65岁以上老年患者心脏瓣膜手术中的体外循环管理

目的总结65岁以上老年人心脏瓣膜置换术的体外循环管理方法。方法回顾性分析2006年1月至2008年12月老年人心脏瓣膜置换术232例患者的临床资料,着重分析体外循环方法和手术方法。全部患者采用气管插管、静吸复合麻醉,中度血液稀释、中度低温、中高流量,冷含血停跳液进行心肌保护,全部应用超滤器。结果体外循环时间（87.2±32.7）min;主动脉阻断时间（58.3±27.5）min。转流中平均动脉压维持在60～90mm Hg（1mm Hg=0.133kPa）,超滤量为800～8300mL,心脏自动复跳率86%,本组早期死亡10例（4.3%）。结论体外循环中加强心肌保护;控制血液稀释度,使用血液超滤技术维持机体内环境的稳定;有效的组织灌注以及良好的保护等综合性措施,有助于脑、肾、肺等重要脏器的保护,有利于提高老年患者心脏瓣膜置换术中体外循环的质量,并确保手术安全。

Transplantation of adipose tissue-derived mesenchymal stem cell for the therapy of acute myocardial infarction in rabbits

Objective To search the dynamic changes of the matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases-1 (TIMP-1) of the atherosclerosis rabbit model, and the efficacy of simvatatin. Methods 50 atherosclerosis models of rabbits were established through high lipid diet and injured femoral arteries by dilated balloon, and be divided to 2 groups equivalently, control group and therapy group, the later were given simvatatin 4mg/kg, on day 1, 7, 14, 21, 28 after injured, MMP1, 9 and TIMP-1 were detected with ELISA assay, then the curve reflecting the dynamic changes was draw in both groups, and the histopathology data was provided as well. Result The curve of dynamic changes MMP-1, 9 similar, the peaks were showed at 1 day after injured, and last for 7 days, the peak of TIMP-1 at the 1st day, and then decrease obviously. Simvastatin inhibitor MMP-1,MMP-9,TIMP-1 at 7 days, 21 days and 1 day respectively. Conclusion The changes of MMPs and TIMP in atherosclerosis rabbit model wediddifferent and so did the secretion time of MMPs/TIMP inhibited by simvastatin.