N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

目的 探讨N-乙酰半胱氨酸对体外循环(CPB)下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响.方法 择期CPB下行心脏瓣膜置换术的风湿性心脏病患者22例,性别不限,年龄21-60岁,ASA Ⅱ或Ⅲ级,心功能Ⅱ或Ⅲ级,随机分为2组(n=11):对照组(C组)和N-乙酰半胱氨酸组(N组).N组预充液中加入N-乙酰半胱氨酸100 mg/kg,停搏液中加入50 mg/kg,C组给予生理盐水替代.于麻醉诱导前10 min和术毕时,记录HR、MAP、中心静脉压(CVP)、肺动脉压(PAP)、肺毛细血管楔压(PCWP)、心输出量(CO)和心脏指数(CI).于切皮前即刻、主动脉开放后0.5、6、12和24 h时,采集桡动脉血样行血气分析,采集中心静脉血样测定血浆白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、丙二醛(MDA)、心肌肌钙蛋白I(cTnI)的浓度和超氧化物歧化酶(SOD)活性.于CPB前即刻和停机即刻,取心肌组织,计数凋亡细胞,观察心肌细胞超微结构.结果 与c组比较,N组HR、MAP、CVP、PAP、PCWP、pH值、红细胞压积、动脉血氧分压、动脉血二氧化碳分压和剩余碱差异无统计学意义(P>0.05),主动脉开放后TNF-α、IL-6、cTnI和MDA的浓度降低,SOD活性升高,CPB停机即刻心肌凋亡细胞计数降低,术毕CO和CI升高(P<0.05或0.01),心肌病理损伤减轻.结论 N-乙酰半胱氨酸可减轻体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

依达拉奉对心脏瓣膜置换术患者颅内静脉血浆S-100β蛋白和NSE浓度的影响

目的探讨依达拉奉对心脏瓣膜置换术患者围体外循环期颅内静脉血浆S-100β蛋白（S-100β）和神经元特异性烯醇化酶（NSE）水平的影响及其机制。方法 20例心脏瓣膜置换术病人,随机分为依达拉奉组（E组）和对照组（C组）,每组10例。于麻醉后用药前（T0）、升主动脉开放时（T1）、CPB结束时（T2）、CPB结束后30 min（T3）、CPB结束后4 h（T4）抽取颈静脉球部血,检测血浆丙二醛（MDA）、超氧化物歧化酶（SOD）、总抗氧化能力（T-AOC）水平;于T0、T2、T3、T4检测S-100β、NSE、白细胞介素-6（IL-6）、肿瘤坏死因子（TNF-a）水平。结果与T0时比较,S-100β、NSE、IL-6浓度两组在T2-4时升高（P〈0.05或0.01）;TNF-a浓度C组T2-4时升高（P〈0.01）,E组仅在T2时升高（P〈0.05）;MDA浓度C组T1-4时升高（P〈0.05或0.01）,E组仅在T2-3时升高（P〈0.05）;SOD活力C组T1-4时降低（P〈0.05或0.01）,E组各时点无显著变化;T-AOC两组在T1-4时降低（P〈0.05或0.01）。与C组比较,E组S-100β、NSE、TNF-a、IL-6浓度在T2-4时降低（P〈0.05或0.01）,MDA浓度在T1-4时降低（P〈0.05）,SOD活力和T-AOC在T1-4时升高（P〈0.05或0.01）。结论依达拉奉在心脏瓣膜置换术患者围体外循环期可减少脑静脉血浆S-100β和NSE的产生,从而减轻脑损伤。     

N-乙酰半胱氨酸对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effects of N-acetylcysteine(NAC)on myocardial ischemia-reperfusion(I/R)injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Twenty-two ASA Ⅱ or Ⅲ patients of both sexes aged 21-60 yr undergoing cardiac valve replacement under CPB were randomly assigned to one of 2 groups(n=11 each):control group(group C)and NAC group.In NAC group NAC 100 mg/kg was added to the priming solution and 50 mg/kg to crystalloid eardioplegic solution,while in control group normal was used instead of NAC.Swan-Gang catheter was placed.Heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),pulmonary medal pressure(PAP),pulmonary capillary wedg pressure(PCWP),cardiac output(CO)and cardiac index(CI)were recorded at 10 min beforeanesthesia induction and at the end of operation.Blood samples were collected before operation and at 0.5,6,12 and 24 h after release of the aortic cross-clamp for determination of blood gas analysis,plasma IL-6,TNF-α,MDA and cTnI concentrations and SOD activity.Myocardial specimens were obtained from right atrium for detection of apeptosis(by TUNEL)and examination of ultrastructure with scanning electron microscope.Results There was no significant difference in HR,MAP,CVP,PAP,PCWP,PaO2,Hct,PaCO2,pH value and BE between bothgroups.The plasma concentrations of MDA,IL-6,TNF-α and eTnI weFe significantly lower,while plasma SOD activity CO and CI were higher in group NAC than in group C.NAC significantly decreased myocardial apeptosis and damage induced by myocardial I/R during CPB.Conclusion NAC can protect myocardium against I/R injury induced by CPB.     

8例席汉氏综合症误诊原因分析

我院妇科门诊及内科门诊自1984年7月年1992年7月8年间共收治席汉氏综合症16例,其中误诊8例,本文就误诊原因分析如下。1 临床资料1.1 一般资料 本组8例均为女性,年龄20～42岁,平均31岁。从发病至确诊时间半年～10年,误诊次数1次至数次不等。1.2 发病因素及误诊情况 分娩时大出血休克及晕厥者6例,产褥感染者1例,产后败血症者1例。8例中误诊为精神性厌食者1例,肝炎者2例,贫血者5例。分别给予相应的精神、保肝及纠正贫血等治疗,效果不佳,并逐渐加重。