Myocardial protection of immature rabbits with an ATP- sensitive K+ channel opener pinacidil

Objective To investigate the effectiveness of pinacidil, an opener of ATP- sensitive K(+) channels, in protecting the myocardium of immature rabbit hearts from ischemic r eperfusion injury. Methods Rabbit hearts underwent 30 min of global normothermic ischemia followed by 30 mi n of reperfusion on the modified Langendorff apparatus. Fifty- two isolated hea rts of 3-4 week- old immature rabbits were divided into 4 groups randomly. Duri ng ischemia, 3 different cardioplegic solutions were administered intermittently by infusion every 15 min (20-25 ml each time in all groups). Group 1: con trol group (n=13); group 2: Krebs- Henseleit (K- H) solution with potassium (16 mmo l/L) (n=13); group 3: K- H solution with potassium (16 mmol/L) and pinacidil (5 0 μmol/L) (n=13); group 4: K- H solution with potassium (16 mmol/L), pinacidi l (50 μmol/L) and glibenclamide (10 μmol/L) (n=13). The pre- ischemic and p ost- ischemic myocardial functions were assessed by the percentage recovery of t he left ventricular developed pressure (LVDP); the left ventricular end- diastol ic pressure (LVEDP); both the positive peak and negative peaks of the first deri vative of the left ventricular pressures (±dp/dt(max)); coronary flow; the level of creatine kinase (CK), lactic dehydrogenase (LDH) and aspartate transcar bamoylase (AST) in coronary sinus venous effluent; and by myocardial ultrastruct ural changes. Results Before myocardial ischemia, there were no significant differences among the four groups in any of the parameters mentioned above. Post- ischemic recovery of LV DP, LVEDP, ±dp/dt(max), coronary flow, the level of CK, LDH and AST, and my ocardial ultrastructural changes were better in group 3 than those in the three other groups.Conclusions As a new and effective composition, pinacidil can significantly improve myocardi al protection from cardioplegia for immature rabbit hearts.     

小儿先天性心脏病体外膜氧合支持的死亡原因分析

目的总结先天性心脏病体外膜氧合(ECMO)支持患儿的死亡原因,以进一步提高生存率。方法回顾性分析2010年1月至2018年12月实施ECMO支持的先天性心脏病患儿33例。结果 33例行ECMO支持的先天性心脏病患儿中,死亡率为54.5%(18/33)。单纯左心功能不全的完全性大动脉转位(TGA)生存率80%(4/5),辅助效果佳; TGA合并冠脉畸形和其他复杂畸形的死亡率100%(7/7); 1例左心发育不良存活;术后心源性休克死亡率29%(2/7);复杂先天性心脏病患儿术前严重低氧急诊手术术后转ECMO的死亡率33.3%(1/3),而TGA术前严重低氧血症先采用ECMO支持2例均于术前死亡; 2例ECMO期间再次手术干预的患者均存活出院。结论 ECMO为先天性心脏病并发难治性心衰的患儿提供了生存机会,心脏功能的可逆程度、心脏畸形的类型以及ECMO时机的把握是先天性心脏病患儿ECMO支持是否成功的主要原因。     

小儿先天性心脏病手术后出凝血管理的研究进展

出血与凝血功能障碍是先天性心脏病(以下简称先心病)手术后常见的并发症,严重者会影响患者预后,甚至直接或间接导致死亡.先心病手术后出凝血管理是围术期管理的重点和难点.手术后早期以旋转式血栓弹力监测(rotational thromboelastometry,ROTEM)算法为导向的出凝血管理在国外心脏手术病人中广泛应用,...     

