丙泊酚对低温体外循环期间胃粘膜酸中毒的影响

目的　探讨丙泊酚对心内直视手术病人低温心肺转流 (CPB)期间胃粘膜酸中毒的影响。方法　 2 0例心内直视手术病人随机分为对照组 (A组 ,n =10 )和丙泊酚组 (B组 ,n =10 )。用芬太尼、咪唑安定、潘库溴铵维持麻醉 ,间断吸入异氟醚。B组于CPB开始至停机前持续静脉注入丙泊酚 5～ 8mg·kg-1·h-1。分别于CPB前 (T1)、停机前 (T2 )和停机后 4 0分钟 (T3)测定PaCO2 和胃粘膜PCO2 (PiCO2 ) ,计算PiCO2 与PaCO2 之差 [P(i a) CO2 ]和胃粘膜pH( pHi)。 结果　A、B两组T2 P(i a)CO2 较组内各时点均明显增高 ,pHi明显降低 (P <0 0 1) ;与A组比较 ,B组T2 、T3P(i a) CO2 显著降低 ,pHi显著增高 (P <0 0 5 ) ;与T1比较 :A组T3P(i a) CO2 仍显著增高 ,pHi显著降低 (P <0 0 5 ) ,B组T3P(i a) CO2 和 pHi基本恢复至T1水平。结论　低温CPB期间持续静脉注入一定剂量的丙泊酚可减轻胃粘膜低灌流和酸中毒。     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

目的 研究小儿体外循环(cardiopulmonary bypass,CPB)中不同氧合器对中性粒细胞(PMN)凋亡的影响,为减轻体外循环伞身炎症反应提供新的思路.方法 将60例室间隔缺损患儿随机分为两组(n=30):西京-90鼓泡式氧合器组(B组)和希健-Ⅱ膜式氧合器组(M组).分别于CPB前、CPB结束时、CPB结束后4、8、24 h 5个时点采取静脉血,以伞血细胞计数仪测定PMN数量,流式细胞仪测定PMN凋亡率和PMN表面黏附分子CD11b表达变化,ELISA法测定血浆弹性蛋白酶浓度.结果 两组患者CPB结束后PMN凋亡率明显降低(P<0.05),PMN数量、CD11b表达、血浆弹性蛋白酶浓度明显升高(P<0.05),在CPB结束时及CPB结束后4、8 h PMN凋亡率M组均高于B组(P<0.05);而PMN数量、CD11b表达、血浆弹性蛋白酶水平B组均高于M组(P<0.05).CPB结束后24 h PMN数量B组高于M组(P<0.05).结论 与西京-90鼓泡氧合器相比,应用希健-Ⅱ膜式氧合器可以减轻CPB对PMN凋亡的抑制,进而减轻全身炎症反应.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

不同氧合器对体外循环心脏手术患儿中性粒细胞凋亡的影响

Objective To evaluate the effect of two kind oxygenators on polymorphonuclear neutrophil (PMN) apoptosis, and to give a method of inhibting the systemic inflammatory response syndrome(SIRS) to cardiopulmonary bypass(CPB). Methods Sixty VSD patients undergoing open heart surgery with CPB were randomly divided into two groups(n = 30): group B(bubble oxygenator), group M(membrane oxygenator). Blood samples were drawn from the central venous line before starting CPB, at the end of CPB, 4, 8 and 24 h after CPB. The PMN counts were performed by blood cell counter. PMN apoptosis and the expression of CD11b were evaluated by flow eytometry. The plasma concentration of elastase was determined by enzyme linked immunosorbent assays. Results The rates of PMN apoptosis were significantly reduced (P<0.05) and the PMN counts, the expression of CD11b and the plasma con-centration of elastase were remarkably increased after CPB(P<0.05), but at the end of CPB, 4 h and 8 h after CPB the rate of PMN apoptosis was higher in group M than that in group B. PMN counts, the expression of CDI lb and the plasma concentration of elastase were higher in group B than in group M (P<0.05). The PMN counts were higher in group B than in group M 24 h after CPB (P< 0.05). Conclusion XiJian-Ⅱ membrane oxygenator can increase PMN apoptosis and depress systemic inflammatory response better than XIJing-90 bubble oxygenator.     

腺苷预处理对体外循环术后心肌肌钙蛋白变化的影响

目的 探讨腺苷预处理对心脏直视手术的心肌保护效果。方法 ３０例择期心瓣膜置换术患者随机分成实验组和对照组，每组１５例。实验组在术前行腺苷预处理。分别于转流前、主动脉阻断３０分钟和６０分钟、主动脉开放后３０分钟及术后２４小时采血测定心肌肌钙蛋白Ｔ（ｃＴｎＴ）、心肌酶谱和丙二醛。结果 腺苷预处理ｃＴｎＴ和心肌酶外漏明显减少，丙二醛生成减少。结论 腺苷预处理能减轻心肌肌缺血再灌注损伤。     

体外循环中乌司他丁对机体的保护作用

乌司他丁（尿胰蛋白酶抑制剂）是由143个氨基酸组成，分子量为6646u的酸性蛋白质，其冻干品为白色或淡褐色块状物和粉末；是从健康男性尿中分离纯化的糖蛋白，它有多种特殊的药理性质，为一种广谱酶抑制剂，对多种酶、糖和脂水解酶有抑制作用。在体外循环过程中由于机体处于一种非生理状态下，同时伴有缺血、缺氧和各种酶、炎性介质、自由基的大量释放，导致机体心脏、肺、肾等重要器官和血管内皮损伤。乌司他丁作为一种蛋白酶抑制剂能较为有效的竞争性或非竞争性抑制由于体外循环非生理作用引发的一系列酶以及炎性介质的释放，同时起到保护机体重要器官的作用。     

