四瓣膜置换手术

1999年 5月 ,我们对 1例感染性心内膜炎瓣膜病病人进行了四瓣膜置换手术 ,现报告如下。临床资料　病人　男 ,48岁。自幼发现心脏杂音 ,但无症状。 1999年 1月后出现低热 ,活动后胸闷、心慌、气短 ,双下肢水肿 ,夜间不能平卧。在外院诊断为“先天性心脏病室间隔缺损、感染性心内膜炎、多瓣膜病变、心衰” ,对症处理后转入我院。体温 38 5℃ ,经检查诊断为 :先天性心脏病、室间隔缺损 (室缺 )、感染性心内膜炎 ,主动脉瓣、二尖瓣、三尖瓣、肺动脉瓣均有赘生物形成 ,并出现中至重度反流。心功能ＩＶ级。肝、肾功能减退 ,严重贫血。入院后血培养…     

离心泵在高体重患者体外循环中的应用

1993年5月至1997年6月,我们施行体外循环手术1602例,其中主动脉瓣置换(AVR)为171例,二尖瓣 主动脉瓣置换(DVR)319例,二尖瓣置换(MVR)为458例,先心654例,其中高体重病人为63例(体重大于70kg)(AVR、DVR、MVR、先心分别为19、23、17、4例).采用Lifestrem离心泵结合滚动泵(用于吸引及心肌保护)行体外循环共37例,年龄为31～65岁,体重70～92kg.全组病人麻醉均采用静脉复合麻醉及芬太尼维持麻醉.心肌保护方法均采用中度低温含血心肌保护复合灌注.监测围体外循环期血流动力学变化,测定血中游离血红蛋白含量,观察尿量及尿色.对照组为同期应用滚动泵的大体重病人.结果:应用离心泵的大体重病人术中能够维持平稳的灌注压力,转流平稳,转流中尿量900±200ml,发生肉眼血尿或血色素尿的发生率为17.4%,明显低于未用离心系的病人(89.9%)(P<0.01)血中游离血红蛋白是,应用离心泵的病人为1.9g/L,未用离心泵的病人为7.9g/L两者比较差异非常显著(P<0.01).结论;离心泵在大体重病人体外循环中起到良好的作用.离心泵对血液破坏少,可在术中、术后长时间转流,且安全度高;特别适宜复杂手术及高体重的病人.     

The expression of β-adrenoceptors in human pancreatic cancer cell lines and their roles in cell invasiveness

Objective To investigate the effect and mechanism of β-adrenoceptors on norepi-nephrine-induced invasiveness of pancreatic cancer cell lines. Methods The expression of β-adrenocep-tors mRNA in human pancreatic cancer cell lines MiaPaCa-2 and BxPC3 was detected by using RT-PCR. The cells were randomly divided into control group.10 mol/L NE intervention group, 1 mol/L propranolol intervention group and NE + propranolol intervention group. After 48 h , transwell invasiveness test was used to examine the changes in invasive ability of MiaPaCa-2. The expression of MMP-2, MMP-9 and VEGF mRNA was measured by semi-quantitative RT-PCR. The levels of MMP-2 , MMP-9 and VECF proteins were assayed by immunocytochemistry. Results Both MiaPaCa-2 and BxPC3 expressed β1-and β2-adrenocep-tors. The absorbance ( A) values of invasive cells in NE, NE + propranolol, propranolol and control groups were 0.78±0.02 ,0.32±0.03 ,0.26±0.01 and 0.28±0.02 , respectively, and those in NE intervention group were significantly higher than in control and NE + propranolol groups ( P <0.05) . There was no sig-nificant difference in the number of invasive cells between propranolol and control groups ( P > 0. 05) . In NE group , the expression index of MMP-2 , MMP-9 and VEGF mRNA was 0. 87±0.02 , 1.04±0.02 and 0. 92±0. 01 , and the gray value of the protein expression was 131.20±2.34,105.32±7.21 and 115.60 ±5. 03 , respectively, which were higher than those in control and NE + propranolol groups ( P<0.05). There was no significant difference in the expression levels of MMP-2 , MMP-9 and VEGF mRNA and pro-tein between propranolol and control groups ( P>0.05 ) . Conclusion β-adrenoceptors play an important role in the process of norepinephrine-induced invasiveness of pancreatic cancer cells. NE can promote the invasiveness of MiaPaCa-2 through up-regulating the expression of MMP-2 , MMP-9 and VEGF via β-adre-noceptors.     