体外膜肺氧合下左心引流治疗儿童难治性心功能衰竭10例临床总结并文献复习

目的 总结体外膜肺氧合(ECMO)救治儿童难治性心功能衰竭过程中左心引流的时机、风险和管理体会。方法 回顾性分析2015年1月至2023年2月浙江大学医学院附属儿童医院对难治性心功能衰竭患儿实施ECMO支持并行左心引流10例的治疗情况。并通过对PubMed、中国知网(CNKI)、万方数据库进行检索,对2000年1月至2023年2月数据库中报道的儿童ECMO下左心减压的病例进行文献总结复习。结果10例患者中6例为暴发性心肌炎并心源性休克,4例为先天性心脏病术后(3例术中脱机困难,1例术后心跳骤停)。死亡6例,存活4例。ECMO支持时间36～476 h,左心引流支持时间36～460 h。严重并发症包括颅内出血引起脑疝(2例)、脑梗伴肢体偏瘫(2例)、左室血栓(1例)。死亡原因为心功能不能恢复(4例)、脑疝(2例)。文献检索出4个研究机构关于儿童左心减压病例汇报。该中心临床结果结合文献对照分析。结论 左心引流能够有效卸载左室前负荷,促进心脏功能恢复。合理把握左心引流时机,预防出凝血,优化体循环/左心引流比例等管理细节,可降低重大并发症发生率。     

小儿体外循环围术期胶体渗透压测定的临床意义

随着先天性心脏病(先心病)外科治疗的不断发展，婴幼儿、新生儿及复杂畸形的先心病外科治疗日益增多。但小婴儿尤其是新生儿及长时间体外循环(CPB)的病儿，术后易并发毛细血管渗漏综合征，严重影响预后。维持合适的血浆胶体渗透压(COP)，可减少该症的发生率。2001年10月-12月，我们连续测定了32例先天性心脏病(先心病)病儿围术     

婴幼儿体外循环对血浆基质金属蛋白酶-9水平的影响

体外循环(CPB)与全身炎症反应(systemic inflammatoryresponse,SIR)密切相关,SIR可引起多种器官功能的障碍,尤其是肺的损伤在临床中较为常见和严重[1,2],CPB术后因肺部合并症而死亡的病人约占CPB术后总死亡率的1/3[3],中性粒细胞的激活在引起肺组织损伤方面起着重要作用,激活的中性粒细胞能通过粘附分子增加对内皮细胞的亲和力,它们大量聚集在肺组织中通过脱壳粒作用释放大量蛋白酶,导致组织水肿,肺泡出血,基质金属蛋白酶(Matrixmetalloproteinases,MMPs)是组织破坏比较重要的酶,与CPB后肺损伤的发生和发展关系密切[4]。本研究观察…     

关闭线粒体通透性转变孔对未成熟兔缺血心肌的保护作用

目的 本实验旨在观察及了解线粒体通透性转变孔(MPTP)抑制剂和钾离子通道(KATP)开放剂对未成熟兔缺血心肌的保护作用及两者间的作用关系.方法 未成熟大耳白幼兔45只,体重350～450g,年龄3～4W.随机分为5组,均取离体心脏悬挂于改良Langendorff灌流装置,K-H液平衡20min后,各组灌注含不同成分的停搏液,各组均30min重复灌注一次停搏液,每次20ml,共灌注2次.心脏置于36±1℃恒温器中,缺血60min,再K-H液灌注60min.5组灌注的停搏液分别为St.Thomas(10只);St.Thomas 30μmol/Ldiazoxide(8只);St.Thomas 0.2μmol/L cyclosporin A(10只);St.Thomas 30μmol/L diazoxide 20μmol/Latractyloside(8只);St.Thomas 30μmol/L diazoxide 100μmol/L 5-hydnyxydecanoic acid(9只).其中St.Thomas cyclosporin A组和St.Thomas diazoxide atractyloside组在缺血60min后先分别给含有0.2μmol/L cyclosporin A或20μmol/L atractyloside的K-H液复灌10min,然后继续给K-H液灌注50min.结果 再灌注后经特异性KATP,开放剂diazoxide或特异性MPTP抑制剂cyclosporin A强化的St.Thomas停搏液组与St.Thomas组比较,可显著促进未成熟兔缺血心肌的功能恢复,冠脉流量恢复率增加明显(P<0.05),而特异性MPTP开放剂atractyloside可阻断它们的效应(P<0.05).特异性KATP阻滞剂5-HD也可阻断diazoxide的效应(P<0.05).结论 ATP钾离子通道开放剂和线粒体通透性转变孔抑制剂均对未成熟缺血心肌有明显的保护作用,且ATP钾离子通道开放剂很可能是通过关闭线粒体通透性转变孔来起到心肌保护作用的.     

