停跳或不停跳心脏手术对血清 S-100B蛋白表达的影响

【目的】研究心脏手术围术期血清S-100B蛋白表达及其与停跳或不停跳心肺转流方式和时间的关系。【方法】体外循环心脏手术患者23例,测转流前、转流10min、转流末、转流后24h的血清S-100B蛋白表达水平。【结果】①血清S-100B蛋白质量浓度在体外循环前后动态变化:转流前(M)为0.27μg/L,转流10min后升至0.57μg/L(P<0.01),转流末达峰值1.80μg/L(P<0.01),转流后24h降为0.22μg/L(P>0.05)。转流末的血清S-100B蛋白质量浓度与转流时间呈正相关(r=0.488,P<0.05)。②停跳组(n=6)转流前、转流10min、转流末、转流后24h平均血清S-100B蛋白质量浓度分别为(0.17±0.09)μg/L、(0.48±0.13)μg/L、(1.65±0.52)μg/L和(0.19±0.04)μg/L,不停跳组(n=6)分别为(0.26±0.14)μg/L、(0.71±0.41)μg/L、(1.59±0.84)μg/L和(0.23±0.11)μg/L,两组差别无统计学意义(P>0.05)。【结论】体外循环可导致血清S-100B蛋白表达增高,其表达水平与心肺转流时间呈正相关,但与停跳或不停跳转流方式无关。     

双频谱指数在心脏瓣膜置换术中的观察

目的应用脑电双频谱指数(BIS)监测常规经验麻醉下瓣膜置换术病人的麻醉深度(意识水平),观察BIS在伤害性刺激时的变化.方法选择30例瓣膜置换术病人,采用芬太尼、咪唑安定、哌库溴铵及心血管活性药物对病人实施麻醉;术中监测并有专人分别记录入室(基础值)、诱导后、插管后、切皮后、锯胸骨时、缝胸骨时及术毕BIS和MAP,HR各参数值,观察不同阶段各参数的变化.结果诱导后各参数均明显降低,虽然切皮后、锯胸骨及缝胸骨等强刺激后MAP和HR未见统计学意义的显著改变,但BIS却显著增高(P＜0.01);全部病人锯胸骨时BIS均在60(67.28±8.97)以上,缝胸骨时63(68.46±8.70)以上,而无1例低于50者.结论该组瓣膜置换术病人麻醉偏浅,尤以锯胸骨、缝胸骨及术毕等时段为甚,表现为BIS值偏高,有知晓发生;知晓可发生在临床认为满意的麻醉中;应用BIS监测,可更加合理地评价麻醉深度.     

A rare case of left ventricular outflow obstruction.

We report a patient with a mass originating from the anterior mitral valve leaflet causing severe left ventricular outflow tract obstruction. Noninvasive imaging provided the best diagnostic tools for diagnosis. Histological findings showed a very rare giant blood cyst of the mitral valve.     

Acute Cholecystitis and Severe Ischemic Cardiac Disease: Is Laparoscopy Indicated?

BACKGROUND AND OBJECTIVES: Laparoscopy in patients with poor cardiac function has been the subject of controversy and is considered by many surgeons a relative contraindication. METHODS: We report the case of a patient who presented with acute cholecystitis and choledocholithiasis concurrent with unstable angina. Our experience in laparoscopic management of patients with calculous biliary disease and severe coronary artery disease is examined. RESULTS: The patient was managed by coronary angioplasty and stenting immediately followed by laparoscopic cholecystectomy and common bile duct exploration under close invasive hemodynamic monitoring and low-pressure pneumoperitoneum. Between 1996 and 2001, 39 patients with coronary artery disease and an ASA class of III or IV underwent laparoscopic cholecystectomy. Eight of these patients (20.5%) had common bile duct stones necessitating laparoscopic common bile duct exploration. No conversions were necessary, and no major morbidity or mortalities occurred. CONCLUSIONS: Laparoscopic cholecystectomy and common bile duct exploration can be safely performed in patients with severe ischemic cardiac disease under close hemodynamic monitoring and a low-pressure pneumoperitoneum (10 to 12 mm Hg).     

