表达谱基因芯片筛选体外循环前后心肌细胞因子的变化

Objestive Systemic inflarmmation may be triggered by injury, hypothermia, ischemia-reperfusion and the contact of the blood with foreign body during cardiopulmonary bypass (CPB). To determine the application values of gene chip technique in the clinical practice and the study of cardiovascular stagery, as well as to provide clues to the study of inflammatory responess during CPB, microarry for gene expression profiles was used to identify the differences in the gene expression of myocardium between pre-and post- CPB. Methods Six adult patients who underwent CPB from March to May in 2003 were involved. Samples of right atrium were col- lected before and at immediate end of CPB. BD AtlasTM cDNA Expression Arrays was used to identify the differences in the gene ex- pression of cytokines. The results were compared with that of semi-quantative RT-PCR. Resellts The mean age of 6 patients (5 males and 1 female) was (32.67± 11.72) years. The baseline heart function was gradeⅡin 3 cases and grade Ⅲ in 3 other cases. The baseline left ventricular ejection fraction(LVEF)was (58.17±7.91)%. The mere duration was (91.67±43.88) minutes for CPB and was (58.67±43.46) minutes for aorta blocking. The minimum nasopharynx/rectal temperture was (29.37±1.90)℃/ (32.15±1.52)℃. Gene expression profiles of cytokines in the myocardium pre- and post-CPB were analysed successfully. The ex- pression of IL-6, IFN-γ,Wnt5a, TNFRSF1B, a member of tumor necrosis factor receptor superfamily, PIGF and MFNG in the myo- cardium were unpregulated after CPB. Conclusion Microarray technique is applicable in the study of cytokines changes dying CPB. cDNA microarray identified pleliminarily the differences in the gene expression between pre- and post-CPB. These genes may be in- valved in inflammation and other psthophysiological responses incuced by CPB. The myocardiym is probably one of the major sources of cytokines during CPB. Further study may be helpful in understanding the llngthe development of inflammation during CPB, and eventually, reducing the post-operative complications.     

常温体外循环下采用缺血预调行心肌保护的研究

为了探讨常温体外循环下采用缺血预调行心肌保护的研究,通过建立犬的常温体外循环全心缺血预调模型,旨在探讨心内直视手术缺血预调保护心肌的可能性。预调组采用升主动脉阻断5分钟,放开10分钟,反复三次的方式预调心脏;对照纽简单并行循环45分钟,而后两组均接受30分钟缺血和60分钟再灌注。结果显示,预调组室颤发生率低(16.7 VS 83.3％P=0.04),无再灌注心律失常(0 VS66.7％P=0.03),心肌ATP消耗减慢(4.69 1.050 VS 2.35±0.86μmol/g wet wt P<0.01),乳酸积累减少(4.49±0.86 VS 9.80 5.53mg/g wet wtP<0.05),心肌细胞超微结构损伤轻。结论:常温体外循环下应用缺血预调保护犬的心肌是可行而有效的。     

VEGF165cDNA治疗缺血心肌的实验研究

目的：观察VEGFl65cDNA治疗缺血心肌后心功能、血流动力学、心肌灌注和代谢的变化。方法：健康杂种犬36只，随机分为VEGFl65cDNA和空质粒(pcDNA3：1)组(n＝12)，心肌梗塞组为对照组。Amroid环致慢性心肌缺血模型。VEGFl65基因转染采用直接心肌注射法。结果：基因转染后4周、8周时VEGF165基因组LVEF和CO及前壁、前侧壁、前间壁心肌灌注量、代谢和FDG摄入量明显高于同期心肌梗塞组。结论：VEGFl65基因治疗后4周和8周时心功能显著改善；成活心肌的数量显著增加和/或称成活心肌功能显著恢复。     

三瓣膜替换术中自体心包片加宽升主动脉及其瓣环2例

三瓣膜替换术中自体心包片加宽升主动脉及其瓣环２例王奇，朱朗标１９９２年２月和１９９４年５月，我们为２例风湿性心脏病联合瓣膜病变病人行二尖瓣、主动脉瓣及三尖瓣三瓣膜替换术的同时，用自体心包片加宽升主动脉及主动脉瓣环，取得良好效果。现报告如下：临床资料２...     

镜像右位心合并复杂心脏畸形1例

患儿,男,８岁。３岁发现心脏杂音,平素易感冒发热。胸廓无畸形,心尖搏动位于右侧第５肋间右锁骨中线外侧１ｃｍ,心率１１０次／分,律整,胸骨右缘３、４肋间闻及３／６级粗糙收缩期杂音。心电图示右位心,右心室肥厚。Ｘ线胸片见两肺血稍多,心影扩大,心尖向右下延伸,Ｃ／Ｔ∶０．５３。超声心动图示心脏位于右侧胸腔完全性大动脉转位,两处室间隔缺损。腹部超声见肝脏、脾脏转位。手术在全麻低温体外循环下进行。暴露心脏后见右位心,升主动脉在左前方,主肺动脉在右后方,房室关系一致,肺动脉根部可扪到细震颤,冠状动脉单开口。…     

二尖瓣替换并全瓣膜腱索乳头肌保留技术初步体会

二尖瓣替换并全瓣膜腱索乳头肌保留技术初步体会中国人民解放军总医院心外科王冬青杨建安余翼飞朱朗标在行二尖瓣替换术（ＭＶＲ）的同时保留全部二尖瓣结构将增进术后恢复期的血液动力学状况，使左心室的功能得到保护。现将我科施行该手术的初步体会报告如下：１临床资...     