低体重婴儿体外循环血浆Ca++、Mg++的监控

体外循环(CPB)心内直视手术期间低钙,低镁已受到重视[1,2],且也比较注意补钙,以支持心肌收缩,取得较好的效果.但小婴儿,特别是低体重先天性心脏病小婴儿CPB期间血浆Ca2 、Mg2 的变化规律及如何补钙问题报道甚少.作者于2003年1～7月对20例6kg以下婴儿体外循环期间血浆Ca 、Mg 水平进行监测,以便为CPB期间补钙提供参考.     

腋下小切口在小儿胸外科应用316例分析

自从 195 2年DenisBrowne首先应用腋下切口进胸术外科处理动脉导管未闭以来 ,腋下小切口已被广泛用于胸外科手术中。随着社会的发展 ,微创、美观切口越来越被人们重视和追求。我院自 1989年 3月起 ,将该切口应用于动脉导管未闭及食道、纵隔和肺部疾病的外科手术治疗 ,现将施行腋下小切口的病例 (316例 )分析、总结如下 ,以探讨腋下小切口在小儿胸外科手术中的临床应用价值。临床资料1　一般资料　自 1989～ 2 0 0 1年选择性应用该切口于 316例小儿胸外科手术病例 ,男 14 6例 ,女 170例 ;年龄 2天～ 15岁 (平均 2 8岁 ) ,体重 2～ 4 0kg (…     

含乌司他丁肺保护液在心肺转流术中的肺保护作用

Objective To evaluate protective effects of hypothermic pulmonary protective solution with uli-nastatin on lung function during cardiopulmouary bypass (CPB) in the patients with congenital heart disease(CHD) and pulmonary hypertenion. Method Fifty-four children,who had CHD of left-to-fight shunts with moderate-se-rious pulmonary hypertension, were enrolled. They had been performed with the radical operation under CPB from September 2005 to December 2006 in the Department of Cardiovascular Surgery, Children' s Hospital of Zhejiang University. Moderate-serious pulmonary hypertension was defined as pulmonary-to-systolic pressure ratio > 0.45(Pp/Ps > 0.45). Fifty-four children were randomly divided into three groups. Patients in group A (n = 18)didn't receive pulmonary protective solution, and scrved as control; patients in group B (n = 18) were adminis-tered with pulmonary protective solution without ulinastatin;patients in group C (n = 18) were administered with pulmonary protective solution with ulinastatin. The serum concentrations of MDA and MPO were measured at five different time points:pre-operation, 0 h, 3 h, 6 h and 24 h in the intensive care unit (ICU) (T1～5). Patients'lung functions were monitored at T1 - T4. The time of mechanical ventilation was recorded. Results No one died in this study. The mean time of mechanical ventilation was shorter in the group B and group C than that in the group A. The MDA and MPO levels were lower in group B compared with group A at T4. The MDA level at T3-T5 and the MPO level at T4 was lower in group C than those in group A. There were no significant in MDA and MPO levels between group B and group C at five time point.A-aDO2 was lower in groups B and C than those in group A at T3 and T4, whereas at T4, A-aDO2 was lower in group C than that in group B. Cdyn was higher in group B at T3and group C at T3 - T4 than those in group A. Cdyn was lower in groups C than that in group B at T4.Condusions Lung perfusion with hypothermic protective solution during CPB can all lung injury and promote recovery after operation, especialy with ulinastatin.