Transient Iron-Overload with Bleomycin-Detectable Iron Present During Cardiopulmonary Bypass Surgery

Extracorporeal circulation of blood during cardiopulmonary bypass surgery exposes cells to non-physiological surfaces and shear stress which can activate several regulatory cascades, and neutrophils to release superoxide and hydrogen peroxide. Shear stresses generated by pumps and suction systems cause lysis of red blood cells and the release of haemoglobin. Together the release of reactive forms of oxygen and haemoglobin can lead to the appearance of low molecular mass chelatable iron (bleomycin-detectable iron). All patients undergoing open heart surgery appear to release iron to plasma transferrin, increasing its iron saturation. In 13% of patients, however, the transferrin became fully iron-saturated, and by the end of open-heart surgery we could detect bleomycin-chelatable iron in the plasma. Saturation of transferrin with iron eliminates its iron-binding antioxidant properties, which can result in a stimulation of iron-dependent radical damage to selected detector molecules.     

Sequential Oxidative Damage, and Changes in Iron-Binding and Iron-Oxidising Plasma Antioxidants During Cardiopulmonary Bypass Surgery

Cardiopulmonary bypass patients undergoing heart valve replacement surgery appear to be under oxidative stress, when compared with normal healthy controls, by showing increased levels of protein and lipid damage. During bypass surgery two further episodes of oxidative stress occur. The first is seen when patients are placed on extracorporeal blood circulation and oxygenation which results in a rise in lipid peroxides and thiobarbituric acid-reactive substances. The second phase of oxidative stress occurs during reperfusion of the myocardium following removal of the aortic cross clamp. Coincident with evidence of increased oxidative damage to lipids during these latter phases of oxidative stress were decreases in plasma iron-binding and iron-oxidising antioxidant activities.     

围术期应用他汀类药物对冠状动脉旁路移植术并发急性肾损伤疗效的研究进展

急性肾损伤是冠状动脉旁路移植术后常见并且严重的并发症,目前临床治疗主要以对症治疗和肾脏替代治疗为主。作为调节冠心病患者血脂的他汀类药物,其对于行冠状动脉旁路移植术患者肾脏的作用也成为了学者研究的热点问题。目前虽已有充分证据表明他汀类药物可以降低行冠状动脉旁路移植术患者院内死亡率,但是尚不清楚其能否降低患者术后急性肾损伤的发生率。对于在冠状动脉旁路移植术围手术期应用他汀类药物,其应用的时间窗以及应用的剂量学者们仍未达成统一意见。本文通过分析他汀类药物在冠心病整体防治中的作用机理机制,以及总结近几年关于他汀用药时间窗,用药剂量对于行CABG患者术后肾脏影响的相关文献,对围手术期应用他汀类药物对于行CABG患者术后急性肾损伤的影响展开综述。     

微创机器人辅助下心脏手术中体外循环的各种引流方法比较

目的：分析比较机器人系统辅助下微创心脏手术中体外循环的各种静脉引流方式和辅助引流方法的特点和管理。方法24例患者接受体外循环下微创机器人辅助（ Da vinci S）心脏手术,股动静脉插管建立体外循环,不同的辅助引流方法分三组,D1组离心泵辅助引流12例,D2组负压辅助引流7例,D3组颈内静脉插管辅助引流5例。结果三组间平均静脉引流量和平均每公斤静脉引流量基本相似,无统计学差异。三组术中转流基本平稳,血流动力学相对稳定,各项监测指标均在正常范围,手术视野暴露清晰满意,全组的平均体外循环时间为139.7±35.5min,平均主动脉阻断时间为84.2±28.8 min。结论在股静脉引流的基础上,根据不同的手术方式和手术医生的要求,灌注师应用不同的辅助引流方式并制定不同的灌注对策,用于保证转流过程中充分的引流和灌注,是机器人辅助微创心脏手术顺利、成功的重要因素之一。     

