心脏移植术后肾功能衰竭的围手术期处理(附2例报告)

目的报告2例原位心脏移植术后肾功能衰竭的发生及治疗经过,探讨其围手术期处理的初步经验和要点.方法我院自2000年12月一2002年12月共对4例终末期心脏病患者施行同种异体原位心脏移植术,4例均为男性,采用标准原位心脏移植术,术后应用三联免疫治疗的方法抗排异.结果4例患者均获得手术成功,术后未发现超急性排斥反应或急性排斥反应,2例术后1周左右并发急性肾功能衰竭,应用床边连续肾脏替代(CRRT)治疗后,1例存活22d,1例完全康复,随访半年患者心功能恢复Ⅰ～Ⅱ级(NYHA),生活质量良好.结论心脏移植手术后肾功能损害较常见,围手术期的肾功能保护非常重要,如符合手术指征,及早手术治疗是抢救成功的关键.     

ANTIHYPERTENSIVE EFFECTS OF MESULERGINE: FURTHER EVIDENCE FOR A PERIPHERAL SITE OF ACTION OF DOPAMINE AGONISTS

The cardiovascular effects of mesulergine were studied in anesthetized dogs. Intravenous (IV) administration (0.3 mg/kg) significantly decreased blood pressure in neurogenic hypertensive dogs without any change in heart rate. This effect was completely antagonized by IV administration of domperidone (0.5 mg/kg). Intracisternal administration of mesulergine (0.03, 0.3 and 3 mg/kg) did not produce any change in blood pressure. However, with the highest dose we observed a significant rise in heart rate during the first 2 min (which was probably nonspecific). These results suggest that mesulergine lowers blood pressure in sinoaortic-denervated dogs by means of a peripheral mechanism probably involving DA2 receptors. The findings confirm the potential interest of dopamine-receptor agonists as future antihypertensive agents.     

Elevations of neuropeptide Y-like immunoreactivity and catecholamines in plasma on increased intracranial pressure in the pig

Graded increases of intracranial pressure (ICP) in anaesthetized pigs induced elevations of plasma levels of neuropeptide Y (NPY)-like immunoreactivity (LI) and catecholamines, simultaneously with hypertension and tachycardia. Plasma adrenaline (ADR) increased at a lower ICP-level than did the plasma levels of noradrenaline (NA) and NPY-LI. At the maximal ICP elevation, 22.9 kPa (172 mmHg), plasma NPY-LI was increased about 10-fold, from 48 +/- 8 pmol/l in the basal state, while NA and ADR concentrations increased more than 100-fold. At this maximal ICP-level the plasma levels of NPY-LI were correlated to the concentrations of both NA (r = 0.87, P less than 0.01) and ADR (r = 0.92, P less than 0.001). Plasma NPY-LI continued to increase to about 1000 pmol/l, 10 min after the maximal elevation of ICP was discontinued, while the catecholamines then had declined considerably. A slight cardiac release of NPY-LI was observed at the maximal elevation of ICP. The half-life of NPY-LI in plasma was about 6 min upon systemic infusion. At plasma levels similar to those obtained upon maximal ICP elevation, exogenous NPY caused slight vasoconstriction in the spleen and skeletal muscle, but had no effects on coronary blood flow or systemic blood pressure. This suggests that NPY mainly exerts local actions after release from nerve endings, while levels of circulating NPY in plasma must be very high to influence blood flow in some organs. It is concluded that elevation of ICP results in hypertension and tachycardia related to elevated plasma levels of NPY-LI and catecholamines.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年心功能不全血浆心钠素浓度的变化

采用放射免疫法测定31例老年心功能不全患者血浆心钠素(ANP)浓度,发现老年心功能不全组ANP明显低于对照组(P<0.01)。血浆ANP含量随心功能不全的严重程度而明显减少(P<0.05)。病程与ANP浓度呈负相关 (r=-0.441,P<0.05)。不同病种、不同受累部位及有或无房颤之间ANP差异无显著性(P<0.05)。     

Rhabdomyoma of the heart with intrapericardial expansion

A rare case of a rhabdomyoma originating from the surface of the right atrium in a 20-year-old female is reported. The tumor showed electrical activity and caused both outflow obstruction and tamponade symptoms. It was successfully removed by a right-sided thoracotomy. The clinical course, diagnostic investigations, and the therapeutical approach of this rare lesion are discussed.     

