于阻断升主动脉前、阻断升主动脉30分钟、开放升主动脉15分钟及术后24小时检测血清肌酸激酶同工酶-MB（CK-MB）、乳酸脱氢酶（LDH）水平。结果：两组血清CK-MB、LDH水平均有明显升高,实验组术中、术后血清CK-MB、LDH水平均明显低于对照组（P〈0.05）。结论：腺苷静脉预处理能模拟缺血预处理（IPC）的心肌保护效应,在体外循环心内直视手术中对缺血/再灌注心肌具有保护作用。     

体外循环阻断与不阻断升主动脉心内直视术临床研究

目的 对比分析体外循环不阻断升主动脉不停跳心内直视手术、不阻断升主动脉停跳心内直视手术、阻断升主动脉心内商视手术的心肌保护效果. 方法 45例先天性心脏病患者,随机选择分为不阻断升主动脉不停跳组(n=15),不阻断升主动脉停跳组(n=15),阻断升主动脉组(n=15).比较心肌细胞三磷酸腺苷含量、血浆丙二醛和心肌钙蛋白Ⅰ浓度,以及电子显微镜下对比观察心肌细胞超微结构. 结果 阻断升主动脉组心肌细胞三磷酸腺苷含量、血浆丙二醛浓度、血浆心肌钙蛋白-Ⅰ浓度均小于不阻断升主动脉停跳组和不阻断升主动脉不停跳组,后两组比较无统计学差异;电子显微镜下观察发现阻断组心肌细胞超微结构破坏较为严重,而不阻断升主动脉停跳组和不阻断升主动脉不停跳组心肌细胞超微结构基本正常. 结论 体外循环不阻断升主动脉心脏跳动或停跳下行心内直视术具有较好的心肌保护作用.     

心内直视手术中应用康斯特保护液的心肌保护研究

目的研究心内直视手术中应用康斯特保护液(HTK液)的心肌保护作用。方法瓣膜置换术患者34例,随机分为两组,HTK液组和4∶1冷含血停搏液组,各17例。主动脉阻断后分别注入5℃~8℃HTK液和4∶1冷含血心肌保护液。在术中和术后抽动脉血测定心肌肌钙蛋白T(cTnT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB、CKMM)和丙二醛(MDA)、超氧化物歧化酶(SOD)和黄嘌呤氧化酶(XOD)浓度,并在电镜下观察心肌超微结构的变化。结果两组中的cTnT、CK、CKMB和CKMM浓度,在开放后均逐步升高,与阻断前比较有统计学差异(P<0.05),HTK液组上升的幅度小于4∶1冷含血停搏液组,在开放后120m in时有统计学意义(P<0.05)。两组中的MDA浓度,在阻断后均逐步升高,于开放后120m in达到高峰,术后24 h稍有下降;两组间在术后24 h的差异有统计学意义(P<0.05)。两组中SOD的浓度均逐渐下降,XOD的浓度则均逐渐上升,变化幅度在开放后120m in和术后24 h有统计学差异(P<0.05)。电镜显示HTK液组中心肌超微结构变化明显优于4∶1冷含血停搏液组。结论心内直视手术中应用HTK溶液进行心肌保护,不仅比我们现在常用的4∶1冷含血心脏停搏液效果好,而且只需要灌注一次,方法简便,特别适用于心肌缺血时间较长的患者,值得在临床上推广应用。     

重症心脏瓣膜病术中应用HTK液进行心肌保护的临床研究

目的:观察HTK液在重症心脏瓣膜病患者心内直视手术中的心肌保护效果。方法:2012年4月-2013年3月,本科在16例重症心脏瓣膜病患者心内直视手术中应用HTK液灌注心脏进行心肌保护,通过与同时期应用冷血停搏液灌注的16例患者的临床指标进行对比分析,评价其心肌保护效果。结果:HTK液组心脏自动复跳率高于冷血停搏液组(P0.05);HTK液组手术时间、体外循环时间、主动脉阻断时间、主动脉开放至心脏复跳时间、后并行循环时间、术后呼吸机辅助时间和ICU停留时间均短于冷血停搏液组(P0.05);HTK液组体外循环停止时多巴胺用量(5±2.5)μg/(kg·min),低于冷血停搏液组(P0.05);HTK液组术后并发症发生率低于冷血停搏液组(P0.05);体外循环后心肌肌钙蛋白(c Tn I)、肌酸磷酸激酶同工酶(CKMB)开始升高,并于术后第1天达最高峰,但HTK液组麻醉诱导之后各时间点的c Tn I、CKMB水平均低于冷血停搏液组(P≤0.05)。结论:在重症心脏瓣膜病患者心内直视手术中应用HTK液灌注心脏,心肌保护效果优于冷血停搏液。     

