水通道蛋白-1在大鼠急性心肌缺血再灌注损伤中的表达

目的:观察水通道蛋白1(AQP-1)在大鼠心肌缺血再灌注损伤过程中表达水平的变化,探讨其与心肌损伤以及损伤程度的关系。方法:采用SD大鼠复制心肌缺血再灌注模型,观察心肌缺血区域颜色和运动的变化,心电图记录心肌急性损伤情况,应用心肌酶学的变化判断大鼠心肌损伤的程度,并通过免疫组织化学方法检测心肌AQP-1的表达。结果:①心肌缺血再灌注损伤后AQP-1水平迅速上升;②AQP-1表达水平与心肌损伤程度存在着正相关性。结论:①心肌缺血再灌注损伤过程中AQP-1水平的迅速上升,其上升水平与心肌损伤程度呈正相关;②应用AQP-1调节剂调节AQP-1的表达水平有望成为心肌保护的新方法。     

激光心房迷宫术治疗心房纤颤的研究

目的 探讨用Ｎｄ：ＹＡＧ激光照射热凝代替手术切开，行改良的迷宫术Ⅱ治疗心房纤颤。方法 ８条犬右锭端安放起搏电极行心房Ｂｕｒｓｔ刺激，或在静滴氯化乙酰胆碱每分钟１μｇ／ｋｇ体的基础上加用心房Ｂｕｒｓｔ刺激诱发房颤，建立持续性房颤模型后以改良的激光心房迷宫术Ⅲ治疗。术后以同样条件刺激，观察是否还可引出房颤。结果 ８条犬在激光心房迷宫术后以同样条件刺激均不能再诱发出房颤，平均心跳停时间为２４ｍｉｎ。结论     

NF-κB信号通路对大鼠深低温缺血再灌注后肺组织水通道蛋白5表达的影响

目的:探讨大鼠深低温缺血再灌注后肺组织水通道蛋白5(AQP5)的变化及核因子kappa B(NF-κB)信号通路对大鼠肺组织AQP5表达的影响。方法:30只Wistar大鼠随机分为假手术组(sham组)、深低温缺血再灌注损伤组(I/R组)、PDTC干预组(I/R+PDTC组)。I/R组大鼠体表降温至深低温后阻断左下肺门30min后开放、复温;sham组只开胸但不降温阻断左下肺门;PDTC组于实验前2d腹腔注射PDTC,其余操作同I/R组;各组于再灌注复温后1h或相应时间段取肺组织行病理学观察、测肺湿/干重(W/D)比值,实时PCR及Western-blot检测肺组织中AQP5及NF-κB p65的表达。结果:I/R组与Sham组比较肺组织NF-κB p65表达增多(P<0.01),AQP5表达减少(P<0.01)、W/D比值增高(P<0.01),肺组织形态及结构明显受损;PDTC干预组与I/R组比较肺组织NF-κB p65表达减少(P<0.01),AQP5表达增加(P<0.01)、W/D比值减低(P<0.01),肺组织病理形态学改变轻于I/R组,与Sham组比较NF-κB p65表达增多(P<0.01),AQP5表达减少,W/D比值增高(P<0.01)。结论:NF-κB p65表达增加和AQP-5表达下降可能与深低温缺血再灌注造成的急性肺损伤有关,NF-κB信号通路可能负向调控AQP-5的表达。     

缺血预处理对缺血脊髓微循环影响的实验研究

目的 探讨缺血预处理（IPC）对缺血损伤脊髓的保护作用及其相关机制.方法 48只健康新西兰大白兔随机分为缺血预处理组（IPC组）和缺血组,应用腹主动脉夹闭法建立脊髓缺血模型.观察两组脊髓组织缺血前、缺血40min及再灌注后2、8、24、72 h内皮素-1（ET-1）、血栓素A2（TXA2）与前列环素（PGI2）含量,并观察脊髓组织病理形态学改变及双后肢神经功能评分.结果 IPC组各时间点ET-1含量、TXB2/6-keto-PGF1α比值均显著低于缺血组（P＜0.05）.两个时间点上IPC组后肢神经功能评分明显高于缺血组（P＜0.001、0.01）,病理学累积评分明显低于缺血组（P＜0.001）.结论 IPC对主动脉阻断所致脊髓缺血再灌注损伤有良好的保护作用,抗“无再灌流”作用可能是其保护作用的重要机制之一.     