急症体外循环

目的：回顾最近2年急诊体外循环病例，分析其特点并总结经验。方法：收集1998－1999年间共97例急诊体外循环心血管手术临床资料，其中动脉瘤20例，冠状动脉旁路移植术15例，粘液瘤17例，心瓣膜置换术16例，先天性心脏病急性缺氧发作18例，大血管破裂出血6例，心室辅助3例，主动脉窦瘤破裂2例，涉及多种体外循环方法的应用。结果：早期主要并发症为低心排血量、出血、短时间的神经系统功能障碍，共20例，占20．6％，死亡8例，占8．2％，其余患者顺利出院，目前正接受长期随访。结论：急诊体外循环在心血管急诊手术中非常重要，快速建立体外循环，针对不同病情采取相应措施是手术成功和减少并发症的关键。     

腺苷对犬体外循环后肺缺血—再灌注损伤的作用

目的　研究腺苷是否能减轻体外循环后肺组织损伤。　方法　12条犬随机分为实验组和对照组。建立体外循环模型,实验组使用腺苷(50μg/kg     

左旋精氨酸对体外循环缺血再灌注损伤心肌的保护作用

目的 探讨左旋精氨酸对体外循环（ＥＣＣ）下心肌缺血再灌注损伤的防护作用。方法 １６例ＥＣＣ下行心脏手术患者分成对照组和治疗组,分别于主动脉阻断前、开放后２小时、４小时、８小时测定血浆一氧化氮（ＮＯ）水平、乳酸脱氢酶（ＬＤＨ）和肌酸磷酸激酶（ＣＰＫ）活性。结果 主动脉开放后不同时点,对照组ＮＯ水平显著下降,ＬＤＨ,ＣＰＫ活性明显增强,与阻断前比较差异均有显著性（Ｐ〈０．０５和Ｐ〈０．０１）;治疗组Ｎ     

重组人红细胞生成素在体外循环围术期中的作用

目的　观察重组人红细胞生成素 (r Hu EPO)在体外循环围术期对红细胞动员的效应。　方法　选择体外循环心脏直视手术患者 80例 ,随机分为两组 ,治疗组 :40例 ,从手术前 7天至术后 7天 ,皮下注射 r Hu EPO,每次 2 0 0～ 2 5 0IU /kg,每周 3次 ,共 2周 ;同时口服铁剂。对照组 :40例 ,不给予 r Hu EPO处理 ,其他同治疗组。术前 7天、1天、术后 1天、7天和 14天测定血红蛋白 (Hb)、红细胞压积 (Hct)、网织红细胞 (Ret)值。　结果　治疗组用药后 7天 Ret明显增高 ,术后 14天达峰值 ,显著高于对照组 (P<0 .0 5 ) ;Hb和 Hct术后 7天、14天均明显高于对照组 (P<0 .0 5 ) ;治疗组术中用血量及术后输血均显著低于对照组 (P<0 .0 5 )。治疗组中出现血压升高、低热等各 1例 ,停药后症状消失。　结论　在体外循环围术期应用 r Hu EPO,可以促进红细胞动员、释放 ,减少术中预充血量及术后迟发性贫血的发生     

体外循环术中小剂量抑肽酶对急性炎性反应的作用

目的 探讨体外循环（ECC）术中小剂量抑肽酶是否能减轻ECC所致的急性炎性反应。方法 将28例首次心瓣膜置换术患者随机分为抑肽酶组和对照组,各14例。于麻醉诱导前、ECC前、ECC后1小时和24小时测定血浆中白细胞介素－10（IL－10）、肿瘤坏死因子－α（TNF-α）和白细胞计数。结果 两组IL－10ECC后1小时比麻醉诱导前明显升高（P＜0．01）,且抑肽酶组明显高于对照组（P＜0．01）;对照组TNF－α和白细胞计数在ECC后1小时和24小时较麻醉诱导前明显升高,且高于抑肽酶组（P＜0．05）。结论 小剂量抑肽酶可抑制ECC所致的炎性反应。     

小型体外循环机对猪主动脉瓣置换术中心肌的保护作用

目的观察小型体外循环机在猪心瓣膜置换术中对心肌的保护效果。方法7只长白猪（Landrace）在小型体外循环机支持下行主动脉瓣置换术,病理观察心肌形态学改变,同时冰冻切片免疫荧光染色法测定心肌组织中补体C3b/c、先天免疫抗体IgG和硫酸肝素蛋白多糖（Heparan sulfate proteoglycans,HSPG）的含量。结果病理HE染色显示猪术前右心房与术后右心房、左心室心肌结构正常,无明显水肿损伤;免疫荧光染色显示：右心房心肌组织中补体C3b/c手术后较手术前稍增强,左心室补体C3b/c较手术前无明显改变;手术前右心房心肌组织中先天性抗体IgG荧光染色较弱,左心室手术后较手术前稍增强,而右心房较手术前荧光染色无明显改变;右心房心肌组织中硫酸肝素蛋白多糖手术后较手术前无明显改变,左心室荧光减弱。结论小型体外循环机能够对猪主动脉瓣置换术心肌起到有效的保护作用。