银杏叶提取物在体外循环心内直视手术中对心肌缺血再灌注损伤的保护作用

目的研究银杏叶提取物（Egb761）在体外循环心内直视手术中对心肌缺血再灌注损伤的保护效果。方法40例冠心病患者于体外循环下行冠状动脉旁路移植,将其随机平分为对照组（ST．Thomas停搏液组）、实验组（ST．Thomas停搏液中加入Egb761,每1000毫升ST．Thomas停搏液中加入50mL Egb761）。两组采取相同的体外循环方法和灌注方法,于阻断升主动脉后,主动脉根部灌注两种不同配方的停搏液,每30分钟复灌1次。分别在术前、主动脉开放即刻、开放后1、8、24h通过桡动脉采集动脉血。测定动脉血肌钙蛋白I（TnI）、肌酸激酶同功酶（CK—MB）水平及内皮素（ET）的浓度;测定心肌组织超氧化物歧化酶（SOD）、丙二醛（MDA）含量,观察心肌细胞的超微结构变化。同时记录心肌阻断时间、心内电除颤次数、心脏复跳时间、体外循环时间、手术时间及术后多巴胺和硝酸甘油的用量。结果两组患者体外循环时间、心肌阻断时间、手术时间以及术后多巴胺和硝酸甘油的用量比较差异无显著性（P〉0．05）。主动脉开放后所有患者的心脏自动复跳。术前两组患者的血清cTnI、CK—MB、ET的水平比较差异无显著性（P〉0．05）。再灌注后2、6、24h实验组血清cTnI、CK—MB、ET及MDA的水平明显低于对照组（均为P〈0．05）。对照组SOD活性明显降低,实验组与对照组在3个时间点对比均有显著性差异,对照组手术后心肌超微结构损伤较重,实验组则损伤较轻。结论Egb761能有效减轻心内直视手术中后对心肌缺血再灌注损伤。     

生脉注射液对心肌缺血与再灌注损伤的保护作用

目的：研究生脉注射液在体外循环术中作为心脏冷停搏灌注液的添加剂使用,对抗体外循环术中心肌缺血性损害及预防再灌注损伤的作用。 方法：心脏手术患者60例,随机分为实验组（30例）和对照组（30例）。实验组患者心脏冷停搏液中加入生脉注射液。测定两组患者血清肌酸磷酸激酶(CK-MB)及超氧化物歧化酶(SOD)活性,电镜下观察心肌超微结构变化。 结果：实验组患者血清CK-MB明显低于对照组（P<0.05）,SOD明显高于对照组（P<0.05）。线粒体形态计量分析,实验组线粒体面数密度及比表面明显高于对照组（P<0.05,P<0.01）。结论：生脉注射液在体外循环心内直视手术时作为心脏冷停搏液的添加剂使用,能保护细胞膜结构的完整性及稳定性,清除氧自由基,保护心肌超微结构,对减轻术中心肌损害有明确的治疗作用。     

不同晶体停搏液对未成熟心肌的保护效果

目的比较不同晶体停搏液对未成熟心肌的保护效果。方法 2013年1月至2013年10月期间在本院行体外循环(CPB)心脏手术治疗的患者年龄在3个月以内的共74例,随机分A、B两组,每组37例。病种有室间隔缺损、房间隔缺损、法洛四联症、右室双出口、完全性房室隔缺损等。两组麻醉方式相同,CPB采用中深度低温,肛温30℃时阻断升主动脉,同时主动脉根部顺行灌注。A组灌注改良St.ThomasⅡ晶体停搏液;B液组灌注康斯特液(HTK液)。观察指标:在麻醉后、术后24 h及72 h时外周血血清的肌钙蛋白Ⅰ(c TnⅠ)和肌酸磷酸激酶同工酶(CKMB)、乳酸脱氢酶(LDH)浓度,心脏自动复跳率,术后应用正性肌力药物,术后监护天数,术后当天左室射血分数(EF),主动脉阻断前及停止CPB前右心房心肌组织的电镜下超微结构。结果自发性复跳率无差别,B组正性肌力药物,术后监护的天数与A组差异明显,B组的术后当天左室EF优于A组,且术后24 h血清c TnⅠ及CKMB、LDH浓度显著低于A组,但术后72 h浓度与A组比较无统计学意义。主动脉阻断前心肌线粒体基本正常,偶见基质颗粒丢失或线粒体肿胀。停止CPB前,线拉体存在不同程度的损伤样改变,如基质外漏、嵴断裂或空泡样改变。主动脉开放后两组患儿心肌线粒体Flameng评分显著增高(P0.01),A组评分比B组明显增高(P0.05)。结论 HTK液对未成熟心肌的保护作用明显优于改良St.ThomasⅡ液。     

1，6—二磷酸果糖冷心停搏液在心脏直视手术中的心肌保护作用

目的研究1,6-二磷酸果糖(FDP)加入冷心停博液对心脏直视手术中的心肌保护作用.方法32例先心病患者随机分为对照组和FDP组,停搏液灌注量按15 ml/kg灌注,间隔20 min,追加首次量一半.于主动脉插管时和主动脉开放后10 min、2 h、6 h、12 h及24 h从中心静脉采血,测定乳酸脱氢酶(LDH)、磷酸肌酸激酶(CK)和磷酸肌酸激酶心脏同功酶(CK-MB)水平,并电镜观察两组病人心肌超微结构的改变及心脏自动复跳率.结果FDP组术后3种酶的上升幅度低于对照组(P＜0.01),心肌超微结构损害较对照组明显减轻,心脏自动复跳率高于对照组(P＜0.05).结论FDP加入心肌保护液有减轻心脏直视手术时心肌损伤的作用.     

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.