金属硫蛋白对离体心脏细胞凋亡和NO、NOS表达的影响

目的 探讨金属硫蛋白（Mr）与离体心脏细胞凋亡和一氧化氮（NO）、一氧化氮合酶（NOS）的关系。方法 Wistar大鼠16只，分为2组：对照组（c），腹腔注射蒸馏水0．5ml24h后取离体心脏灌注HTK心脏保护液，4℃保存3h后建立Langendorff灌注模型，灌注KH液2h；实验组（E）腹腔注射3．6％ZnSO4（1．5ml／ks）24h后取离体心脏，处理方法同C组。测定心肌MT含量、心肌细胞凋亡率、NO、NOS的含量。结果 MT含量E组明显较C组增高（P〈0．05），心肌细胞凋亡率E组明显低于C组（P〈0．01），琼脂糖凝胶电泳检测DNA片段梯E组与C组比较，光密度明显减弱（P〈0．01），E组与C组比较，NO、NOS的含量明显增多（P〈0．01）。MT含量与凋亡细胞率呈负相关（r=-0．96，P〈0．01），与心肌组织中NO含量呈正相关（r=0．97，P〈0．01）。结论 心肌MT可增加心肌中NO、NOS的表达，减少再灌后心肌细胞凋亡的发生。     

支气管异物的外科治疗

支气管异物症是一种常见的危急重症 ,多发生于小儿和老年人。 98%的病人就诊于五官科 ,常通过硬质气管镜或纤维支气管镜钳夹摘除异物 ;仅少数病例因异物形状特异 ,或已嵌入支气管 ,或合并大出血 ,不得不借助外科手术取异物或处理并发症。也有极少数病例 ,完全忘却异物吸入史 ,被诊断为肺不张、肺部感染或肺癌接受手术切除病肺后才发现为异物阻塞所致。现根据 1989～ 2 0 0 2年我们收治的 42例手术治疗病例资料分析 ,对诊断、治疗经验讨论如下。临床资料　本组 42例中男 2 9例 ,女 13例。年龄 3～ 6 5岁。有异物吸入史者 34例 ,无明显异物吸…     

改良全弓置换加支架象鼻术在DeBakeyⅠ型主动脉夹层术中的应用

目的 总结改良主动脉全弓置换加支架象鼻术治疗DeBakey Ⅰ型主动脉夹层的临床经验.方法 2006年1月至2010年10月,101例DeBakey Ⅰ型主动脉夹层患者接受改良全弓置换加支架象鼻术,其中急诊手术73例.全组男性76例,女性25例;年龄21～77岁,平均(49±8)岁.手术包括升主动脉置换术31例、Bentall术29例、Wheat术7例、David术34例.支架象鼻术的同时行左锁骨下动脉开窗以重建血运.在深低温停循环时改行双侧顺行脑灌注下完成脑保护.结果 手术改良后平均心肺转流时间(212±40)min,平均心肌阻断时间(95±16)min,平均停循环时间(42±8)min.手术死亡1例,住院死亡5例,分别死于感染败血症、急性肾功能衰竭、偏瘫并发多器官功能衰竭.双侧脑灌注后脑血管意外和短暂脑神经功能障碍的发生率低于选择性脑灌注.76例患者出院前复查主动脉CT血管造影,人工血管无扭曲,血流通畅,胸降主动脉夹层假腔闭合率为78.9%.71例随访5～49个月,其中50例复查CT血管造影,胸降主动脉夹层假腔闭合率为88.0%,无晚期死亡及再次手术者.结论 改良的全弓置换加支架象鼻术治疗DeBakey Ⅰ型主动脉夹层安全、有效,可减少术后并发症.

Abstract：

Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010, 101 cases of DeBakey Ⅰ aortic dissection were treated by modified total arch replacement and stent elephant trunk technique, in which emergency surgery for 73 cases. There were 76 male and 25 female patients, aged from 21 to 77 years with a mean of(49 ±8)years. Intraoperative ascending aortic replacement in 31 cases, Bentall procedure in 29 cases, Wheat procedure in 7 cases, David procedure in 34 cases. At the same time stent elephant trunk in the left subclavian artery corresponding position was windowed to rebuild the blood supply. Deep hypothermic circulatory arrest cerebral protection was completed by bilateral antegrade cerebral perfusion. Results The mean cardiopulmonary bypass time was(212 ±40)min, mean myocardial occlusion time was(95 ± 16)min, mean circulatory arrest time was (42 ±8)min. Operative mortality was 1 case and hospital mortality was 5 case, which died of septicemia,acute renal failure and hemiplegia complicated with multiple organ failure. Compared with selective cerebral perfusion, the incidence of postoperative cerebral vascular accident and transient neurological dysfunction decreased. Seventy-six cases received aorta CTA before discharged, the closure rate of descending thoracic aortic dissection false lumen was 78. 9%. Seventy-one patients were followed up for 5 to 49 months, 50cases was reviewed by CTA, of which closure rate of descending thoracic aortic dissection false lumen was 88.0%, no late death and re-surgery. Conclusions The modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey Ⅰ thoracic aortic dissection was safe and effective, with less postoperative complications.     

