先天性心脏病术后完全性房室传导阻滞的防治

目的探讨１７５４例先天性心脏病直视术后１０例完全性房室传导阻滞（ＣＡＶＢ）的发生原因和转归，提出正确的防治方案。方法手术中立即发生ＣＡＶＢ８例；其中６例立即再次阻断主动脉重新修补，２例使用心外膜起搏和异丙肾上腺素处理，其中１例术后第７天再次手术重新修补缺损；手术后３～４天由于ＣＡＶＢ发生心源性昏厥２例，均安置临时心内膜起搏器。结果全组患者无住院死亡，全部康复出院未留置永久性心内膜起搏器。结论ＣＡＶＢ的发生与房间隔缺损（ＡＳＤ）、室间隔缺损（ＶＳＤ）的位置和手术操作有关；正确认识房室传导组织的解剖是防止损伤的关键，术中一旦发生ＣＡＶＢ应果断拆除原修补缝线，重新修补缺损；术后安置心外膜或心内膜临时起搏器对防止心源性昏厥非常有效。     

生物起搏与电子起搏"串联"起搏心脏的研究

目的 观察自体窦房结细胞移植与电子起搏器"串联"起搏心脏的作用.方法 健康成年犬12条,随机分为实验组和对照组(n=6).所有犬安置电子心脏起搏器以保证存活,然后切取窦房结.将实验组犬窦房结组织消化成细胞悬液后,注射到自体右室前壁心肌内,对照组相同部位注射等量培养液.2周后射频消融希氏束,建立完全性房室传导阻滞犬模型,观察并记录犬心律.对实验组犬经股静脉应用异丙肾上腺素,研究心律变化.免疫荧光染色观察移植的细胞存活状况及其与心室肌细胞形成的缝隙连接结构.结果 建立完全性房室传导阻滞犬模型1 h后,实验组心率高于对照组(P＜0.01).注射异丙肾上腺素后,实验组心率变化明显(P＜0.01).实验组心律在14 d内保持稳定.免疫荧光染色法证实,移植的细胞在移植部位存活,且细胞间有缝隙连接结构形成.结论 自体窦房结细胞移植是一种对儿茶酚胺类物质的调节作用反应敏感的生物起搏技术,并且在与电子起搏技术串联后,其起搏作用在14 d内保持稳定.移植的窦房结细胞可与周围细胞形成电-机械耦联的结构基础.     

自体脾脏移植

重点复习了动物和人体中自体脾脏移植预防脾切除术后凶险性脓毒症（Ｏｖｅｒｗｈｅｌｍｉｎｇ ｐｏｓｔｓｐｌｅｎｅｃｔｏｍｙ ｓｅｐｓｉｓ，ＯＰＳＳ）的评估。     

自体干细胞移植治疗下肢缺血

自体骨髓和外周血干细胞移植治疗下肢缺血性疾病是近年来刚刚开展的一项新技术,无论是动物实验,还是临床研究,都显示出了干细胞移植改善下肢缺血的有效性。尽管还有很多尚未解决的问题,但这一技术业已展现了美好的前景。     

心耳肌细胞移植治疗心脏传导阻滞的研究

本研究旨在探索治疗心脏传导系统疾病的实验方法,以避免现有人工心脏起搏器的缺点,为临床治疗各类缓慢型心律失常提供全新的思路。一、材料和方法1.材料:健康成年杂种犬20只,雌     

自体主动脉瓣移植纠治完全性大血管错位伴肺动脉瓣狭窄

目的探讨解剖纠治完全性大血管错位（TGA）伴肺动脉瓣狭窄的手术方法。方法1例8月龄、体重6．5kg的TGA伴肺动脉瓣狭窄男病婴，术中将原主动脉瓣移植至肺动脉瓣处形成新的主动脉；再行Switch术，同种带瓣管道连接右心室与肺动脉。另1例10月龄、体重9．8kg的该病男病婴，术中将整个主动脉瓣取下，保留左、右冠状动脉，向后移植，后半部分直接与原肺动脉瓣环连续缝合，前半部分与室间隔缺损之间采用dacron补片连续缝合关闭；肺动脉与右心室切口直接连接。结果2例手术均取得成功。出院时超声检查各吻合口通畅，无残余分流．无主动脉瓣反流。术后随访12个月和6个月，生长发育良好，心胸比率0．75。超声示左心功能良好，前例示主动脉瓣轻度反流．后例左、右心室流出道无残余梗阻．结论采用自体主动脉瓣移植纠治完全性大血管错位伴肺动脉瓣和瓣下狭窄，从解剖上得到彻底纠治．效果良好。由于病例少，随访时间短．还需进一步观察。     