冠状动脉旁路移植术围术期心肌肌钙蛋白I动态变化

目的　观察心肌肌钙蛋白I(cTnI)和CK -MB在冠状动脉旁路移植术 (CABG)围术期变化 ,以判断心肌损伤状况。方法　 19例CABG病人 ,其中 3例同时行左室室壁瘤切除。平均体外循环时间12 1min ,阻断升主动脉 5 6min。灌注冷血停跳液保护心肌 ,平均每例搭桥 3 2支。围术期 2 0个时间点取静脉血标本 ,留血浆测cTnI和CK MB。术前及术后第 7d作标准 12导联心电图 (ECG)。结果　cTnI术前 5例升高者 ,停机后全部升高 ,第 8h达高峰 ,术后第 7d有 7例 (36 8% )仍高于正常 ;CK MB阻断升主动脉前正常 ,停机后升高 ,第 6h达高峰 ,术后第 2d全部恢复正常 ;2例发生围术期心梗 (PMI)者 ,整个围术期cTnI高于无PMI者 ;cTnI阻断升主动脉前已升高者 ,术后升高更显著。结论　cTnI与CK MB在CABG术后变化规律相似 ,但cTnI高于正常的持续时间长于CK MB ,有利于回顾性诊断 ;若阻断升主动脉前cTnI已升高 ,术后水平更高 ;cTnI诊断心肌损伤敏感性高于CK -MB。     

室壁瘤切除左室成形的临床经验

目的探讨室壁瘤切除并左室成形术的手术经验。方法1998年至2006年,共58例患者行室壁瘤切除并左室成形术,包括Jatene术式12例、Dor术式44例及Cooley术式2例,均同期行冠脉搭桥术。所有患者术前及术后均行超声心动图(经胸壁和/或经食道超声心动图),记录左室射血分数、左室收缩及舒张末期容积和左室收缩及舒张末期容积指数等指标。结果所有患者无死亡。超声心动图显示,与术前相比,所有患者的左室收缩及舒张末期容积均显著降低、左室射血分数则显著升高,尤其是后10例患者的射血分数增加更为明显。远期随访发现,2例患者心功能恶化,其余患者心功能状况良好,无死亡病例。结论对于心肌缺血导致的慢性心力衰竭,外科手术行左室减容和几何成形、同期行冠脉搭桥是一种积极有效的治疗措施。术后左室收缩末容积指数是判断近、远期疗效的关键指标。     

表达谱基因芯片筛选体外循环前后心肌细胞因子的变化

Objestive Systemic inflarmmation may be triggered by injury, hypothermia, ischemia-reperfusion and the contact of the blood with foreign body during cardiopulmonary bypass (CPB). To determine the application values of gene chip technique in the clinical practice and the study of cardiovascular stagery, as well as to provide clues to the study of inflammatory responess during CPB, microarry for gene expression profiles was used to identify the differences in the gene expression of myocardium between pre-and post- CPB. Methods Six adult patients who underwent CPB from March to May in 2003 were involved. Samples of right atrium were col- lected before and at immediate end of CPB. BD AtlasTM cDNA Expression Arrays was used to identify the differences in the gene ex- pression of cytokines. The results were compared with that of semi-quantative RT-PCR. Resellts The mean age of 6 patients (5 males and 1 female) was (32.67± 11.72) years. The baseline heart function was gradeⅡin 3 cases and grade Ⅲ in 3 other cases. The baseline left ventricular ejection fraction(LVEF)was (58.17±7.91)%. The mere duration was (91.67±43.88) minutes for CPB and was (58.67±43.46) minutes for aorta blocking. The minimum nasopharynx/rectal temperture was (29.37±1.90)℃/ (32.15±1.52)℃. Gene expression profiles of cytokines in the myocardium pre- and post-CPB were analysed successfully. The ex- pression of IL-6, IFN-γ,Wnt5a, TNFRSF1B, a member of tumor necrosis factor receptor superfamily, PIGF and MFNG in the myo- cardium were unpregulated after CPB. Conclusion Microarray technique is applicable in the study of cytokines changes dying CPB. cDNA microarray identified pleliminarily the differences in the gene expression between pre- and post-CPB. These genes may be in- valved in inflammation and other psthophysiological responses incuced by CPB. The myocardiym is probably one of the major sources of cytokines during CPB. Further study may be helpful in understanding the llngthe development of inflammation during CPB, and eventually, reducing the post-operative complications.     

异体心肺联合移植动物实验——犬异体心肺移植

1970年,Grinnan报告25条犬异体心肺移植,13条因技术问题如出血、气管支气管树血液和分泌物的潴留或急性肺水肿而于24小时内死亡,11条生存24～72小时,最长的1条生存10天,证明技术上是可行的,但因犬不能耐受肺去神经,终因呼吸衰竭导致死亡。1972年Castaneda用狒狒行自体心肺移植,23条狒狒中21条恢复自主呼吸,3条生存8个月以上,并显示了正常的呼吸功能。实验证明了灵长类动物有耐受心肺完全去神经的能力。Stanford大学医院于1980年在恒