可逆性肺动脉高压的治疗在心脏移植围术期的应用

目的：通过早期判断并治疗心脏移植围术期可逆性肺动脉高压,降低移植手术后右心功能衰竭的发生率。方法：20例接受心脏移植手术的病人,术前放置肺动脉导管,测定肺动脉压、肺循环阻力。对肺动脉高压的病人在肺动脉端泵入硝酸甘油、前列腺素E1以确定可逆性。并在术后早期抗排异治疗的基础上应用增强心肌收缩力、降低肺动脉压力、强化氧疗和呼吸管理等综合措施。结果：20例病人中6例出现急性右心功能衰竭,其中4例经治疗后症状改善、出院,2例死亡。结论：术前早期判断并治疗可逆性肺动脉高压,可以有效预防并减少心脏移植术后右心功能衰竭的发生,提高手术成功率。     

健康教育在子宫颈癌围手术期的应用

子宫颈癌是原发于子宫颈部的恶性肿瘤,居女性生殖器官恶性肿瘤的首位,多见于40～50岁的妇女。其发病因素目前尚不清楚,国内外大量临床资料和流行病学表明,早婚、早育、多产、宫颈慢性炎症及有性乱史者其发病率明显升高。临床表现为接触性出血、绝经后阴道流血、阴道排液。晚期癌组织坏死继发感染时,则出现大量脓性或米汤样恶臭白带,累及盆壁闭孔神经、腰骶神经时可出现持续性腰骶部或坐骨神经痛,单侧下肢疼痛、肿胀。     

人性化护理在普外科围术期患者中的应用效果观察

目的:探讨普外科患者围术期治疗中人性化护理的应用效果观察.方法:选择自2010年4月～2012年1月我院收治的普外科围术期的78例患者,按照患者的自愿原则,随机将患者分为观察组与对照组,每组39例.对照组采用常规的护理措施,观察组在常规护理的基础上采用人性化护理模式,对两组患者的心理状况改善情况、对护理满意程度及疼痛缓解情况等进行比较分析.结果:观察组患者对护理的满意度与对照组比较,具有统计学意义(P＜0.05),护理中患者心理状况的改善情况、对自身疾病相关知识的了解程度、疼痛的缓解情况均显著优于对照组患者(P＜0.05).结论:将人性化护理模式应用于普外科围术期患者中,可以提高患者对护理的满意度,增加患者对疾病相关知识的了解,缩短住院时间,减少患者的疼痛,是临床上行之有效的护理措施.     

他达那非治疗肺动脉高压进展

肺动脉高压是一类以小肺动脉血管重构为特征的恶性肺血管疾病,肺血管阻力进行性升高最终导致右心衰竭死亡。肺动脉高压的药物治疗主要针对前列环素、内皮素、一氧化氮三个靶点。他达那非(Tadalafil)是一种口服、长效、选择性5-型磷酸二酯酶抑制剂,增加环磷酸鸟苷(cGMP)浓度,通过一氧化氮途径起到治疗作用。PHIRST临床试验证实肺动脉高压患者每日一次口服他达那非40mg,能够提高6分钟步行距离,减少临床恶化。本文就他达那非治疗肺动脉高压研究新进展作一综述。     

聚焦治疗肺动脉高压的靶向药物

肺动脉高压(PAH)是一种以血管收缩和重构所致的肺血管阻力升高为病理生理学特征的临床综合征,其呈进行性发展,最终可 导致右心衰竭甚至死亡,预后差。随着对 PAH 病理生理学机制的深入研究,该病所涉不同信号通路的关键位点逐渐被认识,相应的靶向 药物也不断涌现,它们的应用明显改善了PAH患者的生活质量和预后。综述针对PAH 发生发展过程中所涉的3条主要通路:前列环素通路、 内皮素通路和一氧化氮-鸟苷酸环化酶-环磷酸鸟苷通路以及其他靶点(如酪氨酸激酶受体和 Rho 激酶等)而开发的靶向药物研究进展。     