Age-Dependent Prevalence of Cardioembolic Sources Detected by TEE: Diagnostic and Therapeutic Implications

To define the prevalence of cardioembolic sources found by transesophageal echocardiography (TEE) in different age groups of patients with and without cryptogenic systemic embolism, TEE risk factors for cardiogenic embolism were identified from 341 consecutive patients referred for TEE. One hundred and thirty-five had cryptogenic cerebral or systemic peripheral embolic events (CEE) and 206 other indications for TEE (CTR). Cardioembolic sources were found in 40% of CEE and in 29% of CTR (P < 0.02). Specifically, left atrial (LA) thrombi (P < 0.0001), atrial septal aneurysm with right-to-left shunt (P < 0.002), and atherosclerotic aortic plaques (P < 0.02) were more frequent. The prevalence of potential cardioembolic sources was significantly higher in patients ≥ 70-years old than in younger patients (P < 0.03), specifically LA thrombi (P < 0.004) and atherosclerotic aortic plaques (P < 0.0001). In patients ≥ 70-years old, potential cardioembolic sources were found in 63% and in 40% in CEE and CTR (P = 0.073), respectively. However, LA thrombi were more frequent in CEE (P < 0.003). Thus, potential cardioembolic sources observed by TEE are found more frequently in patients ≥ 70-years old than in younger patients. LA thrombi were more frequent in CEE than in CTR patients ≥ 70-years old. In patients ≥ 70-years old with CEE who are eligible for an anticoagulant regimen, a search for potential cardioembolic sources by TEE should be considered.     

Primary Prevention of Sudden Cardiac Death in Heart Failure: Will the Solution Be Shocking?

Sudden cardiac death (SCD) may occur in as many as 40% of all patients who suffer from heart failure. This review describes the scope of the problem, risk factors for SCD, the effect of medications used in heart failure on SCD and the potential effect of the implantable cardioverter-defibrillator in primary prevention.     

人工心脏起搏器的植换

探讨人工心脏起搏器植换方式选择。方法：起搏器植换２２例，其中，能源耗竭１４例，感知和起搏功能障碍４例，囊袋感染破溃致ＰＭ外露４例。非感染者起搏阈值，〈２．５Ｖ，行原位植换：ＰＴ值〉３．０Ｖ或有感染者，更换全套起搏系统。结果：非感染的１８例中，１０例ＰＴ〈２．５Ｖ，实行原位植换；８例ＰＴ值〉３．０Ｖ和其余４例有感染者，植入新的起搏系统。     

人白细胞干扰素诱导慢性乙型肝炎病人DNA损伤修复的探讨

应用不同浓度人白细胞干扰素处理10例慢性乙型肝炎病人外周血淋巴细胞,观察病人姐妹染色单体互换(SCE)频率的动力学变化.结果表明,人白细胞干扰素处理组SCE平均频率明显低于对照组,差异高度显著(P<0.01);慢性迁延性肝炎和慢性活动性肝炎处理组之间SCE平均频率无显著性差异;但人白细胞干扰素处理低浓度组SCE平均频率低于高浓度组,差异不显著(P>0.05).提示人白细胞干扰素具有诱导HBV损伤人体DNA的修复作用;大剂量人白细胞干扰素对HBV损伤人体DNA的修复未必有益.     

主动脉内球囊反搏在小儿中的应用

主动脉内球囊反搏(intraaortic balloon pump，IABP)已广泛应用于成年人心源性休克和围手术期低心排血量综合征的治疗，并取得良好的治疗效果，但在小儿中的应用仍较局限。现就有关IABP在小儿中的应用进行综述，着重分析IABP的适应证和影响在小儿中应用的技术困难和其他因素，介绍小儿IABP应用的技术要点，可能的并发症和治疗效果。在无体外膜式氧合器(ECMO)和左心辅助设备的情况下，小儿心脏直视手术后如不能脱离体外循环机或发生严重低心排血量综合征等，应用IABP治疗可收到较好的效果。