Changes in plasma granulocyte elastase, myeloperoxidase and fibronectin during and after open heart surgery

Arterial and pulmonary arterial levels of plasma granulocyte elastase, myeloperoxidase and fibronectin were measured during and after cardiac surgery by using a bubble oxygenator. Granulocyte elastase-proteinase inhibitor and myeloperoxidase increased significantly from the end of cardiopulmonary bypass to the first postoperative day. The levels of granulocyte elastase-proteinase inhibitor and myeloperoxidase correlated with the perfusion time with cardiopulmonary bypass, but did not correlate with respiratory index except correlation of the level of arterial myeloperoxidase with respiratory index on the first postoperative day. We speculate that microvascular leukostasis occurs after cardiopulmonary bypass on account of the differences of the level of myeloperoxidase between arterial and pulmonary arterial blood. Plasma fibronectin decreased slightly during operation and on the first postoperative day.     

Effects of ulinastatin on changes of plasma granulocyte elastase, myeloperoxidase and fibronectin during and after open heart surgery

We investigated effects of ulinastatin on plasma levels of granulocyte elastase in alpha 1-proteinase inhibitor complex, myeloperoxidase and fibronectin in 20 patients during and after open heart surgery. Ulinastatin, 300,000 units were given immediately after the induction of anesthesia. Plasma fibronectin increased significantly after cardiopulmonary bypass (CPB) in ulinastatin group (group U) compared with control (group C) group. Regression coefficients between CPB time and changes of plasma fibronectin in group U were significantly different from those in group C after CPB. Plasma levels of granulocyte elastase in alpha 1-proteinase inhibitor complex were not different between the two groups. Regression coefficients of group U were smaller than those of group C after CPB. Plasma levels of myeloperoxidase were not different between the two groups. Regression coefficients of group U were significantly smaller than those of group C. Ulinastatin suppressed significantly the decrease of plasma fibronectin after CPB. Ulinastatin had no effects on plasma granulocyte elastase in alpha 1-proteinase inhibitor complex during and after CPB. Ulinastatin inhibited the increase of plasma myeloperoxidase in proportion to CPB time.     

心内直视手术期间血浆P物质的变化

目的：了解血浆Ｐ物质（ＳＰ）在心内直视手术期间的水平变化。方法：采用放免法对１２例心内直视手术患者的血浆ＳＰ浓度分别在麻醉前、麻醉后、转机前、转机中、转机后、术毕及术后第二天七个时间点进行了动态观察。结果：在体外循环期间血浆ＳＰ水平非常显著高于麻醉前基础值（Ｐ＜０．０１）。结论：ＳＰ参与了体外循环心内直视手术期间心血管活动的调节。     

The effects of ulinastatin on the release of granulocyte elastase during pancreas surgery

During a major abdominal surgery, intraoperative manipulation may cause circulatory changes, which lead to release of granulocyte elastase. Twenty one patients were studied to elucidate the release of granulocyte elastase and the inhibitory effect of a protease inhibitor (ulinastatin) on lysosomal enzyme release during pancreas surgery. Patients were divided into 3 groups. Patients in group A served as control. Patients in group B were given ulinastatin 10,000 units.kg-1 intravenously prior to surgery. Patients in group C were given ulinastatin 5,000 units.kg-1 intravenously twice prior to surgery and 3 hours after the start of surgery. The granulocyte elastase was measured by commercially available kits, at 7 points: prior to induction of anesthesia, immediately after tracheal intubation, 30, 60, 120, 180 min after the start of surgery and 30 min after surgery. The plasma level of elastase increased markedly during the operation in group A, it did not increase in groups B and C during the operation. Thirty min after the operation, the plasma level of elastase increased markedly in group A (354 +/- 63 micrograms.l-1), and in group B (396 +/- 167 micrograms.l-1). The plasma level of elastase was restored to normal levels 30 min after the operation in group C. These results indicate that granulocyte elastase values were maintained at significantly higher levels during and after pancreas surgery, and suggest that ulinastatin inhibits the release of granulocyte elastase during pancreas surgery.     