缩短体外循环管道对新生儿和小婴儿心脏手术输血量的影响

目的回顾分析了逐步缩短体外循环管道对新生儿和小婴儿心脏手术输血量的影响。方法将2000年至2010年体重10kg以下病人4822例,分为3组：组1（n=1265）Dedico901/902/Medtronic氧合器＋Stockert II/Jostra HL20人工心肺机;组2（n=2534）Rx-05氧合器＋Stockert II/Jostra HL20人工心肺机;组3（n=1023）Rx-05氧合器＋Jostra HL30人工心肺机。比较各组预充总量,红细胞悬液的使用量和血球压积。结果组3和组2的预充量显著低于组1预充量（组1,718±15ml;组2,458±15ml;组3,334±8ml,P〈0.001）。围术期各组血球压积无显著差异;然而各组在预充液中加入的红细胞悬液有显著差异（组1,313±5 ml;组2,205±5ml;组3,167±8ml,P〈0.001）,体外循环转流中加入的红细胞悬液组间也有显著性差异（组1,117±8ml;组2,88±7ml;组3,60±8ml,P〈0.001）。结论通过改进氧合器和缩短管道长度能减少预充量和总用血量,逐步向不用血心脏外科迈进。     

体外循环心脏手术患者肝功能的表达水平及腺苷蛋氨酸的干预机制研究

目的:探讨体外循环心脏手术患者肝功能的表达水平及腺苷蛋氨酸的干预机制。方法:选取2017年5月至2018年6月在海南医学院第二附属医院接受体外循环心脏手术的患者184例,根据随机数字表法分为观察组及对照组各92例,分别比较术前、术后所有患者肝功能指标水平。术后对照组患者给予生理盐水干预7d,观察组患者给予腺苷蛋氨酸干预7d,比较两组患者干预7d后肝功能指标、炎症反应指标以及心肌损伤指标水平。结果:术前患者的总胆红素(TBI)、直接胆红素(DBI)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平均显著低于术后,差异均有统计学意义(P0.05)。干预7d后观察组患者的TBI、DBI、ALT、AST、血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT)水平均显著低于对照组,而白细胞介素-10(IL-10)水平显著高于对照组,差异均有统计学意义(P0.05)。观察组不良反应发生率为7.61%(7/92),与对照组的2.17%(2/92)相比,差异无统计学意义(P0.05)。结论:体外循环心脏手术会对患者肝功能造成一定程度的损害,而腺苷蛋氨酸对患者的肝功能以及心肌组织均有一定的保护作用,同时能减轻炎症反应程度,无严重药物不良反应发生。     

患儿体外循环直视心脏术后高尿酸血症分析

目的：探讨体外循环心脏术后24h患儿高尿酸血症发生的原因、影响因素和预后。方法：以2006年9～12月我院心脏外科收治的106例体外循环心脏手术患儿为研究对象,收集其年龄、体外循环时间、尿量、预后资料和心脏术后24h血尿酸、尿素氮、肌酐、胱抑素、血糖、总胆红素、直接胆红素等生化指标数据;以空腹血尿酸为标准,将患儿分为无高尿酸血症组和高尿酸血症组,用SPSS11．0软件分析两组之间临床资料的差异、高尿酸血症组血尿酸与其他指标的相关性及影响患者预后的因素。结果：患儿术后高尿酸血症组患者53例（50％）,与无高尿酸血症组相比P〈0．01,除年龄因素外,其他临床指标均有统计学意义;高尿酸血症组的血尿酸与血糖、总胆红素无相关性,与年龄、尿量呈显著负相关,与转流时间、尿素氮、肌酐、胱抑素、直接胆红素含量呈极显著正相关;在预后良好组与死亡组的比较中,转流时间、血尿酸、尿素氮、肌酐含量有统计学意义。结论：患儿体外循环心脏术后高尿酸血症的发生较常见,血尿酸水平对患者术后肾功能状态及预后具有重要临床意义,连续监测术后血尿酸、尿素氮、肌酐水平是及时判断患者临床状况以采取相应措施改善预后的重要方法;低心排血量综合征是引起患者死亡的危险因素之一,通过提高体外循环心脏手术水平,尽量缩短转流时间,加强围手术期监护,可有效减少术后并发症,降低死亡率。     