献血者血清过氧化氢酶活性测定

关于血清过氧化氢酶 (ｃａｔａｌａｓｅ ,ＥＣｌ,ｌｌ,ｌ,6 ;ＣＡＴ)活性测定的方法学及其临床应用研究 ,我们已作过报道。本文着重报道对献血者血清ＣＡＴ活性的测定。现将 79例合格献血者与 2 5 0例不合格献血者的ＣＡＴ活性测定结果报告如下。1　材料与方法　　经临床体检合     

The expression of β-adrenoceptors in human pancreatic cancer cell lines and their roles in cell invasiveness

Objective To investigate the effect and mechanism of β-adrenoceptors on norepi-nephrine-induced invasiveness of pancreatic cancer cell lines. Methods The expression of β-adrenocep-tors mRNA in human pancreatic cancer cell lines MiaPaCa-2 and BxPC3 was detected by using RT-PCR. The cells were randomly divided into control group.10 mol/L NE intervention group, 1 mol/L propranolol intervention group and NE + propranolol intervention group. After 48 h , transwell invasiveness test was used to examine the changes in invasive ability of MiaPaCa-2. The expression of MMP-2, MMP-9 and VEGF mRNA was measured by semi-quantitative RT-PCR. The levels of MMP-2 , MMP-9 and VECF proteins were assayed by immunocytochemistry. Results Both MiaPaCa-2 and BxPC3 expressed β1-and β2-adrenocep-tors. The absorbance ( A) values of invasive cells in NE, NE + propranolol, propranolol and control groups were 0.78±0.02 ,0.32±0.03 ,0.26±0.01 and 0.28±0.02 , respectively, and those in NE intervention group were significantly higher than in control and NE + propranolol groups ( P <0.05) . There was no sig-nificant difference in the number of invasive cells between propranolol and control groups ( P > 0. 05) . In NE group , the expression index of MMP-2 , MMP-9 and VEGF mRNA was 0. 87±0.02 , 1.04±0.02 and 0. 92±0. 01 , and the gray value of the protein expression was 131.20±2.34,105.32±7.21 and 115.60 ±5. 03 , respectively, which were higher than those in control and NE + propranolol groups ( P<0.05). There was no significant difference in the expression levels of MMP-2 , MMP-9 and VEGF mRNA and pro-tein between propranolol and control groups ( P>0.05 ) . Conclusion β-adrenoceptors play an important role in the process of norepinephrine-induced invasiveness of pancreatic cancer cells. NE can promote the invasiveness of MiaPaCa-2 through up-regulating the expression of MMP-2 , MMP-9 and VEGF via β-adre-noceptors.     

术前套管针静脉输液的操作与体会

术中输液要求严格，有时常需在短时间内输入大量液体或血液，因此，必须在术前建立完善而通畅的静脉通路才付之实现。我室几年来使用进口静脉套管计术有穿刺输液1600例次，有效的保证了术中输液输血的需求，收到了较满意的临床效果，现总结如下；1·材料选择选西德贝朗生产的静脉套管针16＃、工8＃、20＃、22＃和24＃，体外长度和外任分别为55mrn和1．6rum，45mm和1．Zm；n、44mm和l．Omm、25mm和O．smm、19。m和O．7n。m．置入福尔马林熏箱。一消毒备湖。｝资料与方法本组择期手术患者12OO例、急、诊｝未能叫儿成人W90例，小比例0例、年…     