Intra- and postoperative autotransfusion in open heart surgery under simple hypothermia in children

A new autotransfusion unit was developed by the authors and the favorable results of 21 operations of open heart surgery under simple hypothermia were described. The patients were all children with simple congenital heart diseases. The amounts of autotransfused blood ranged from 2.8 to 15.5 ml/kg. Intraoperative autotransfusion proved to be an effective means of minimizing blood loss during surgery (range 3.2 to 12.8 mg/kg) and performing open heart surgery without donor blood transfusion. Postoperative autotransfusion (range 0 to 14.3 ml/kg) served as a supplementary means of avoiding homologous blood transfusion. Among the 21 autotransfused patients, there were no complications, while two patients developed heaptitis out of 19 patients who received homologous blood in the control group.     

Pathogenesis and treatment of metabolic acidosis in open heart surgery under surface induced deep hypothermia

Metabolic acidosis observed in open heart surgery under surface induced deep hypothermia is due to lactacidemia, but is reversible, returning to precooling level 24 hours after the operation, and it can be considered more or less as a pathognomonic finding. Although the correction of acidosis present did not influence the level of lactic acid in blood, it was found to be clinically advantageous during the heartresuscitation. Therefore, it is advisable to maintain acid-base balance within-10 mEq per 1 of base excess.     

心内直视手术中应用乌司他丁对β-GCD、Gel及Fn的影响

目的观察心内直视手术中应用乌司他丁(UTI)对β-葡萄糖醛酸酶(β-GCD)、粒细胞弹性蛋白酶(GeI)及纤维连接蛋白(Fn)的影响及其量-效相关性。方法择期CPB下心内直视术病人30例,ASAⅡ～Ⅲ级,随机分为二组:UTI组(U组,n=15),于麻醉后、CPB开始前将UTI 20万U溶于20 ml生理盐水中静注(约10 min);如(CPB超过4 h,可在CPB开始后4 h追加一次,剂量方法同前。对照组(C组,n:15),用等容量的生理盐水代替UTI。分别于麻醉前及CPB结束后检测β-GCD活性及Gel和Fn的含量;计算上述三指标麻醉前与CPB结束后的差值(分别以△β-GCD,△Gel及△Fn表示),并对C组三指标差值的两两间进行线性相关分析;同时将U组的UTI剂量分别与三指标的差值进行线性相关及回归分析。结果麻醉前两组病人β-GCD活性、Gel及Fn含量差异均无显著性(P>0.05)。CPB结束后,①两组病人Gel含量和β—GCD活性均比麻醉前升高(P<0.05～0.01),U组较C组低(P均<0.05)。两组病人Fn含量均较麻醉前显著减少(P<0.01),U组较C组高(P<0.05)。②C组病人△Gel、△Fn和△β—GCD两两间的相关均有非常显著性或显著性(r分别为-0.70,0.62和-0.52,P分别<0.01、0.05)。③U组UTI剂量与△β-GCD、△Gel及△Fn均呈负相关(分别为r=0.78、-0.70、-0.81),且相关有非常显著性(尸均<0.01)。结论     

黄芪在犬肾离体灌注保存中的作用

目的研究黄芪提取液对犬肾离体低温灌注及保存中缺血再灌注损伤的影响。方法以常规的HC-A保存液为对照组,以高渗枸橼酸盐嘌呤溶液(HC-A)添加黄芪提取液为实验组,分别对离体犬肾进行低温灌注保存24、48、72 h。通过光镜、电镜观察肾组织结构变化,建立犬肾移植模型,检测移植前后生化指标变化,综合分析。结果实验组保存的犬肾组织超微结构损伤明显轻于对照组。病理组织检查评分,实验组低于对照组(P<0.05)。移植肾早期功能指标检测,移植后2 h实验组血肌酐值(98.25±36.76)μmol/L明显低于对照组(147.26±59.67)μmol/L;移植后24 h血肌酐值(221.55±62.13)μmol/L明显低于对照组(316.12±74.31)μmol/L,而内生肌酐清除值实验组(1.91±0.76)ml·min-1·kg-1明显高于对照组(0.87±0.82)ml·min-1·kg-1,差异均具有显著性(P<0.05)。结论黄芪用于肾脏低温灌注保存中,对缺血再灌注损伤的肾脏有一定保护作用。     

