支架型人工血管治疗降主动脉假性动脉瘤

目的探讨支架型人工血管介入治疗降主动脉假性动脉瘤的可行性及疗效。方法2001年9月至2004年12月,行支架型人工血管治疗降主动脉假性动脉瘤8例,其中男性7例,女性1例,年龄22~65岁,平均(45.4±15.1)岁。病因4例为外伤,1例为动脉硬化,3例病因不明。瘤体直径(3.9±1.3)cm。4例为急诊手术,4例择期手术。结果6例采用全身麻醉,2例采用硬膜外麻醉。支架型人工血管均顺利植入。术后30d内无死亡。1例有近端内漏。术后脑梗塞1例。术后随诊2~30个月,平均(9.3±10.7)个月,术后4个月死亡1例,病因为内漏导至动脉瘤破裂。1例于5个月后因再发假性动脉瘤,接受再次支架型血管植入术,于2次手术后2个月死亡。随诊死亡2例,死亡率25%。结论支架型人工血管是治疗主动脉假性动脉瘤的有效方法,中远期效果还有待进一步观察。     

术前低剂量胺碘酮预防非体外循环冠状动脉旁路移植术后心房颤动

Objective To assess the safety, tolerability and efficacy of preoperative low dose intravenous amiodarone in the prevention of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods Two hundred patients with coronary atheroselerotic heart disease underwent selected OPCAB and were randomly divided into two groups: control group (100 cases) and experimental group (100 cases). Patients in control group were given conventional medicines and placebo, and patients in experimental group were treated with low dose intravenous amiodarone daily for 4 days before surgery. They were given conventional medicines after surgery. Results After the off-pump coronary artery bypass grafting, the incidence of AF, ventricular rate and the duration of AF in the experimental group were lower than those in control group [15% vs. 41%, χ2=16.766, P=0.000; (126.0±20.8) times/ min vs. (150.0±25.6) times/ min, t=0.478, P =0. 017; (8. 0±8. 6) h vs. (12.0±9.6) h, t=0. 439, P=0. 019]. No significant difference were found in the incidence of side effect between low close amiodarone group and the control group. Conclusions Prophylactic application of low dose intravenous arniodarone before off-pump coronary artery bypass grafting can safely and effectively reduce the postoperative ventricular rate and the incidence of AF, shorten the duration of AF, promote the rehabilitation and slightly improve the clinical symptoms.     

激光心肌血运重建术后5年随访

1997年7月至2000年12月连续采用高功率CO2激光心脏打扎器治疗冠心病病人98例，手术早期死亡4例。现将94例生存者随访结果报道如下。     

术前低剂量胺碘酮预防非体外循环冠状动脉旁路移植术后心房颤动

Objective To assess the safety, tolerability and efficacy of preoperative low dose intravenous amiodarone in the prevention of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods Two hundred patients with coronary atheroselerotic heart disease underwent selected OPCAB and were randomly divided into two groups: control group (100 cases) and experimental group (100 cases). Patients in control group were given conventional medicines and placebo, and patients in experimental group were treated with low dose intravenous amiodarone daily for 4 days before surgery. They were given conventional medicines after surgery. Results After the off-pump coronary artery bypass grafting, the incidence of AF, ventricular rate and the duration of AF in the experimental group were lower than those in control group [15% vs. 41%, χ2=16.766, P=0.000; (126.0±20.8) times/ min vs. (150.0±25.6) times/ min, t=0.478, P =0. 017; (8. 0±8. 6) h vs. (12.0±9.6) h, t=0. 439, P=0. 019]. No significant difference were found in the incidence of side effect between low close amiodarone group and the control group. Conclusions Prophylactic application of low dose intravenous arniodarone before off-pump coronary artery bypass grafting can safely and effectively reduce the postoperative ventricular rate and the incidence of AF, shorten the duration of AF, promote the rehabilitation and slightly improve the clinical symptoms.     