完全胸腔镜辅助下心脏手术体外循环的建立与管理

目的总结完全胸腔镜辅助下心脏手术的体外循环建立和管理方法。方法分析103例心脏病患者借助电视胸腔镜进行房间隔缺损修补术、室间隔缺损修补术和二尖瓣置换术的体外循环建立方法、过程和术后结果。结果术中1例因调整股静脉插管位置时不慎将股动脉带出,出血约200ml,遂重新插入股动脉建立体外循环;术中1例因心包粘连,纵行切开胸骨第3肋间,横断第3、4肋骨,胸腔镜辅助下完成二尖瓣置换术;术后1例1周后出现残余漏,再次手术治疗。全组患者均痊愈康复出院。结论胸壁打孔体外循环下完全借助于电视胸腔镜实施心脏手术安全、可行,是常规心脏外科手术方法的一种补充,加强体外循环的应对措施和管理尤为重要。     

一种改进的简便经济的大鼠胰腺腺泡细胞分离提纯方法

目的:探索一种简单、经济和稳定的胰腺腺泡分离纯化的新方法,并探讨其对细胞功能的影响.方法:16只SD大鼠随机分成改进方法组和内灌注方法组,戊巴比妥腹腔麻醉后,其中8只按改进方法迅速切取并剪碎胰腺组织后置于新鲜配制的细胞分离液中,37℃,CO2孵箱中孵育30 min,过滤获得细胞悬液, Hanks液(不含钙离子)清洗后获得胰腺腺泡细胞,另外8只采用内灌注方法获取胰腺腺泡细胞,然后进行细胞计数、活力测定、纯化鉴定和细胞内钙离子测定.结果:改进方法所获得的胰腺腺泡数量[(5.0±0.7)×106]、纯度[(78±6)%]与内灌注方法所获得的胰腺腺泡数量[(4.7±0.9)×106]、纯度[(79±7)%]比较无统计学意义(P＞0.05),而细胞活力[(93±4)%]显著高于内灌注方法[(84±3)%](P＜0.05),细胞内钙离子浓度(3.62±0.54)显著低于内灌注方法(5.31±0.37)组(P＜0.05).结论:改进方法是一种稳定高效且对细胞活力及功能影响较小的胰腺腺泡细胞分离提纯方法.     

舒芬太尼复合氯诺昔康用于妇科肿瘤病人术后静脉镇痛的疗效观察

目的观察比较等效剂量的舒芬太尼和芬太尼分别复合氯诺昔康用于妇科肿瘤手术患者术后自控静脉镇痛（PCIA）的效果和不良反应。方法将妇科肿瘤手术术后需行PCIA的60例患者随机分为A组（芬太尼＋氯诺昔康）和B组（舒芬太尼＋氯诺昔康）,各组30例,并记录术毕各组6h,12h,24h,48h各时点的平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏氧饱和度（SPO2）,并对各时点的镇痛、镇静进行评分,记录（实际/有效）按压次数,并记录有无恶心呕吐、呼吸抑制、头晕、皮肤瘙痒等不良反应。结果两组患者的生命体征差异无统计学意义（P〉0.05）;B组术毕6h镇静评分明显低于A组,差异有统计学意义（P〈0.05）;术毕6h和12h,PCIA（有效/有效）按压次数,B组明显高于A组,差异有统计学意义（P〈0.05）。结论等效剂量舒芬太尼和芬太尼分别复合氯诺昔康均可用于妇科肿瘤患者术毕静脉镇痛,但舒芬太尼复合氯诺昔康组的镇痛效果更确切、安全,不良反应较低,是一种值得推广的镇痛方法 。     

滤除白细胞含血心肌保护液对心肌再灌注损伤的保护作用

目的 研究滤除白细胞含血心肌保护液对心肌再藻注损伤的保护作用。方法 随机选择２０例心肺转流术患者,采用中度低温含血心肌保护液持续顺行灌注,分为对照组与实验组,每组１０例。对照组：未用白细胞滤过器;实验组：于含血心肌保护液通路加用白细胞滤过器。测定实验组滤过前、后血细胞的变化,升主动脉阻断前５分种、升主动脉开放后３０分钟、１小时两组血清丙二醛水平,心肌超微结构变化;应用持续左心功能监测术后血流动力学