乌司他丁对老年体外循环心脏手术患者肾功能的影响

目的探讨乌司他丁在体外循环心脏手术中的应用价值。方法择期行全麻体外循环心脏手术的老年患者42例,按是否使用乌司他丁分为未使用组和使用组,每组21例。未使用组采用常规的体外循环器官功能保护方法,在未使用组的基础上,使用组加用乌司他丁。对比分析术前和术后1 d、3 d、7 d两组血清尿素氮(BUN)、血清肌酐(Cr)、血清β2-微球蛋白(MG)、尿视黄醇结合蛋白(RBP)、尿中N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿β2-MG水平变化,记录两组不良不良反应发生情况。结果两组术前血清BUN、Cr、β2-MG和尿β2-MG、RBP、NAG差异无统计学意义(P0.05);与术前对比,未使用组术后1 d、3 d血清BUN、Cr和血清β2-MG均呈现上升趋势,术后1 d、3 d、7 d尿β2-MG、RBP、NAG均呈现上升趋势(P0.05);使用组术后1 d血清BUN、Cr和尿β2-MG、RBP呈现上升趋势,术后3 d血清β2-MG、尿RBP呈现上升趋势,术后3 d、7 d尿NAG呈现上升趋势(P0.05);与未使用组对比,使用组术后1 d、3 d血清BUN、Cr均明显降低,术后7 d血清β2-MG均明显降低,术后1 d、3 d、7 d尿β2-MG、RBP、NAG均明显降低,差异具有统计学意义(P0.05);未使用组药物相关不良反应发生率为14.29%(3/21),使用组为19.05%(4/21),两组比较差异无统计学意义(P0.05)。结论乌司他丁能有效改善老年体外循环心脏手术患者术后血清BUN、Cr、β2-MG及尿β2-MG、RBP、NAG水平,对患者的肾功能具有保护作用,且药物相关不良反应的发生率较低。     

两种冠状动脉旁路手术方式对老年患者肾功能的影响

目的比较非体外循环(Off-pump)心脏不停跳与体外循环(CPB)心脏停跳两种冠状动脉旁路移植术式对老年患者肾功能的影响。方法将30例行冠状动脉旁路移植手术的老年患者分为Off-pump组和CPB组,每组15例。测定患者围术期尿中N-乙酰基-β-D-葡萄糖苷酶(NAG)和γ-谷氨酰转移酶(γ-GT)的浓度,同时测定血尿素氮(BUN)和肌酐(Cr)浓度,计算尿酶排出量和Cr清除率。结果两组均无急性肾功能衰竭发生。尿NAG和γ-GT排出量术中均升高,术后第1天清晨基本复原,Off-pump组尿NAG峰值排出量[(26±11)U／g Cr]显著低于CPB组[(52±48)U／g Cr],P<0．05;而两组同时相尿γ-GT排出量分别为(45±31)U／g Cr和(52±47)U／g Cr,差异无统计学意义(P>0．05)。血BUN和Cr术后均升高,组间差异无统计学意义(P>0．05)。Cr清除率术中升高术后下降,CPB组波动明显大于Off-pump组。从术前(90±23)ml／min升至术中(139±46)ml／min,术后第1天降至(73±24)ml／min,差异均有统计学意义(P<0．01)。结论老年患者冠状动脉旁路移植术围术期在肾小球和肾小管水平发生可逆的亚临床肾损伤。off—pump心脏不停跳术式对肾功能的影响小于体外循环心脏停跳术式,所以,前者更适用于肾功能不全的老年患者。     

乌司他丁对食管癌患者术后肝、肾功能和免疫状况的影响

60例食管癌患者随机分为对照组、乌司他丁组,两组均于术后给予7d全胃肠外营养（TPN）;其中乌司他丁组同时给予乌司他丁40万U／d静滴,并分别于手术前及手术后第2天、第6天晨抽静脉血测量丙氨酸转氨酶（ALT）、血尿素氮（BUN）、血肌酐（Cr）,T细胞亚群、IgA、IgG、IgM。结果乌司他丁组ALT、BUN、Cr、IgG、CD4、CD8^＋、CD4／CD8^＋在术后第6天较对照组有显著的改善。认为食管癌患者在术后常规TPN治疗的基础上,应用乌司他丁可以更好的改善患者肝、肾功能以及免疫状况。     

