Recipient hypertonic saline infusion prevents cardiac allograft dysfunction

Objective

Hypertonic saline (HTS) has potent immune and vascular effects. We assessed recipient pretreatment with HTS on allograft function in a porcine model of heart transplantation and hypothesized that HTS infusion would limit endothelial and left ventricular (LV) dysfunction following transplantation.

DIFFERENCES IN ENDOTHELIUM-DEPENDENT RELAXATION IN VARIOUS ARTERIES FROM WATANABE HERITABLE HYPERLIPIDAEMIC RABBITS WITH INCREASING AGE

1. Endothelium-dependent relaxation in response to acetylcholine (ACh) and the calcium ionophore A 23187 was examined in aorta, coronary, basilar and renal arteries isolated from Watanabe heritable hyperlipidaemic (WHHL) rabbits of 2, 6 and 12 months of age, with normolipidaemic heterozygous WHHL rabbits as controls. 2. In the rings of WHHL rabbit aortae and coronary arteries preconstricted with vasoconstrictors, endothelium-dependent relaxation in response to ACh was attenuated with age compared to the heterozygous WHHL rabbits. A significant negative correlation was found between the total cholesterol content and the relaxation response to ACh in the aortae or coronary arteries from 6 and 12 month old WHHL rabbits. 3. In the rings of basilar arteries, endothelium-dependent relaxations to ACh were not modified with age. Similarly, in the rings of renal arteries, the relaxation response to ACh was not changed with age, but in the 6 and 12 month preparations, after the age of 6 months, a contraction following the relaxation appeared at higher concentrations of ACh (10^?7 to 10^?6 mol/L). The contraction was endothelium-dependent and inhibited by indomethacin. 4. A 23187-induced endothelium-dependent relaxations were also markedly attenuated in the aorta and significantly in the coronary artery with age. 5. Endothelium-independent relaxation to sodium nitroprusside was not changed in all arteries from WHHL rabbits of different ages. 6. These findings indicate that in the aorta and coronary artery of the WHHL rabbit, the endothelium-dependent relaxation to ACh and A 23187 becomes impaired with increasing age (i.e., with the progression of cholesterol deposition in the arterial wall) but is preserved in the basilar and renal artery.     

移植肾破裂的处理

目的　提高移植肾破裂的防治水平。方法　 6例移植肾破裂 ,手术前 2例 ,手术后 4例。 2例术前供肾破裂 ,采用切开移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。 1例术后移植肾破裂早期 ,出血少 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物。 3例术后移植肾破裂出血量估计超过 10 0 0ml者 ,采用手术延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾。结果　 ( 1)手术前 2例手术后 4例 ,采用切开或者延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾并配合“硝普钠”降压的方法处理 ,均未再破裂出血 ,移植肾功能恢复良好。 ( 2 ) 1例术后移植肾破裂早期的患者 ,针对顽固性高血压采用“硝普钠”降压 ,配合常规抗排斥药物 ,非手术治疗成功。结论　 ( 1)采用手术切开或延长移植肾破裂处包膜 +裂口内明胶海绵填塞 +肠线修补 +肠线编织肾袋收缩保护移植肾可以有效治疗移植肾破裂。 ( 2 )移植肾破裂出血少的情况下 ,可以在密切观察下非手术治疗     

硝普钠结合控制性再灌注预防肺缺血再灌注损伤的实验研究

目的　探讨硝普钠结合控制性再灌注在预防肺缺血再灌注损伤中的作用及其机制。方法　将 1 4只猪随机分为对照组 (Ⅰ组 )和实验组 (Ⅱ组 )。对照组在去除肺动脉阻断 ,恢复自体血流前 ,给予控制性再灌注处理 (灌注液 :去白细胞∶改良Buckberg液 =4∶1 ,灌注压 1 8mmHg ,灌注时间 1 0min ,温度 37℃± 1℃ )。实验组在去除肺动脉阻断 ,恢复自体血流前 ,给予控制性再灌注 ,后经肺动脉以每分钟 1 .0 μg kg注入硝普钠 1 0min ,余处置同对照组。 0 .5 ,1和 2h后测血氧分压、肺血管阻力、肺顺应性及肺氧合功能变化 ,实验结束后 ,取肺组织测NO含量、MDA含量及肺含水量。结果　实验组的左肺氧合功能和肺顺应性明显好于对照组 (P <0 .0 5 )。肺循环阻力、丙二醛 (MDA)值及肺含水量均低于对照组 (P <0 .0 1 )。实验组肺中NO含量较对照组明显升高 (P <0 .0 1 )。结论　硝普钠结合控制性再灌注能明显降低肺缺血再灌注损伤 ,起到了较好的移植肺保护效果     

THE CAIMA SYSTEM

CAIMA is the abbreviation of Computer-Assisted Instant Monitoring drug Administration. CAIMA works on the principle of closed-loop negative feedback. Special programs have been designed to meet the needs of: a) Patients' safety, b) Response level desired, c) Output necessary for actuating the injecting pump. The pump forces the drug solution to enter the body with high precision. The author shows 8-year experience of using CAIMA system in laboratory and in hospital operating rooms. Experimental studies revealed that: CAIMA system attenuates the overshots and undershots usually present in reaction to drug administration, thus saves the drug and thereby causes less side-efiffeets, while the recovery is also much shortened. CAIMA system provides a greater tolerance to extra-stimuli and preserves the body original reactive sensitivity to drug. The homeostasis in animals is better kept with CAIMA than without. Clinically, the arbitrary hypotension during brain surgery with sodium nitroprusside and the control of muscle relaxation in general surgery with muscle relaxants have been successful using CAIMA system.     

二尖瓣置换术围手术期硝普钠的应用

本文介绍了20例二尖瓣置换术病人围手术期使用硝普钠的经验。术中和术后早期使用硝普钠可降低肾素-血管紧张素系统的活性、减轻外周血管阻力和后负荷,增强泵血功能,从而使心脏指数升高,降低术后高血压和肺水种的发生率。体外循环停止后,硝普钠与低浓度升压药并用可增强心肌收缩力,预防低排综合征     

硝普钠透皮递药系统控释膜的制备

为了寻找能够控制硝普钠释放的控释膜,研究了数种高分子膜的通透性,其中以经过热处理的聚乙烯醇(PVA)膜控制硝普钠释放性能较好。进一步研究了热处理条件对PVA膜通透性的影响,发现只要热处理的温度和时间恰当,就可以获得具有一定通透性的PVA膜。     

高容血液稀释联合术中控制性降压对腰椎手术病人心率变异性的影响

目的:探讨术前急性高容血液稀释联合术中硝普钠控制性降压对腰椎手术病人心率变异性(HRV)的影响.方法:15例腰椎骨折椎板减压、切复内固定病人,术前输入6%羟乙基淀粉20ml/kg和乳酸林格氏液20ml/kg以实施急性高容血液稀释,术中采用硝普钠微泵输注实施控制性降压,输注速度为0.5～6μg·kg-1·min-1,控制平均压(MAP)在55～65mmHg之间.观察插管后稀释前(T0)、稀释后降压前(T1)、降压后10min(T2)、30min(T3)和停降压后10min(T4)和30min(T5)6个时间点总功率谱(TP)、低频值(LF)、高频值(HF)、LF/HF、标化低频值(Lfnrom)和标化高频值(Hfnorm).结果:以上6个时间点TP、LF、HF、LF/HF、Lfnrom和Hfnorm均无显著变化.结论:术前急性高容血液稀释联合术中控制性降压时心脏自主神经功能稳定.