成纤维细胞生长因子治疗冠心病新进展

自 1991年Ｂａｎａｉ等〔1〕 开始研究酸性成纤维细胞生长因子 (ａＦＧＦ)对心肌的作用以来 ,人们已对ＦＧＦ的种类、受体、作用机制等进行了大量的研究。结果表明 ,通过不同途径应用ＦＧＦ可促进心肌血管新生 ,改善缺血心肌血流灌注和功能。现概述ＦＧＦ治疗冠心病的研究进展如下。心肌血管新生的特性血管新生包括 :内皮下的基质水解 ;内皮细胞增殖、迁移和再粘附 ;新的有三维结构的血管形成 3个阶段〔2〕。心脏的血管新生有 2种情况 :一是心肌内侧支循环发展 ,以直径2 0 0 μｍ以下、中层发育差的薄壁血管的出现和直径在 2 0 μｍ以下、只…     

多次移植人脐带间充质干细胞对大鼠Th1和Th2比值的影响

目的:观察多次静脉移植人脐带间充质干细胞(human umbilical mesenchymal stem cells,HUMSCs)对大鼠Th1和Th2轴的影响。方法:①体外培养HUMSCs;流式细胞仪鉴定第4代hUMSCs表面抗原的表达;特异性诱导染色并鉴定第4代HUMSCs分化脂肪细胞和成骨细胞的潜能;②雄性SD大鼠30只,体质量182²03g,分为3组:空白对照组;0.9%氯化钠液组;干细胞移植组,每组10只。干细胞移植组:1次/w经尾静脉注射3.5×107/kg的HUMSCs,连续3次。第三次移植HUMSCs后11d,各组经腹主动脉取血,流式细胞仪检测T淋巴细胞的IFN-γ和IL-4阳性率。结果:3次注射干细胞后实验动物全部存活,干细胞组的Th1、Th2阳性率较0.9%氯化钠液组差异无统计学意义(P>0.05);Th1/Th2比值、血清IFN-γ和IL-4水平与对照组比较差异无统计学意义(P>0.05);干细胞组的心、脑、肺、肝及肾等脏器未发生病理改变。利用红色荧光蛋白转染的HUMSCs示踪,发现移植的HUMSCs大部分归巢于骨髓中。结论:多次尾静脉注射HUMSCs,未引起大鼠Th1、Th2细胞免疫和体液免疫系统的变化,Th1/Th2轴无明显改变。移植的HUMSCs能较长时间的存活于大鼠骨髓内,具有较好的免疫相容性。     

环孢霉素A对异体心肌诱导大鼠脾淋巴细胞表面分子表达时间窗的影响

目的:体外建立异体心肌组织抗原诱导大鼠淋巴细胞表面蛋白分子及编码基因表达时间窗模型,动态观察环孢素A对表达时间窗的影响。方法:实验分4组:对照组、抗原组、环孢组和抗原+环孢组。2、6、12、24、48h和72h观察脾白细胞其表面蛋白分子及编码基因的变化。结果:4组MHC-Ⅱ、CD4、CD8分子、ICAM-1无显著差异,CD4分子环孢霉素组2～24h有一个平台期。IL-2R分子抗原组12h达高峰值,环孢素A组6h有小峰值,抗原+环孢素A组表达较平稳。P59基因对照组逐步负调,而抗原组在2h内和12～24h有2个正调表达,2～12h负调至谷底,后再正调、负调表达,环孢素A组表达较稳定,抗原+环孢素组48h达到谷底,后迅速上升。CD4基因对照组2h、抗原组6h到谷底,后迅速上升,环孢素A组48h达到峰值,抗原+环孢素A组2h内有一个峰值,2组后逐步负调。CD8基因4组均负性表达,除抗原组无谷底外,对照组加药12h出现谷底,环孢素组加药6h出现谷底,抗原+环孢素A组加药12h出现谷底,3组后迅速上升。结论:异体心肌组织抗原可在2h内引发白细胞开始释放细胞表面蛋白分子IL-2R、P59基因表达,刺激6h可以诱发CD4基因开始转录表达,环孢素A 2h开始释放ICAM-I、IL-2R分子。这些结果为更加具体的描述移植免疫排斥反应的时间进程提供了详实的依据,并为更深入阐述环孢素A抑制移植排斥反应的机理提供了可靠依据。