The antiinflammatory effects of propofol in endotoxemic rats during moderate and mild hypothermia

Purpose We previously found that propofol attenuated the mortality rate and inflammatory responses during endotoxemia in rats; however, whether propofol retains its antiinflammatory effects during hypothermia has not been determined. We investigated the effects of propofol on endotoxemic rats subjected to moderate or mild hypothermia. Methods Male Wistar rats (n = 88) were anesthetized intraperitoneally with pentobarbital sodium and assigned to one of two protocols: one representing moderate hypothermia (30°–32°C) and the other representing mild hypothermia (33°–35°C). Each protocol included four equal-sized groups: group A, Escherichia coli endotoxin (15 mg·kg⁻¹, i.v.) and normothermia; group B, propofol (10 mg·kg⁻¹·h⁻¹, i.v.) and normothermia after endotoxin injection; group C, endotoxin (15 mg·kg⁻¹, i.v.) and hypothermia; and group D, propofol (10 mg·kg⁻¹·h⁻¹, i.v.) and hypothermia after endotoxin injection. Rats then were warmed or cooled to maintain rectal temperatures as above for 6 h. The mortality rate was assessed up to 6 h after endotoxin injection. In addition, we assessed hemodynamics, acid–base status, and plasma cytokine concentrations. Results Endotoxemic rats developed hypotension and metabolic acidosis as well as increased plasma cytokine concentrations. Mortality rates 6 h after endotoxin injection were 70%, 40%, 10%, and 0% for groups A–D, respectively, at moderate hypothermia. Propofol administration to endotoxemic rats with hypothermia, whether moderate or mild, also attenuated the high mortality rate, metabolic acidosis, and elevation of cytokines, but these effects were not superior to those of hypothermia alone. Conclusion During hypothermia, propofol administration does not have additive beneficial antiinflammatory effects.     

深低温低流量灌注降温期pH稳态对乳猪脑保护的研究

目的：在深低温低流量灌注模式下，观察快速降温期应用不同血所气管理对乳猪脑功能的影响。方法：12只乳猪随机均分成2组。alpha组：降 温期应用alpha稳态；pH组：降温期应用pH稳态。脑功能的监测包括：脑血流量、脑部温度、生化指标，并计算脑氧代谢参数和复温末脑水含量。结果：pH组降温末脑血流量和脑皮质ATP含量均高于alpha组（P＜0．05），而脑氧代谢率、乳酸含量和降温期脑部温差均低于alpha组（P＜0．05），两组脑水含量的差异无显著意义。结论：深低温低流量灌注快速降温期应用pH稳态管理血气，可提供更好的脑保护。     

The relation between EEG and mental development following cardiac surgery performed under simple deep hypothermia in children

In order to assess the accuracy of electroencephalography (EEG), in children who have undergone cardiac surgery under simple deep hypothermia, the relation between IQ or schoolwork achievement and the duration of circulatory arrest was investigated in 75 such children. Abnormal preoperative EEG's were found in 16 per cent of the children while abnormal postoperative EEG's were found in 17 per cent. The children were divided into 4 groups, according to pre- and postoperative EEG results. Schoolwork achievement scores ranged between 3.0 and 3.2, the difference among the groups being insignificant. Moreover, no significant shift in IQ was found among the groups. Finally, regarding the number of children who were able to go on to a higher level of education, including high school the college or university, again no significant differences were found among the 4 groups. In a comparison with the number of such children in neighboring Nagasaki prefecture able to continue on to a higher level of education, no significant differences were seen either. The findings and statistics of this investigation therefore indicate that pre- and postoperative EEG's are not always a reliable reference for assessing the prognosis of cerebral activity.