乌司他丁对重症心瓣膜置换术后肾功能的保护作用

目的观察乌司他丁（UTI）对重症心瓣膜置换术后患者肾功能的影响。方法将重症心瓣膜置换术患者随机分成3组,对照组在体外循环术中静注0．9％氯化钠注射液20ml;实验1组在体外循环时静注UTI2万U／kg;实验2组在体外循环时静注UTI2万u／kg,术后1、2、3天再静注30万U。各组分别于术前（T0）和术后第1天（T1）、第3天（T3）、第5天（T5）、第7天（T7）检测血清β2微球蛋白（β2-MG）、血清肌酐（Cr）、血清尿素氮（BUN）水平。结果三组血β2-MG、BUN、Cr于术后T1、T3均高于T0;实验组术后BUN、Cr、β2-MG在T1、T3、T5均低于对照组;实验2组T3、L5时的β2-MG、BUN均低于实验1组（P均〈0．05）。结论重症心瓣膜置换术患者在体外循环心外直视手术中的肾功能均受到损伤,UTI对患者围手术期的肾损伤有一定的保护作用,术后再连续应用效果更佳。     

乌司他丁在婴幼儿体外循环手术期间的心肌保护作用

目的探讨乌司他丁在婴幼儿体外循环手术中对心肌缺血/再灌注损伤的保护作用。方法选择38例诊断为室间隔缺损的婴幼儿患者,随机分为试验组(n=18):1.2万U/kg乌司他丁;对照组(n=20):以等量生理盐水代替。记录阻断和转流时间,血管活性药物使用和心脏复跳情况。于转流前,主动脉开放即刻,开放30min,停机后4h、24h检测CK、CK-MB和cTnI,并观察心肌超微结构。结果①两组CK-MB、CK和cTnI转流前差异均无统计学意义,CPB后明显升高(P<0.05);试验组停机后4h、24h,CK、CK-MB较对照组低(P<0.05),cTnI主动脉开放30min,停机后4h、24h低于对照组(P<0.05)。②实验组多巴胺/多巴酚丁胺平均使用剂量少于对照组(P<0.05),心脏自动复跳率明显高于对照组(P<0.01),术后心肌组织超微结构显示心肌细胞损害较对照组轻。结论乌司他丁能降低CK、CK-MB、cTnI的释放,减轻婴幼儿体外循环手术中心肌损害,对心肌缺血/再灌注损伤有保护作用。     

心脏手术患者尿微量蛋白水平变化及抑肽酶对它的干扰

目的观察抑肽酶对心脏手术患者尿微量蛋白水平的干扰。方法选择心脏手术患者40例,随机分为抑肽酶组和对照组,比较两组患者术后尿微量蛋白水平。结果术后尿白蛋白（A lb）、免疫球蛋白G（IgG）和α-微球蛋白（α-MG）,尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）水平均高于术前,而血液BUN、Cr水平没有显著变化。术后抑肽酶组尿A lb、IgG、α-MG显著高于对照组,而两组间NAG、BUN、Cr并没有统计学差异。结论尿A lb、IgG、α-MG、NAG能反映早期肾损害,但尿A lb、IgG、α-MG容易受抑肽酶干扰,因此不适合监测心脏手术患者肾损害。     