Stanford A 型主动脉夹层手术中的主动脉根部处理

目的 总结Stanford A型主动脉夹层手术中主动脉根部处理的临床经验.方法 根据主动脉夹层累及主动脉根部的程度及主动脉根部基础病变,对59例Stanford A型主动脉夹层病人进行主动脉根部处理.Bentall手术31例,Wheat手术15例,David手术13例.结果 手术死亡1例(1.72%).术后一过性精神状态异常17例;术后感染2例,1例死亡;胸骨哆开1例;单侧下肢血供障碍1例,二期行股股分流术后恢复正常.出院前复查心脏彩超、主动脉CT血管成像及心电图,均正常.随访2～54个月,4例死于非心源性疾病,余者正常.结论 根据主动脉夹层累及主动脉根部的程度及主动脉根部基础病变,制定相应处理方案,可显著提高手安全性并改善预后.

Abstract：

Objective To summarize the experience of aortic root surgery in Stanford A aortic dissection operations.Methods From January 2005 to September 2010, the clinical data of 59 patients with Stanford A aortic dissection was analyzed. There were 43 men and 16 women , ranging in age from 21 to 74 years old, duration of disease varied from 16 hours to 27 days. Among the group, 31 complicated by aortic valve incompetence, 12 Marfan syndrome, 9 single lower limb blood supply dysfunction, 6 right coronary artery involvement. All cases received aortic root surgery under deep hypothermic circulatory arrest. Bentall procedure was performed in 31 patients, Wheat procedure in 15 patients and David procedure in 13 patients.Results The time of cardiopulmonary bypass in the group was 149 to 204 min with an average of ( 171 ± 19) min,and the cross clamp time was 81 to 122 min with an average of (104 ±13) min, and the arrest time was 30 to 47 min with an average of (39 ±7) min. There was 1 case of operative death, which was treated on an emergency basis. Postoperative complications occurred in 20 cases. 17 cases experienced temporary mental dysfunction, 2 cases were infected with MRS A, 1 of which died from MODS, 1 case of single lower limb blood supply dysfunction remained after the first operation and recovered by reoperation (bilateral femoral bypass operation) . All cases were reexamined before discharge, postoperative mean LVEF was (56. 3 ±3.4)% (ranged 51% -62%), aortic annular diameter varied from 22 mm to 27 mm, aortic sinus diameter range from 23 mm to 31mm. 51 patients were followed up, with a mean follow-up time of (24.9 ± 17.2) months (ranged 2-54 months). 54 patients of Stanford A aortic dissection survived well with normal lives and activities. Four non cardiac deaths, one was chronic renal failure, the others were brain hemorrhage. Conclusion Prognosis and operative security of Stanford A aortic dissection patients can be significantly improved by individualized aortic root surgery.     

温敏水凝胶Dex-PCL-HEMA/PNIPAAm的生物学性能

目的:对温度敏感水凝胶葡聚糖接枝聚己内酯-甲基丙烯酸羟乙酯共聚N-异丙基丙烯酰胺(Dex-PCL-HEMA/PNIPAAm)合成及体外降解进行研究,了解水凝胶的体外生物学性能.方法:利用自由基聚合法合成Dex-PCL-HEMA/PNIPAAm,并对其作LCST的测定、内部形貌观察、体外降解、体外控制释放胎牛血清蛋白(BSA).结果:水凝胶的较低临界溶解温度(LCST)为33.2～34.2℃;内部形貌观察到水凝胶的孔径随着Dex-PCL-HEMA的含量的增大而缩小;体外酶降解显示DN水凝胶在前3天降解比较快,在第4～16天间,DN1、DN2、DN3、DN4四种水凝胶的降解率依次增大,16天后基本上不再降解;DN Dex-PCL-HEMA/PNIPAAm凝胶体外释放BSA曲线显示前5小时内释放最快,此后逐渐减慢.结论:Dex-PCL-HEMA/PNIPAAm水凝胶保持了其良好的温度敏感性,体外实验显示生物相容性良好,因此可以作为动物实验的材料.     

川崎病合并左主干冠状动脉瘤和室壁瘤的手术疗效

目的:总结川崎病合并左主干冠状动脉窦瘤和室壁瘤的手术疗效及治疗经验。方法:回顾性分析2002年1月至2012年1月期间,经手术治疗的川崎病合并左主干冠状动脉瘤和室壁瘤5例患者的临床资料。手术方法为室壁瘤切除并冠状动脉旁路移植术,并随访6至12个月。结果:术后5例患者均存活,手术成功率100%。左室射血分数术前从平均33%改善至术后近期50%,随访期间为57%(P<0.01);左室舒张末内径从术前平均58mm改善至术后近期49mm,随访平均内径为48mm(P<0.01);心功能分级(NYHA)从术前2.8级改善至术后2.2级,随访期间为1.6级(P<0.05)。随访复查冠状动脉CTA提示冠状动脉瘤瘤径无扩大,桥血管通畅。结论:对于川崎病合并左主干冠状动脉瘤和室壁瘤的患者,瘤径小于10mm时,术中可旷置。