Cardiac Electrophysiological Experiments in Numero, Part III: Simulation of Arrhythmias and Pacing

This paper is the third and final part of a series of articles reviewing mathematical and computer models of the electrophysiological processes. This section reviews the arrhythmia simulation and discusses models of arrhythmogenic processes, fibrillation and defibrillation, and of heart-pacemaker interaction. The models of arrhythmogenesis are classified into three main sections: models of reentry and vortex reentry, models of myocardial electrotonic interactions, and models of macroreentrant supraventricular tachycardias. This final part of the review discusses the future potential of mathematical and computer models of different cardiac processes.     

Changes in cardiovascular function induced by verapamil in healthy subjects and in patients with ischemic heart disease

Alterations in cardiovascular function induced by the acute intravenous administration of verapamil (5 or 10 mg) in 52 patients (29 with ischemic heart disease and 23 without heart disease) were evaluated with use of invasive techniques (right and left heart catheterization, left ventricular cineangiography, and coronary arteriography). The most significant changes were represented by a decrease in systemic vascular resistance and systemic arterial pressure, and an increase in heart rate and cardiac output. Contractility indexes were not depressed in either group, and altered ventricular wall motion tended to improve to a slightly smaller degree than in patients treated with nitroglycerin. The use of verapamil in patients with ischemic heart disease appears to be safe, and concern about the negative inotropic influences in humans no longer seems justified.     

Cora Rotary Pump for Implantable Left Ventricular Assist Device: Biomaterial Aspects

Abstract: Our group is developing a left ventricular assist device based on the principle of the Maillard-Wankel rotative compressor: it is a rotary, not centrifugal, pump that produces a pulsatile flow. Stringent requirements have been defined for construction materials. They must be light, yet sufficiently hard and rigid, and able to be machined with high precision. The friction coefficient must be low and the wear resistance high. The materials must be chemically inert and not deformable. Also, the materials must be biocompatible, and the blood contacting surface must be hemocompatible. We assessed the materials in terms of physiochemistry, mechanics, and tribology to select the best for hemocompatibility (determined by studies of protein adsorption: platelet, leukocyte, and red cell retention: and hemolysis, among other measurements) and biocompatibility (determined by measurement of complement activation and toxicity, among other criteria). Of the materials tested, for short- and middle-term assistance, we chose titanium alloy (Ti₆AI₄V) and alumina ceramic (Al₂O₃) and for long-term and permanent use, composite materials (TiN coating on graphite). We saw that the polishing process of the substrate must be improved. For the future, the best coating material would be diamond-like carbon (DLC) or crystalline diamond coating.     

Milk consumption and prevalence of coronary heart disease in men and women from the Scottish Heart Health Study

This report uses cross-sectional results from the Scottish Heart Health Study to investigate whether milk consumption has an independent effect on the prevalence of coronary heart disease. Milk consumption was assessed by questionnaire in men and women aged 40–59 years (n = 10359) who participated in a survey of risk factors for coronary heart disease between 1984 and 1986. Odds ratios for coronary heart disease were calculated according to volume and type of milk consumed for subjects with and without symptoms of coronary heart disease. Statistical adjustment was made for the classicial risk factors.
A higher percentage of men and women with diagnosed coronary heart disease (CHD) usually consume low-fat milk, compared with asymptomatic controls. Odds ratios for having undiagnosed heart disease did not differ significantly with volume or type of milk. However, the odds ratios for having diagnosed heart disease were lower in the moderate (0.5–1 pint/d) milk consumption group. Patterns of milk consumption in patients diagnosed as having CHD are likely to be confounded by dietary changes post-diagnosis. Milk consumption appears to have little independent effect on the prevalence of coronary heart disease in this Scottish population.