急性心肌梗死患者冠脉搭桥术前中性粒细胞-淋巴细胞比率与围术期心肌损伤相关分析

目的：探讨急性心肌梗死患者冠脉搭桥（CABG）术前中性粒细胞．淋巴细胞比率（NLR）与围术期心肌损伤的关系,为,临床CABG围术期心肌保护提供参考依据。方法：选取2012年1月至2012年6月于首都医科大学附属北京安贞医院因急性心肌梗死接受冠脉搭桥手术（CABG）患者210例,收集术前血常规及术后肌钙蛋白I（cTnI）？Life酸激酶同工酶（CK-MB）,计算NLR;采用四分位法根据NLR水平将患者分为四组,比较各组cTnI及CK—MB峰值,多元逐步回归分析NLR与cTnI及CK-MB峰值的相关性。结果：随着NLR水平升高,高血压病史和射血分数〈50％患者比例逐渐增多;白细胞计数、术后CK-MB及cTnI峰值、术后血肌酐值均逐渐增加;多元逐步回归分析显示,NLR、WBC分别与cTnI峰值呈正相关（r=0．526,r=0．186,P〈0．05）。结论：术前NLR、WBC与cTnI峰值呈正相关,NLR可能是反应急性心肌梗死患者冠脉搭桥围术期心肌损伤的良好标志物。     

乌司他丁对心肺转流下心脏手术患者炎症因子及认知功能的影响

目的:探索乌司他丁(UTI)对心肺转流(CPB)下心脏手术患者炎症因子及认知功能的影响。方法:选择自2010年5月至2014年9月我院收治的CPB瓣膜置换手术患者60例,按照随机数表法将患者分成对照组和观察组,每组30例。观察组患者在麻醉诱导后静脉泵入1.2×10~4U/kg UTI,在CPB结束前5 min从体外管道内给予0.6×10~4U/kg UTI,对照组患者给予等量的生理盐水。对比两组CPB前(T0)、CPB开始后1 h(T1)、CPB结束后1 h(T2)、术后4 h(T3)及术后24 h(T4)的血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6/10(IL-6/10)、中性粒细胞弹性蛋白酶(NE)、星形胶质细胞S100蛋白的β亚型(S100β)、超氧化物歧化酶(SOD)和丙二醛(MDA),在术前1 d和术后7 d时,采用简易精神状态检查表(MMSE)对患者进行神经精神功能测试,并评价患者的术后认知功能障碍(POCD)的发生率。结果:与T0相比,两组患者T1-T4的TNF-α、IL-6、NE、S100β、MDA水平明显升高,且观察组显著低于对照组,而两组IL-10、SOD水平显著下降,观察组显著高于对照组(P0.05)。术后7d,两组患者MMSE评分均明显高于术前1 d,且观察组显著高于对照组(P0.05);观察组POCD的发生率明显低于对照组(P0.05)。结论:UTI可以有效降低CPB下行瓣膜置换术患者的炎症因子水平,并改善患者的POCD,对于临床用药具有指导意义。     

急性心肌梗死患者冠脉搭桥术前中性粒细胞-淋巴细胞比率与 围术期心肌损伤相关分析*

摘要目的：探讨急性心肌梗死患者冠脉搭桥（CABG）术前中性粒细胞- 淋巴细胞比率（NLR）与围术期心肌损伤的关系,为临床 CABG 围术期心肌保护提供参考依据。方法：选取2012 年1 月至2012年6 月于首都医科大学附属北京安贞医院因急性心肌梗死 接受冠脉搭桥手术（CABG）患者210 例,收集术前血常规及术后肌钙蛋白I（cTnI）及肌酸激酶同工酶（CK-MB）,计算NLR;采用 四分位法根据NLR 水平将患者分为四组,比较各组cTnI 及CK-MB 峰值,多元逐步回归分析NLR 与cTnI 及CK-MB 峰值的相 关性。结果：随着NLR 水平升高,高血压病史和射血分数＜50%患者比例逐渐增多;白细胞计数、术后CK-MB 及cTnI峰值、术后 血肌酐值均逐渐增加;多元逐步回归分析显示,NLR、WBC分别与cTnI 峰值呈正相关（r=0.526,r=0.186,P<0.05）。结论：术前 NLR、WBC 与cTnI 峰值呈正相关,NLR 可能是反应急性心肌梗死患者冠脉搭桥围术期心肌损伤的良好标志物。     

