玻璃体切除联合硅油填充术治疗老年复杂性视网膜脱离病人的护理

目的：探讨用玻璃体切除联合硅油填充术的方法治疗老年复杂性视网膜脱离病人的护理方法。方法对52例老年复杂性视网膜脱离病人进行手术前后护理干预。结果48例视网膜复位，42例视力提高，视网膜复位率及视力改善率分别为92．30％和80．76％。术后并发高血压8例，心律失常1例，心绞痛1例，眼压升高13例，经对症处理均好转。结论术前做好心理疏导，予以相关知识教育，术后严密观察病情变化，及时发现并发症，并做好相应处理，对老年复杂性视网膜脱离病人的视网膜复位率及视力改善率均有帮助。     

Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography–based and Doppler tissue imaging–based analysis of right atrial and ventricular function

Aim

The aim of our study was to describe right atrial (RA) and right ventricular (RV) function, assessed by Doppler tissue imaging and 2D speckle tracking echocardiography (2DSTE), in women with signs of early impaired left ventricular diastolic function (DD).

Methods and Results

In a cross‐sectional trial, standard parameters of diastolic and right heart function were investigated in 438 women of the Berlin Female Risk Evaluation (BEFRI) study. In a subset of women, average peak systolic RA strain (RAS), as well as the average peak systolic RV strain of the free wall (RVS free wall) and of all RV segments (average RV strain; RVS Avg), was analyzed using 2DSTE. Compared to women with normal diastolic function (DD0), RAS, RVS free wall and RVS Avg were significantly reduced in DD (43.1% ± 11.9%, ?26.7% ± 5.6%, and ?23.3% ± 3.5% in DD0; vs 35.1% ± 10.4%, ?23.9% ± 5.5%, and ?20.6% ± 3.8% in DD; P < .01). Peak RV myocardial velocity (RV‐IVV) and acceleration during isovolumetric contraction (RV‐IVA) were markedly higher in DD (15.0 ± 3.9 cm/s and 3.1 ± 1.0 m/s² in DD vs 11.9 ± 3.2 cm/s and 2.8 ± 0.8 m/s² in DD0; P < .05). RAS and RV‐IVV were significantly associated with DD after adjustment to age, BMI, and left atrial strain in multivariate regression analysis.

Conclusion

Systolic right heart function is significantly altered in DD. DTI as well as 2DSTE constitute sensitive echocardiographic tools that enable the diagnosis of impaired right heart mechanics in early‐staged DD.     

Pulmonary artery pulsatility index predicts prolonged inotrope/pulmonary vasodilator use after implantation of continuous flow left ventricular assist device

Objective: Predictors of right ventricle (RV) dysfunction after continuous‐flow left ventricular assist device (CF‐LVAD) implantation in children are not well described. We explored the association of preimplantation Pulmonary Artery Pulsatility index (PAPi) and other hemodynamic parameters as predictors of prolonged postoperative inotropes/pulmonary vasodilator use after CF‐LVAD implantation.
Design: Retrospective chart review.
Setting: Single tertiary care pediatric referral center.
Patients: Patients who underwent CF‐LVAD implantation from January 2012 to October 2017.
Interventions: Preimplantation invasive hemodynamic parameters were analyzed to evaluate the association with post‐CF‐LVAD need for prolonged (>72 hours) use of inotropes/pulmonary vasodilators.
Measurements and main results: Preimplantation cardiac catheterization data was available for 12 of 44 patients who underwent CF‐LVAD implant during the study period. Median (IQR) age and BSA of the cohort were 15.3 years (10.2, 18) and 1.74 m2 (0.98, 2.03). Group 1 (n = 6) included patients with need for prolonged inotropes/pulmonary vasodilator use after CF‐LVAD implantation and Group 2 (n = 6) included those without. Baseline demographic parameters, cardiopulmonary bypass time, and markers of RV afterload (pulmonary vascular resistance, PA compliance and elastance) were similar among the two groups. PAPi was significantly lower in group 1 compared to group 2 (0.96 vs 3.6, respectively; P = .004). Post‐LVAD stay in the intensive care unit was longer for patients in group 1 (46 vs 23 days, P = .52). Brain natriuretic peptide was significantly higher at 3 months after implantation in group 1; P = .01.
Conclusions: The need for inotropes/pulmonary vasodilators in the postoperative period can be predicted by the preimplantation intrinsic RV contractile reserve as assessed by PAPi rather than the markers of RV afterload. Further investigation and correlation with clinical outcomes is needed.     

当药苷调节兴奋-收缩耦联改善心肌缺血再灌注损伤的机制

目的 探索当药苷通过兴奋-收缩耦联信号通路对缺血再灌注损伤后心脏收缩/舒张功能的影响。方法 24只健康雄性SD大鼠随机分为正常组、模型组、10 μmol·L^-1当药苷给药组与1 μmol·L^-1地高辛给药组，并采用Langendorff系统结合左前降支冠状动脉结扎建立缺血再灌注损伤模型（I/R），2，3，5-氯化三苯基四氮唑（TTC）染色检测各组心脏梗死面积，Powerlab生理记录仪检测血流动力学参数，如左心室舒张压（LVDP）、左心室终末舒张压（LVEDP）、左心室终末收缩压（LVESP）、左心室内压最大上升速率（+dp/dt_max）和左心室内压最大下降速率（-dp/dt_max）；提取分离乳鼠原代心肌细胞（NRCMs），建立缺氧/复氧（H/R）损伤模型，随机分为正常组、模型组、1 μmol·L^-1当药苷给药组和10 μmol·L^-1当药苷给药组，多功能成像细胞分析仪和激光共聚焦显微镜测定各组心肌细胞活力、心率、收缩幅度、收缩时程、达峰时程和舒张时程及钙瞬变峰值。根据前期转录组学测序结果及文献调研，利用实时荧光定量聚合酶链式反应（Real-time PCR）检测L型钙通道相关基因（Cacnb2），细胞色素C氧化酶相关基因（Cox6a2），肌钙蛋白（Tnnc1、Tnni3、Tnnt2）、肌动蛋白（Actc1）、肌球蛋白（Myh6、Myl2、Myl4）等兴奋-收缩耦联通路基因的mRNA表达并对差异基因进行聚类分析。结果 与正常组比较，模型组心肌梗死面积显著增加（P<0.01）、LVDP显著降低（P<0.01）、LVEDP显著上升（P<0.01）、LVESP明显下降（P<0.05）、+dp/dt_max有下降趋势和-dp/dt_max上升趋势及心肌细胞活力降低、心率降低、收缩幅度降低、收缩时程升高、达峰时程升高和舒张时程升高（P<0.01），而当药苷可以逆转上述指标（P<0.05）。此外，心肌细胞经H/R损伤后，Cacnb2、Cox6a2、Tnnc1、Tnni3、Tnnt2、Actc1、Myh6、Myl2、Myl4等兴奋-收缩耦联通路的基因表达下降（P<0.05、P<0.01）。而使用当药苷预处理后，可以增强上述基因的表达（P<0.05）。结论 当药苷通过调节兴奋-收缩耦联信号通路，从而调节原代乳鼠心肌细胞内钙离子水平，增强心肌收缩功能，对抗I/R损伤。