肺动脉长轴切面在肺高压肺动脉内径测量中的价值

目的:探讨胸骨旁肺动脉长轴切面在肺动脉高压肺动脉内径测量中的诊断价值。方法:对61例肺动脉高压患者在大血管短轴切面、肺动脉长轴切面测量肺动脉主干内径,并分别与CT测量结果进行对照。结果:大血管短轴切面测得的肺动脉内径与CT测值有显著性差异,肺动脉长轴切面与CT测值相关性好。结论:肺动脉长轴切面测量肺动脉内径明显优于大血管短轴切面。     

Miles术病人围手术期健康教育

直肠癌是普外科常见病,Miles术适用于距肛门7cm以内的直肠癌,对实施Miles术的直肠癌病人进行围手术期健康教育,使病人自觉采取有利于健康的行为,能提高病人对手术的耐受力,保证手术顺利进行和有效地减少手术并发症。     

剖宫产术围术期预防性应用抗生素的成本效果分析

目的:探讨剖宫产术围术期预防性应用抗生素的成本效果,为剖宫产手术提供有效、经济的抗生素应用方案。方法:选取我院近3年接诊的80例实施剖宫产产妇纳入本次研究,将其随机分为研究组和对照组,每组产妇40例。研究组在胎儿娩出断脐后立即静脉滴注头孢呋辛,术后不再应用抗生素,而对照组术后静脉滴注头孢呋辛,对比两组产妇的成本效果。结果:两组产妇术后体温(平均体温、最高体温)、体温恢复时间、住院时间和术后感染发生率对比均无统计学差异(P0.05);研究组成本效果明显低于对照组(P0.05)。结论:剖宫产术围术期预防性应用抗生素可达到良好的抗感染效果,选择头孢呋辛作为剖宫产手术围术期预防性抗菌药物,是一种有效、经济的方案,可避免围术期过度使用抗生素。     

肺血管结构重建在低氧性肺动脉高压形成中的作用

８０年代后期提出低氧性肺动脉高压是一种以血管结构改变为主的疾病。本文介绍了低氧诱导肺血管壁细胞及细胞外基质的变化特征及其发生机理。     

内源性硫化氢在脂多糖引起的肺动脉高压中的作用

为观察硫化氢(hydrogen sulfide,H2s)在脂多糖(1ipopolysaccharide,LPS)引起的肺动脉高压中的作用,应用离体血管环张力测定方法测定肺动脉反应性,采用生物化学方法测定肺动脉组织中H2S产出率和胱硫醚-γ-裂解酶(cystathionine γ-lyase,CSE)活性,定量PCR方法测定肺动脉组织中CSE表达水平.结果如下:(1)与对照组相比,LPS可显著升高肺动脉平均压(mean pulmonary arterial pressure,mPAP)[(1.82±0.29)kPa vs(1.43±0.26)kPa,P<0.01],降低肺动脉组织中H2S产出率[(26.33±7.84)vs(42.92±8.73)pmoFg wet tissue per minute,P<0.01]和ACh诱导的肺动脉内皮依赖性舒张反应[(75.72±7.22)%vs(86.40±4.40)%,P<0.01];(2)NariS可部分逆转上述变化,而PPG加剧上述变化;(3)CSE活性和CSE mRNA表达的变化与H2S产出率的变化相同.结果提示,LPS对内皮依赖性舒张反应的抑制导致肺动脉高压的发生,此作用可能与H2S有关.     

Recapitulation of Developing Artery Muscularization in Pulmonary Hypertension

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Increasing Pulmonary Artery Pulsatile Flow Improves Hypoxic Pulmonary Hypertension in Piglets