Serum Ghrelin Levels in Response to Glucose Load in Obese Subjects Post‐Gastric Bypass Surgery

Objective: We sought to elucidate further the mechanisms leading to weight loss after gastric bypass (GBP) surgery in morbidly obese individuals. Ghrelin is a gastroenteric appetite‐stimulating peptide hormone, fasting levels of which decrease with increasing adiposity and increase with diet‐induced weight loss. In addition, ghrelin levels rapidly decline postprandially. Research Methods and Procedures: We measured serum ghrelin responses to a 75‐g oral glucose tolerance test (OGTT) in 6 subjects who had undergone GBP surgery 1.5 ± 0.7 years before testing and compared these responses with 6 obese subjects about to undergo GBP surgery, 6 obese nonsurgical subjects (matched for BMI to the post‐GBP surgical group), and 5 lean subjects. Results: Despite weight loss induced by the GBP surgery, fasting serum ghrelin levels were significantly lower in the post‐GBP surgery group than in the lean subject (by 57%) or pre‐GBP surgery (by 45%) group. Serum ghrelin levels during the OGTT were significantly lower in postoperative than in lean, obese pre‐GBP surgical, or obese nonsurgical subjects. The magnitude of the decline in serum ghrelin levels between 0 and 120 minutes post‐OGTT was significantly smaller in postoperative (by 62%), obese pre‐GBP surgical (by 80%), or obese nonsurgical (by 69%) subjects in comparison with lean subjects. Discussion: Serum ghrelin levels in response to OGTT are lower in subjects post‐GBP surgery than in either lean or obese subjects. Tonically low serum ghrelin levels may be involved in the mechanisms inducing sustained weight loss after GBP surgery.     

冠脉搭桥术后肺水肿患者氧化应激状态的变化观察

目的:研究冠脉搭桥术后肺水肿患者氧化应激状态变化观察,评价氧化应激状态与肺水肿的关联性,为临床减轻冠脉搭桥术后肺部并发症提供依据。方法:将本院2014年1月-2015年6月收治的冠脉搭桥术后肺水肿患者40例作为试验组,另选同期冠脉搭桥术后未发生肺水肿患者40例作为对照组。检测并比较两组患者术后3天、7天及14天的丙二醛(MDA)、总抗氧化能力(TAC)、过氧化氢酶(CAT)、C反应蛋白(CRP)、过氧化脂(LPO)及超氧化物歧化酶(SOD)的水平变化。结果:与对照组患者相比,试验组患者术后3 d、7 d、14 d三个时间点MDA,LPO及CRP表达水平均显著提高,而TAC,SOD及CAT表达水平均显著降低,差异均具有统计学意义(P0.05)。与术后3 d相比,两组患者术后7 d、14 d两个时间点的MDA,LPO和CRP表达水平均显著降低,而TAC,SOD及CAT表达水平均显著提高,差异具有统计学意义(P0.05)。结论:冠脉搭桥术后肺水肿的发生与患者氧化应激状态密切相关,机体自由基增多、抗氧化能力下降是肺水肿发生的重要机制。     