乌司他丁对急性主动脉夹层围术期氧自由基的影响

目的:探讨乌司他丁早期干预对急性主动脉夹层(AAD)围术期氧自由基水平的影响。方法:选择发病48h内拟行主动脉外科手术的急性主动脉夹层住院患者。年龄18~70岁。随机将患者分为安慰剂组(n=40,对照组)和乌司他丁组(n=50,试验组)。乌司他丁组按1.2万U/kg的剂量溶入250m L 0.9%氯化钠液,术前4h缓慢静脉滴注;对照组用同等容量的0.9%氯化钠液代替,操作程序及注入时间同试验组。两组患者均检测麻醉诱导前(T1)、麻醉诱导后(T2)、离室前(T3)、术后6h(T4)及术后24h(T5)血浆氧自由基水平。结果:(1)试验组与对照组间基线数据比较,性别、年龄、质量指数及术前心功能、主动脉阻断时间及转机时间差异均无统计学意义(P0.05);(2)试验组术后血浆MDA及MPO水平较术前(T1)明显降低(P=0.000),TAOC及TSOD的血浆水平在在围术期则相对提高(P=0.000)。结论:对于接受急性主动脉夹层手术的患者,乌司他丁的早期应用可以起到抑制机体发生过氧化反应的作用。     

乌司他丁联合甲强龙对体外循环心脏术后全身炎症反应观察

目的探讨乌司他丁联合甲基强的松龙对体外循环心脏术后的应用价值。方法将2013年3月-2014年3月期间对我院实施体外循环心脏术后90例患者纳入研究对象,根据治疗方法不同分为观察组及对照组,对照组按常规营养心肌细胞支持心功能,预防感染,呼吸机辅助呼吸,地塞米松静注抗炎,观察组在对照组基础上改用乌司他丁联合甲强龙抗炎,比较两组患者的体温、呼吸、心率、中心静脉压、氧合指数、Lac、TNF-α、IL6、CRP、尿蛋白、尿NAG酶的变化。结果观察组的体征指体温心率氧合指数改善明显优于对照组,乳酸、TNF-α、IL6、CRP、等炎症指标及尿蛋白尿NAG酶肾损害指标均明显低于对照组。结论乌司他丁联合甲基强的松龙抗炎能明显改善体外循环心脏术后全身炎症反应,减少对心、肺、肾的损害。     

心脏瓣膜置换术患者围术期乌司他丁对基质金属蛋白酶9的影响

目的观察乌司他丁对心脏瓣膜置换术患者围术期基质金属蛋白酶9的影响,以了解乌司他丁对体外循环所致的肺损伤是否具有保护作用。方法40例择期心脏瓣膜置换术患者,随机分为2组(每组20例)。乌司他丁组按12ku/kg体重计算乌司他丁用量,分别在麻醉诱导和心肺转流开始时按6ku/kg静注乌司他丁共两次,对照组用等量生理盐水替代,用法同乌司他丁组。分别于麻醉诱导前,心脏直视手术体外循环10min,30min,心脏直视手术体外循环后1h,3h,6h抽取桡动脉血,用ELISA法测定血浆基质金属蛋白酶9的浓度。同时测定诱导前,心脏直视手术体外循环后1h,3h,6h等时间点的肺死腔率和血浆肺泡动脉血氧分压差。结果两组患者年龄、体重、性别比、体表面积、血红蛋白、红细胞压积、术前心肺功能,病种,总转流时间、主动脉阻断时间,手术类别和手术时间的变化均无统计学意义。心脏直视手术体外循环10min至循环后6h两组基质金属蛋白酶9均较麻醉诱导前明显升高(P<0.05),均在心脏直视手术体外循环达高峰。循环后1h至6h至两组肺死腔率,肺泡动脉血氧分压差均较诱导前明显升高(P<0.05),肺死腔率在体外循环后1h达高峰,肺泡动脉血氧分压差在体外循环后3h达高峰。乌司他丁组体外循环30min至体外循环后6h时基质金属蛋白酶9和循环后1h至6h肺死腔率,肺泡动脉血氧分压差均明显低于对照组(P<0.05)。结论乌司他丁能明显减轻心脏瓣膜置换术患者围术期基质金属蛋白酶9的过度释放,减轻术后早期肺死腔率和肺泡动脉血氧分压差,对改善肺氧合保护肺功能有一定的作用。     