骨髓单个核细胞自体移植促进心脏血管再生

目的探讨骨髓单个核细胞自体移植于梗死心肌后实现血管再生的能力。方法结扎45只5月龄日本大耳白兔的冠状动脉左前降支建立心肌梗死模型，随机分为骨髓单个核细胞自体移植组(5-溴-2’-脱氧尿嘧啶核苷标记的自体骨髓单个核细胞直接心肌注射至梗死周边区域)，心肌梗死未治疗组及假手术组，分别在细胞移植后2、4、8周时处死，应用免疫组织化学方法检测骨髓单个核细胞在梗死心肌组织中的分化、毛细血管密度以及细胞因子的表达。结果骨髓单个核细胞在梗死心肌组织中分化为血管内皮细胞和血管平滑肌细胞。在骨髓单个核细胞移植早期，心肌白细胞介素-1β(IL-1β)、碱性纤维母细胞生长因子(bFGF)、血管内皮生长因子(VEGF)表达水平显著增高。细胞移植后4、8周骨髓单个核细胞移植组毛细血管密度明显高于心肌梗死未治疗组及假手术组。结论骨髓单个核细胞自体移植于梗死心肌区能促进血管再生，改善侧支循环。     

自体造血干细胞移植治疗小细胞肺癌的护理

小细胞肺癌是肺癌中发展最迅猛的一种。其发病率占肺癌的 2 0 % 30 % [1] 。它具有独特的组织学和生物学特性 ,恶性程度高 ,易耐药和血行转移。常规化疗很难完全缓解 ,超大剂量化疗可显著提高对肿瘤的杀伤力 ,但其对骨髓的严重抑制限制了化疗剂量的增加。自体造血干细胞移植(ＡＨＳＣＴ)旨在解救超剂量化疗受抑制的骨髓 ,使其重建造血功能 ,恢复免疫力 ,提高小细胞肺癌治疗的有效率和生存率[2 ] 。我科于 2 0 0 1年 3月至 2 0 0 2年 4月对 6例小细胞肺癌病人实施自体造血干细胞移植 ,效果满意 ,现将护理报告如下。1　临床资料　　一般资料 :…     

Ethanol induction of complete heart block in swine

OBJECTIVES: A method for the induction of complete heart block (CHB) by ethanol injection and its success rate in a pig model of acute right ventricular failure is reported. Additionally, a review of the literature for the induction of CHB in laboratory animals is detailed. The literature review was undertaken to both compare our rate of success with other methods and provide insight into our technique and refine its implementation. BACKGROUND: Animal models of CHB have facilitated the understanding of therapeutics for various cardiac pathologies in humans. In our laboratory, CHB in pigs is used for complete control of heart rhythm in studies of biventricular pacing. MATERIALS AND METHODS: Experiments carried out on pigs in our laboratory that required the induction of CHB were reviewed retrospectively. In addition, review of the literature for creating CHB in animals was undertaken. Our success rate was compared to that of other groups. RESULTS: Our success rate (93%) is similar to other models of CHB, in general, and to those models that used the injection of caustic substances with thoracotomy. CONCLUSIONS: Review of the literature indicates that our success rate is comparable to other groups and that, although many approaches have been described in both open- and closed-chest models, success is likely dependent on the practice and skill of the experimenter. In addition, review of the literature has afforded us new perspectives on the experimental induction of CHB.     

原位心脏移植20例动物实验研究

本文报告１９９２年４月至１９９３年１２月对２０只犬进行原位心脏移植的实验研究。２０只实验犬均手术成功，获得满意的结果。文中就供体的准备，供心的荨取，供心的保存，爱体的准备，受体心的切除，供心移植的技术进行了描要这和讨论 。     

Anaesthetic management in a neonate with congenital complete heart block

We present the case of a neonate undergoing surgery on the first day of life for the installation of a permanent pacemaker because of the existence of congenital complete heart block (CCHB) with a basal heart rate of 43 b.min(-1) and minimal elevation after initiating an isoproterenol perfusion. The intervention was under general anaesthesia with laryngeal mask airway (LMA) and spontaneous ventilation. The principal anaesthetic goals were to assure adequate anaesthesia, with haemodynamic and respiratory stability, to maintain the best possible heart rate and to avoid postoperative respiratory depression or apnoea.     