体外循环预充还原型谷胱甘肽对心脏瓣膜置换术患者的临床研究

摘要 目的：观察体外循环（CPB）预充还原型谷胱甘肽（GSH）对心脏瓣膜置换术患者心肌损伤指标和炎症因子指标的影响。方法：选择2020年10月到2021年10月期间于我院行心脏瓣膜置换术治疗的180例患者。以随机数字表法分为对照组和研究组,均为90例。研究组患者CPB预充GSH 1200 mg,对照组患者预充等量氯化钠注射液。观察两组患者围术期指标、心肌损伤指标[肌酸激酶（CK）、乳酸脱氢酶（LDH）、肌钙蛋白Ⅰ（cTnⅠ）、肌红蛋白（Mb）]、炎症因子指标[肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）]变化,并记录两组并发症发生情况。结果：研究组术中转流时间、呼吸机使用时间、ICU留置时间、术后多巴胺使用天数短于对照组,术后多巴胺使用总量少于对照组（P<0.05）。主动脉开放后2 h、12 h、24 h,两组CK、LDH、cTnⅠ、Mb水平均升高后下降（P<0.05）,且研究组CK、LDH、cTnⅠ、Mb水平低于对照组（P<0.05）。主动脉开放后2 h、12 h、24 h,两组IL-6、TNF-α水平均升高后下降（P<0.05）,且研究组IL-6、TNF-α水平低于对照组（P<0.05）。研究组的并发症发生率低于对照组（P<0.05）。结论：CPB预充GSH可减轻心脏瓣膜置换术患者心肌损伤,有效控制炎症反应,同时还可降低并发症发生率,缩短呼吸机使用时间、术中转流时间、ICU留置时间、术后多巴胺使用天数,减少术后多巴胺使用总量,效果显著。     

Role of iron chelators in growth-promoting effect on mouse hybridoma cells in a chemically defined medium

Summary The role of various iron chelators on the multiplication of mouse hybridoma cells in an albumin-free, transferrin-deficient defined medium was investigated. Fe(III)-dihydroxyethylglycine, Fe(III)-glycylglycine, Fe(III)-ethylenediamine-N,N′-dipropionic acid, or Fe(III)-iminodiacetic acid supported the excellent growth of the cells. In addition, the growth of the iron-starved cells, which had been preincubated in a protein-, iron- and chelator-free defined medium, restored rapidly when the medium was supplemented with holotransfeerrin, ferric iron, and chelator compared to that when supplemented with holotransferin, but without iron and chelator. The results suggest that such chelators modulate a progression of transferrn cycle in the presence of transferin and ferric iron. An alternative explantation is that there is a decrease in generation of iron-catalyzed free radicals.     

不同血糖水平对体外循环心脏手术围术期患者血乳酸以及康复进程的影响

目的:探讨体外循环(CPB)心脏手术围术期患者不同血糖水平对血乳酸值及术后康复进程的影响。方法:选择2016年3月至2018年5月在我院行CPB心脏手术的患者78例为研究对象,根据术前血糖水平分为糖尿病组(术前空腹血糖≥7.0 mmol/L)33例和非糖尿病组(术前空腹血糖7.0 mmol/L)45例,于术前2h(T_1)、麻醉后(T_2)、CPB转机后5 min(T_3)、主动脉阻断后5 min(T_4)、停止CPB时(T_5)、手术结束时(T_6)、术后2h(T_7)、4h(T_8)、6h(T_9)、8h(T_(10))、12h(T_(11))、24h(T_(12))及48h(T_(13))监测两组血糖及血液乳酸水平,比较两组康复进程指标及并发症发生情况。结果:糖尿病组患者围手术期各时间点血糖及血乳酸水平均高于非糖尿病组,且两组血糖与血乳酸水平呈正相关(P0.05);两组各时间点血糖及血乳酸水平均高于T_1时刻(P0.05)。非糖尿病组患者呼吸机辅助通气时间、ICU停留时间、术后住院时间均短于糖尿病组(P0.05)。非糖尿病组并发症发生率为4.44%(2/45),与糖尿病组的15.15%(5/33)比较无统计学差异(P0.05)。结论:CPB心脏手术患者围术期血糖及血乳酸水平明显升高,二者呈正相关关系,但术前糖尿病患者围手术期血糖及血乳酸水平波动更明显,控制围手术期血糖水平有助于加快康复进程。     

Transferrin 1 Functions in Iron Trafficking and Genetically Interacts with Ferritin in Drosophila melanogaster

1. Download high-res image (177KB)
2. Download full-size image

     