乌司他丁联合改良超滤对体外循环术后婴幼儿肺功能的影响及机制

目的观察乌司他丁联合改良超滤对婴幼儿体外循环术后肺功能的影响,并探讨其机制。方法 60例先天性心脏病患儿,随机分为对照组(C)、乌司他丁组(U)、改良超滤组(M)和乌司他丁联合改良超滤组(D)。C组为空白对照,M、D组在转流结束后应用改良超滤,U组和D组于麻醉诱导后体外循环(CPB)前给予乌司他丁1万U/kg泵入。分别在转流前5 min(T1)、转流结束后20 min(T2)、术后2 h(T3)、术后6 h(T4)、术后12 h(T5)记录气道峰压(Ppeak)、呼吸停顿压(Ppause)、潮气量(TV)、呼吸频率(F)、吸入氧浓度(FiO2),计算肺静态顺应性(Cstat)、气道阻力(Raw)、氧合指数(OI);同时采集动脉血行血气分析,记录肺泡—动脉血氧分压差(A-aDO2),同时检测血清IL-6和IL-8。结果 T3、T4、T5时点U、M、D组Cstate均高于C组,Raw明显低于C组(P均<0.05);而T4、T5时点U、M组的Cstate低于D组、Raw高于D组(P均<0.05)。T3、T4、T5时点U、M、D组的A-aDO2均明显低于C组,OI明显高于C组(P均<0.05);T4、T5时点M、U组的A-aDO2明显高于D组,OI明显低于D组(P均<0.05)。T2、T3、T4、T5时点D、U组IL-6和IL-8明显低于M、C组(P均<0.05)。结论联合应用乌司他丁和改良超滤可明显改善婴幼儿CPB心脏直视手术后肺功能,且效果优于单用其中一种者。其机制可能与联合应用乌司他丁和改良超滤降低肺组织IL-6和IL-8释放有关。     

依达拉奉对瓣膜置换术后患者血流动力学及肝肾功能的影响

目的: 探讨依达拉奉（edaravone,MCI-186）对瓣膜置换术后患者血流动力学以及肝、肾功能的影响。方法: 40例风湿性心脏病行瓣膜置换术的患者随机分为两组,试药组20例,对照组20例。试药组接受MCI-1860.5 mg/kg在主动脉开放前10 min一次性加入体外循环机静脉储血罐中,对照组不接受MCI-186。分别于术前、主动脉开放后2、8和24 h用Swan-Gans漂浮导管监测血流动力学指标,于术前、主动脉开放后8、16和72 h测量血清总胆红素(TBIL)、谷草转氨酶（AST）、谷丙转氨酶（ALT）、血尿素氮（BUN）和肌酐（Cr）,记录术后正性肌力药物的应用情况。结果: ①平均动脉压（MAP）、心率（HR）和肺动脉楔压(PAWP)组间比较均无统计学差异;心排指数（CI）在各组中随时间升高,在主动脉开放后8 h试药组高于对照组（P<0.05）,且在2 h、24 h更显著（P<0.01）;心脏每搏指数（SVI）、左心室做功指数（LVSWI）在主动脉开放后24 h试药组高于对照组（P<0.05）。②TBIL、AST、ALT、BUN、Cr组间比较均无统计学差异,且各组中BUN、Cr均在正常范围,TBIL、AST、ALT在主动脉开放后72 h亦恢复正常。试药组术后48 h多巴胺平均最大剂量少于C组（P<0.05）。结论: MCI-186能促进瓣膜置换术后患者血流动力学的恢复,改善左室功能,增加心排指数和左室做功指数,对患者肝、肾功能未见明显影响。     