星状神经节阻滞对甲状腺手术患者颈丛阻滞时心率变异性的影响

目的 探讨星状神经节阻滞(SGB)对甲状腺手术患者颈丛阻滞时心率变异性的影响.方法 择期行甲状腺腺瘤切除术的患者45例,ASA Ⅰ或Ⅱ级,年龄20～60岁,体重40～70 kg,性别不限,随机分为3组(n=15):对照组(C组)、左侧SCB组(LS组)及右侧SGB组(RS组).SGB成功后15 min行颈丛神经阻滞.于入室后(基础状态)、颈丛阻滞结束即刻、阻滞5min.10min、切皮及术毕时记录SBP、DBP、HR;心率变异性参数:总功率(TP)、低频功率(LF)、高频功率(HF)、低频与高频比值(IF/HF比值),并计算LF、HF的标准化值(LFnu、HFnu).结果 与基础值相比,术中C组LFnu和LF/HF比值升高,HR、HF及HFnu下降,RS组LF、HF及HFnu下降,HR升高,三组SBP和DBP均升高(P<0.05或0.01),LS组心率变异性参数差异无统计学意义(P>0.05).与C组相比,LS组HR、LFnu下降,HF和HFnu升高(P<0.05),RS组上述指标差异无统计学意义(P>0.05).结论 甲状腺手术患者颈丛阻滞前行SGB可调节颈丛阻滞引起的交感神经兴奋性,维持交感/副交感神经张力平衡,且左侧SGB效果较好.     

Anesthetic management of the neonate with congenital complete heart block: a 16-year review

BACKGROUND: Anesthesia for patients with complete heart block can be associated with significant hemodynamic instability. The aim of this study is to review our anesthetic experience of neonates with congenital complete heart block (CCHB) who underwent placement of either a temporary epicardial pacing system or a permanent epicardial pacemaker. METHODS: The anesthetic management of neonates with CCHB who underwent pacemaker placement at a single institution over a 16-year period was reviewed. RESULTS: Twenty-four neonates were identified, 17 with a structurally normal heart (NL) and seven with associated congenital heart defects (CHD). Median (range) gestational age was 36.9 (26-41) weeks, birth weight 2.9 (1.0-4.1) kg, and baseline heart rate 47 (38-80) b.min(-1). A temporary epicardial pacing system was placed in six patients (four CHD, two NL; P = 0.003) following institution of mechanical ventilation and inotropic support for a low cardiac output state, and a permanent epicardial pacemaker was placed in 18 patients. Atropine 0.02 mg.kg(-1) IV prior to induction (n = 5) increased heart rate less than 20%. Intraoperative hypotension was documented in nine neonates, five of seven with CHD and four of 17 with NL (P = 0.02). In four patients (44%) hypotension occurred despite concurrent inotropic support. Intraoperative cardiac arrest occurred in one neonate, necessitating institution of extracorporeal membrane oxygenation. Two patients (8.3%) died in hospital from complex CHD and complications of prematurity. CONCLUSIONS: Early institution of mechanical ventilation, inotropic support and pacing are necessary in the neonate with CCHB and poor hemodynamic function, particularly with coexisting CHD or prematurity.     

Renal autotransplantation combined with direct pyelocystostomy for a doubled renal artery aneurysm of a stone forming kidney

A 35-yr-old female patient presented with recurrent left-sided calcium oxalate nephrolithiasis in combination with equilateral doubled renal artery aneurysm. Approximately two-thirds of the cumulative renal function were scintigraphically calculated in favour of the affected kidney. After a left-sided nephrectomy, "workbench surgery" with resection of both aneurysms was performed. The renal artery was reconstructed with contralateral internal-iliac artery graft. To allow passage of renal calculi, the kidney was transplanted in the right iliac fossa combined with a wide pyelocystostomy. The patient recovered uneventfully and presented with good physical health and regular serum creatinine 1 yr postoperatively.     

骨髓间充质干细胞自体介入移植治疗糖尿病Beagle犬

目的 观察转人胰岛素(Insulin,INS)和绿色荧光蛋白(EGFP)基因的Beagle犬骨髓间充质干细胞(BcMSCs)经动脉介入移植入糖尿病Beagle犬自体肝内后的长时程疗效及安全性.方法 构建逆转录病毒双表达载体pMSCV-INS-IRES-EGFP,转染BcMSCs后,经肝动脉介入移植到糖尿病Beagle犬自体肝脏.结果 糖尿病Beagle犬治疗组接受移植后,体质量至第10周上升8.83%.移植后第7、70天空腹血糖值分别为(19.80±3.41)、(10.53±2.12)mmol/L,与对照组差异有统计学意义(P＜0.05).血清及肝脏中检测到人胰岛素.静脉葡萄糖耐量实验示血糖水平下降.形态学分析证实移植入的BcMSCs在肝内定植并分泌人胰岛素,移植部位无病理形态学改变.结论 该法能有效降低糖尿病Beagle犬血糖水平.     

Myocyte transplantation for treatment of complete heart block

We hypothesize that it may be possible to treat complete heart block by transplanting right atrial myocytes directly into the ventricular wall where they may set the rate of ventricular contraction at their own intrinsic rate. The biologic background for this conjecture has already been determined to a large extent. However, a few critical unanswered biologic questions must be addressed before the development of this suggested new therapy becomes a mere technologic exercise.