胃转流术后远端肠黏膜形态及生长因子表达的变化

目的:探讨胃转流术后远端肠管黏膜的适应性变化及生长因子的表达情况。方法:将8周龄的Wistar大鼠随机分为对照组、假手术组和胃转流术组,术后8周取吻合口远端肠管行常规病理切片检查,测量肠黏膜厚度和绒毛高度,采用免疫荧光法检测肠粘膜中表皮生长因子(EGF)和胰岛素样生长因子-1(IGF-1)的表达。结果:胃转流术组黏膜厚度(672±39与500±31μm,P<0.01)和绒毛高度(445±19与342±15μm,P<0.01)均显著高于假手术组(P<0.01),而对照组和假手术组间均无显著差异。与假手术组比较,胃转流术组肠粘膜中EGF和IGF-1的表达显著升高(P<0.01),而对照组和假手术组间无显著差异。结论:胃转流术后远端肠管粘膜发生适应性增生,同时伴随着EGF和IGF-1表达水平的升高。     

Iron Enhancement of Ascorbate Toxicity

Iron has been shown to enhance ascorbate-induced damage to both acetylcholine esterase and E. coli B in a manner analogous to previous studies with ascorbate and copper ions. It is suggested that the mechanism of damage entails interaction of iron with biological macromolecules, followed by its reduction by ascorbate. Subsequently, the iron (11) could participate in generating hydroxyl radicals from hydrogen peroxide via the Fenton reaction, which in turn, could damage biomolecules in a site-specific and multiple hit fashion. The high abundance of iron in biological systems, especially in certain storage disorders, may indicate an important toxicological role of the combination of iron and ascorbate.     

Iron stores at birth in a full-term normal birth weight birth cohort with a low level of inflammation

Iron stores at birth are essential to meet iron needs during the first 4–6 months of life. The present study aimed to investigate iron stores in normal birth weight, healthy, term neonates. Umbilical cord blood samples were collected from apparently normal singleton vaginal deliveries (n=854). Subjects were screened and excluded if C-reactive protein (CRP) > 5 mg/l or α1-acid glycoprotein (AGP) > 1 g/l, preterm (<37 complete weeks), term < 2500g or term > 4000g. In total, 762 samples were included in the study. Serum ferritin, soluble transferrin receptor (sTfR), hepcidin, and erythropoietin (EPO) were measured in umbilical cord blood samples; total body iron (TBI) (mg/kg) was calculated using sTfR and ferritin concentrations. A total of 19.8% newborns were iron deficient (ferritin 35 μg/l) and an additional 46.6% had insufficient iron stores (ferritin < 76 μg/l). There was a positive association between serum ferritin and sTfR, hepcidin, and EPO. Gestational age was positively associated with ferritin, sTfR, EPO, and hepcidin. In conclusion, we demonstrate a high prevalence of insufficient iron stores in a Chinese birth cohort. The value of cord sTfR and TBI in the assessment of iron status in the newborn is questionable, and reference ranges need to be established.     

损伤控制手术对严重胸腹联合伤患者胃肠功能及血清炎症因子水平的影响

目的:探讨损伤控制手术治疗严重胸腹联合伤患者的临床观察及对患者胃肠功能的影响。方法:选择2014年9月至2016年9月我院接诊的96例严重胸腹联合伤患者,通过随机数表法分为观察组(n=48)和对照组(n=48)。对照组行确定性手术,观察组行损伤控制性手术。观察并比较两组患者手术时间、术中出血量、血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及C反应蛋白(CRP)水平、排便时间、排气时间、肠鸣音恢复时间、进食时间及术后并发症的发生情况。结果:观察组手术时间短于对照组,术中出血量少于对照组(P0.05);观察组患者血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)及C反应蛋白(CRP)水平均低于对照组(P0.05);观察组排便时间、排气时间、肠鸣音恢复时间及进食时间均早于对照组(P0.05);观察组术后并发症发生率低于对照组(P0.05);观察组死亡率低于对照组(P0.05)。结论:在严重胸腹联合伤患者中实施损伤控制手术效果显著,可促进术后胃肠功能的恢复,减少并发症,降低死亡率,值得应用推广。