氨溴索、乌司他丁对体外循环心脏手术患者肺功能的保护作用及机制

目的观察氨溴索、乌司他丁对体外循环（CPB）心脏手术患者肺功能的保护作用,并探讨其机制。方法40例CPB下行瓣膜置换手术患者,随机分为氨溴索组（A组）、乌司他丁组（U组）、联合组（AU组）和对照组（C组）,每组10例。A组麻醉诱导后静脉滴注氨溴索0.5 mg/kg,U组在CPB过程中予1万U/kg乌司他丁,AU组联合应用上述两种药物;C组均未应用氨溴索及乌司他丁。分别在CPB前（T1）、CPB停止（T2）、CPB结束后2 h（T3）、CPB结束后4 h（T4）及CPB结束后18 h（T5）采集桡动脉血,测定血清白介素-6（IL-6）、白介素-8（IL-8）、白介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）,并通过血气分析计算呼吸指数（RI）和肺氧合指数（OI）。结果四组患者CPB后RI和OI较CPB前均有不同程度升高（P均〈0.05）;CPB后各时点A、U、AU组患者RI、OI均明显低于C组,AU组RI、OI明显低于其他3组（P均〈0.05）。四组患者血清中IL-6、IL-8、IL-10、TNF-α水平在T2开始升高并很快达到峰值,后逐渐下降,IL-6、IL-8和TNF-α直到术后18 h仍未降至术前水平（P均〈0.05）。与C组相比,CPB结束后各时点U组、AU组患者血清中IL-6、IL-8、IL-10、TNF-α水平明显减低（P均〈0.05）,AU组降低更加明显（P均〈0.05）。结论氨溴索、乌司他丁均可对CPB心脏瓣膜置换手术患者围术期肺功能起到保护作用。乌司他丁的肺保护作用与其抑制炎症因子的释放有关,从而减轻肺功能损伤,保护并改善术后肺功能。     

经冠状静脉窦逆行灌注心脏跳动中主动脉瓣置换术（附5例报告）

对3例主动脉瓣狭窄并关闭不全、2例主动脉瓣狭窄关闭不全并二尖瓣狭窄关闭不全患者,经冠状静脉窦逆行灌注,在心脏有节律的空跳中施行主动脉瓣置换或主动瓣二尖瓣双瓣置换手术。在整个手术过程中,心脏持续得到氧合血的供应,并测定术中及术后血清肌酸激酶（CPK）及乳酸脱氢酶（LDH）含量。结果术后患者恢复顺利,多巴胺用量少,未出现低心排出量综合征、严重心律失常及气体栓塞等严重并发症,术中及术后CPK及LDH含量无显著性差异。认为浅低温体外循环经冠状静脉窦逆行灌注心脏不停跳技术是一种简单、安全、接近生理状态的心肌保护措施。     

Value of the assay of 4 urinary enzyme activities in the diagnosis of the infectious or toxic (aminoglycosides) origin of a renal disease. Preliminary results

Occurrence of a renal failure in an infected patient may be referred to various causes: infection, renal toxicity of drugs (for instance aminoglycosides), shock . . . Determination of some urinary enzymatic activities might be helpful in unravelling the mechanism involved in such cases. Therefore a prospective study of the specificity of some urinary enzymatic activities was performed. The whole LDH activity, the LDH isoenzyme 5 (LDH 5), and two lysosomal enzymes, N-acetyl-beta-D-glucosaminidase (NAG) and beta-glucuronidase (beta-GLU) were dosed systematically, in several groups of patients: I (n = 34): healthy control, with normal renal function; II (n = 24): renal impairment, without recent upper urinary-tract infection (UTI) or aminoglycoside treatment; III (n = 27): upper UTI without aminoglycoside treatment, IV (n = 22): patients treated with aminoglycosides (without upper UTI); V (n = 16): upper UTI treated with aminoglycosides. Results showed a rather good specificity of whole LDH and LDH 5 for infectious kidney damage, and of NAG for tubular injury due to aminoglycoside treatments. Values of urinary beta-glucuronidase varied over a wide range; they were little increased in group III, without a great discriminative value. No significant difference was noted between group I and group II, for any enzyme whatever.     

影响2型糖尿病患者尿铜蓝蛋白及白蛋白的因素

目的　评价影响 2型糖尿病患者尿铜蓝蛋白 (Cp)及尿白蛋白 (Alb)的因素。 方法　记录及测定 1 0 4 6例 2型糖尿病患者的年龄、性别、糖尿病病程、血压、腰围、臀围、腰臀比、身高、体重、体重指数、空腹血糖、HbA1c、空腹胰岛素、尿素氮、肌酐 (Cr)、尿酸、血脂、血Alb,并留取晨尿测定Cp、Alb及Cr,对尿Alb/Cr、尿Cp/Cr与以上因素行多元线性回归分析。部分患者分入控制血糖组、控制血压组或对照组 ,6个月后复查上述指标 ,比较尿Alb/Cr及尿Cp/Cr的变化。结果　尿Alb/Cr与血白蛋白、血Cr、尿酸、收缩压、体重、体重指数等因素相关 (P <0 .0 5)。尿Cp/Cr与血Alb、收缩压、空腹血糖、HbA1c等因素相关 (P <0 .0 5)。控制血糖和控制血压可降低尿Alb/Cr及尿Cp/Cr。 结论　尿Alb/Cr及尿Cp/Cr均受到糖代谢、脂质代谢、血压及肥胖等因素的影响     

Studies on the renal handling of urea nitrogen, creatinine, water and electrolytes in hyperthyroid patients with Graves' disease

To delineate the pathophysiological basis for increased blood urea nitrogen (BUN), decreased serum creatinine (SCr) and increased BUN/SCr ratio in patients with hyperthyroidism due to Graves' disease, systematic evaluation on renal handling of solutes and water was carried out before and during treatment of the disease. First, BUN, SCr, serum sodium (Na), serum potassium (K), serum chloride (Cl), creatine kinase (CK), serum triiodothyronine (T3) and serum thyroxine (T4) were consecutively measured in 16 patients (aged 18-62 yrs, 4 males and 12 females) with Graves' disease before and during antithyroid drug therapy, and 16 healthy subjects (aged 22-64 yrs, 4 males and 12 females) served as controls. BUN (14.8 +/- 2.9 mg/100ml) was significantly higher (p less than 0.01), and SCr (0.62 +/- 0.16 mg/100ml) and CK (41.7 +/- 23.6 U/l) were significantly lower (p less than 0.01) in untreated patients compared to respective values in the control group (BUN, 13.2 +/- 2.9 mg/100ml; SCr, 0.87 +/- 0.16 mg/100ml; CK, 99.3 +/- 49.5 U/l). Consequently, BUN/SCr ratio was significantly elevated (p less than 0.01) in the patients. As T4 and T3 returned to normal, BUN, SCr, BUN/SCr ratio and CK of the patients also normalized. Serum electrolytes were not significantly different in the patients compared to the controls. Second, renal clearance of para-aminohippurate (CPAH), inulin (CIn), creatinine (CCr), free water (CH2O) and chloride (CCl) was evaluated in 7 untreated patients (aged 17-44 yrs, 4 males and 3 females) and in 7 controls (aged 24-39 yrs, 5 males and 2 females). In patients with untreated Graves' disease, CPAH, CCr and Curea were significantly greater than in the controls (847 +/- 367 vs 442 +/- 124 ml/min, p less than 0.05, 132.7 +/- 14.7 vs 76.6 +/- 14.4 ml/min, p less than 0.01, and 86.9 +/- 16.0 ml/min vs 52.1 +/- 12.6 ml/min, p less than 0.05, respectively). CIn was slightly but insignificantly increased in the patients (95.3 +/- 20.8 ml/min) compared to the controls (76.7 +/- 13.3 ml/min). As a result, CCr/CIn and Curea/CIn were significantly greater in the patients than in the controls (142.7 +/- 32.0 vs 100.7 +/- 7.1%, p less than 0.01, 92.4 +/- 18.7 vs 68.4 +/- 14.4%, p less than 0.05, respectively). The difference between CCr and CIn indicates that 40% of urinary creatinine is of tubular origin. Renal excretion of urea and creatinine was increased by 117% and decreased by 77%, respectively in the patients, but the differences were not statistically significant.(ABSTRACT TRUNCATED AT 400 WORDS)     

Evaluation of intravascular hemolysis with erythrocyte creatine in patients with cardiac valve prostheses

STUDY OBJECTIVES: To detect intravascular hemolysis in patients with cardiac valve prostheses. Erythrocyte creatine, a marker of erythrocyte age that increases with shortening erythrocyte survival, was evaluated with other hemolytic markers and hemodynamic parameters. DESIGN: Prospective study. Patients and measurements: Erythrocyte creatine was enzymatically assayed in 33 patients with prosthetic valves, including 15 patients with aortic valve replacement, 13 patients with mitral valve replacement, and 5 patients with double-valve (aortic and mitral) replacement, and 33 control subjects. Blood flow velocity and valvular regurgitation were determined by Doppler echocardiography. Other hemolytic markers (lactate dehydrogenase [LDH], reticulocyte count, and haptoglobin) and cardiac muscle markers (myoglobin and myosin light chain 1) were also measured. RESULTS: Erythrocyte creatine and LDH levels were significantly higher (p < 0.0001) and the haptoglobin level was lower (p < 0.0001) in patients with a prosthetic valve as compared with control subjects. However, there were no significant differences in these markers between those with (n = 17) and without (n = 16) regurgitation. Patients with high erythrocyte creatine levels (> 1.8 micro mol/g hemoglobin) exhibited significantly higher total peak flow velocity (sum of peak flow velocities at mitral and aortic valves) than those with normal erythrocyte creatine levels (p = 0.006). Erythrocyte creatine had a significant correlation with total peak flow velocity (r = 0.64, p < 0.0001), but LDH and haptoglobin had no significant correlation with total peak flow velocity. Patients with high LDH levels (> 460 IU/L) showed significantly higher myoglobin (p = 0.008) and myosin light chain 1 (p = 0.02) than those with normal LDH levels, whereas erythrocyte creatine was not related to cardiac muscle markers. CONCLUSIONS: Erythrocyte creatine is a quantitative and reliable marker for intravascular hemolysis in patients with prosthetic valves. Mild hemolysis is ascribable to valvular flow velocity rather than regurgitation.     

大剂量阿托伐他汀预防对比剂肾病

目的 研究大剂量(80 mg)阿托伐他汀在对比剂肾病预防中的作用.方法 将100例行冠状动脉介入诊断与治疗的患者随机分为大剂量组和小剂量组,在全部采用水化治疗和给予阿托伐他汀10 mg/d的基础上,大剂茸组术前12～24 h阿托伐他汀加量至80 mg口服.观察术前、术后血清肌酐(Scr),内生肌酐清除率(Ccr),血β2-微球蛋白,尿N-乙酰-β-D-葡萄糖酸苷酶(NAG)/尿肌酐(Cr),尿渗透压的改变情况.结果 血β2-微球蛋白于术后1、3、5 d时,大剂量组显著低于小剂量组[(2.35±0.52)mg/L比(2.67±0.64)mg/L,P=0.008]、[(2.49±0.55)mg/L比(2.80±0.64)mg/L,P=0.011]、[(2.29±0.53)mg/L比(2.56±0.66)mg/L,P=0.026];尿NAG/Cr于术后1、3、5 d时,大剂量组显著低于小剂量组[(1.19±0.30)U/mmol比(1.46±0.34)U/mmol,P＜0.001]、[(1.30±0.30)U/mmol比(1.59±0.33)U/mmol,P＜0.001]、[(1.10±0.30)U/mmol比(1.34±0.35)U/mmol,P=0.001];Ccr术后1、3 d大剂量组显著高于小剂量组[(73.69±20.99)ml/min比(65.19±18.72)ml/min,P=0.035]、[(64.04±15.82)ml/min比(56.79±14.50)ml/min,P=0.019].结论 血管造影前使用大剂最(80 mg)的阿托伐他汀可能有助于减少对比剂肾病的发生.     

氯沙坦对伴有微量蛋白尿的老年高血压患者的影响

目的　观察氯沙坦对伴有微量蛋白尿（ ＭＣＡ） 的老年高血压患者改善肾损害的作用。　方法　采用连续样本,自身前后及分组对照方法,对３２ 例高血压伴ＭＣＡ 者（ＥＨ 组） ,男２４ 例,女８ 例,平均年龄（７１－６ ±６－８）岁,观察在治疗前和每天服用氯沙坦５０ ｍ ｇ １２ 周后的血压、血尿素氮（ＢＵＮ） 、血肌酐（Ｃｒ） 、２４ｈ 内生肌酐清除率（Ｃｃｒ） 、尿白蛋白／ 肌酐（Ａｌｂ／Ｃｒ） 的变化,ＥＨ 组治疗前在ＢＵＮ、Ｃｒ 、Ｃｃｒ 方面与１２ 例非高血压老人作对照（ 对照组） 。　结果　治疗前ＥＨ 组的Ｃｃｒ 水平较对照组明显降低（ Ｐ＜ ０－０５） ,用氯沙坦治疗后,除血压有明显下降外,尿Ａｌｂ／Ｃｒ 亦显著性降低（ Ｐ＜ ０－０１） ,Ｃｃｒ 明显升高（ Ｐ＜ ０－０５） 。　结论　氯沙坦对老年高血压患者不仅有良好的降压效果,同时可降低尿白蛋白的排泄,改善肾功能     

Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement

BACKGROUND: The development of late tricuspid regurgitation (TR) following left cardiac valve replacement is an important complication, as it is associated with a severe impairment of exercise capacity and a poor symptomatic outcome. The pathogenesis of this condition remains poorly defined. It is still a challenge in terms of its prevention, treatment and indications for surgical correction. AIMS: To investigate the possible pathogenesis and report the surgical results of the late TR after left cardiac valve replacement. METHODS: There were 56 patients with moderate to severe TR after left cardiac valve replacement, divided into normal prosthesis group (10 patients with normal prosthetic valve function) and dysfunctional prosthesis group (46 patients with prosthetic valve dysfunction). In the normal prosthesis group, 4 patients underwent mitral valve replacement (MVR) and 6 patients underwent combined mitral and aortic valve replacement (DVR). Patients in the dysfunctional prosthesis group included MVR in 36, aortic valve replacement (AVR) in 4 and DVR in 6, with bioprosthetic valve dysfunction occurring in 18, mechanical prosthetic valve obstruction in 22 and periprosthetic valve leakage in 6 patients. At the initial operation, 10 patients underwent DeVega's tricuspid annuloplasty and 46 patients' tricuspid valves were normal. At the second operation, the surgical treatment of TR included tricuspid valve replacement (TVR) in 9 and tricuspid annuloplasty in 47. RESULTS: Two patients died postoperatively giving a 3.6% hospital mortality. The 54 survivors were followed up for 6-132 months (mean of 79.4 months). Heart function improved significantly in 8 with TVR and in 40 with tricuspid annuloplasty. Echocardiography showed moderate TR in 5 and severe TR in 1 patient with tricuspid annuloplasty who need a further surgical treatment. CONCLUSION: Pulmonary hypertension, myocardial dysfunction, and atrial fibrillation might be responsible for the development of late TR after left cardiac valve replacement. Tricuspid annuloplasty, as the surgical method of first choice, resulted in improvement in 87% of patients with late TR after left cardiac valve replacement. TVR can also be safely applied to repair organic disease and the extremely dilated tricuspid valve annulus. If the TR area is more than 25cm(2), the TVR is recommended.