Pulmonary arterial hypertension (PAH) is a disease affecting distal pulmonary arteries (PA). These arteries are deformed, leading to right ventricular failure. Current treatments are limited. Physiologically, pulsatile blood flow is detrimental to the vasculature. In response to sustained pulsatile stress, vessels release nitric oxide (NO) to induce vasodilation for self-protection. Based on this observation, this study developed a protocol to assess whether an artificial pulmonary pulsatile blood flow could induce an NO-dependent decrease in pulmonary artery pressure. One group of piglets was exposed to chronic hypoxia for 3 weeks and compared to a control group of piglets. Once a week, the piglets underwent echocardiography to assess PAH severity. At the end of hypoxia exposure, the piglets were subjected to a pulsatile protocol using a pulsatile catheter. After being anesthetized and prepared for surgery, the jugular vein of the piglet was isolated and the catheter was introduced through the right atrium, the right ventricle and the pulmonary artery, under radioscopic control. Pulmonary artery pressure (PAP) was measured before (T0), immediately after (T1) and 30 min after (T2) the pulsatile protocol. It was demonstrated that this pulsatile protocol is a safe and efficient method of inducing a significant reduction in mean PAP via an NO-dependent mechanism. These data open up new avenues for the clinical management of PAH.     

Up-Regulated Lipocalin-2 in Pulmonary Hypertension Involving in Pulmonary Artery SMC Resistance to Apoptosis

A key feature of pulmonary hypertension (PH) is the remodeling of small pulmonary arteries due to abnormal pulmonary artery smooth muscle cell (PASMC) proliferation and resistance to apoptosis. However, the cellular mechanisms underlying how PASMCs in the pathological condition of pulmonary hypertension become resistant to apoptosis remain unknown. It was recently reported that lipocalin 2 (Lcn2) is up-regulated in a wide array of malignant conditions, which facilitates tumorigenesis partly by inhibiting cell apoptosis. In this study, we observed that the expression levels of Lcn2 were significantly elevated in a rat PH model induced with monocrotaline and in patients with congenital heart disease-associated PH (CHD-PH) when compared with respective control. Therefore, we hypothesize that Lcn2 could regulate human PASMC (HPASMC) apoptosis through a mechanism. By the detection of DNA fragmentation using the TUNEL assay, the detection of Annexin V/PI-positive cells using flow cytometry, and the detection of cleaved caspase-3 and caspase-3 activity, we observed that Lcn2 significantly inhibited HPASMC apoptosis induced by serum withdrawal and H₂O₂ treatment. We also observed that Lcn2 down-regulated the proapoptotic protein Bax, decreased the levels of cellular ROS, and up-regulated the expression of superoxide dismutases (SOD1 and SOD2). In conclusion, Lcn2 significantly inhibits HPASMC apoptosis induced by oxidative stress via decreased intracellular ROS and elevated SODs. Up-regulation of Lcn2 in a rat PH model and CHD-PH patients may be involved in the pathological process of PH.     

Investigating Perioperative Heart Migration During Robot-Assisted Coronary Artery Bypass Grafting Interventions

OBJECTIVE:: For robot-assisted coronary artery bypass graft interventions, surgeons typically use a preoperative thoracic computed tomography scan of the patient to plan the procedure. However, the cardiac anatomy is prone to changes induced perioperatively in the effort to access the heart and surgical targets, which, in turn, may invalidate the initial plan. This article presents a method to estimate the perioperative heart migration, information which can be further exploited to refine the preoperative surgical plan. METHODS:: Tracked transesophageal ultrasound images of four patients' hearts were acquired at each stage in the procedure: before lung deflation, after lung deflation, and after both lung deflation and CO2 thoracic insufflation. Anatomic features of interest-the mitral and aortic valves-were identified from each dataset, and their movement between the different procedure stages was recorded and used to estimate the global heart displacement. Moreover, the local morphology of the features of interest was investigated to provide insight on the extent of the deformation the heart has undergone during the workflow. RESULTS:: The study suggested that the heart does undergo substantial displacement-on the order of 10 to 15 mm in each direction (axial, coronal, and sagittal) after lung deflation and CO2 thoracic insufflation. However, no significant differences (P > 0.1) were observed in the morphologic characteristics of the features of interest across the multiple workflow stages, suggesting that local deformations occur at a much smaller scale compared with the global migration. CONCLUSIONS:: The quantification of the perioperatively induced changes is critical to track the displacement of the heart and surgical targets. The recorded migration patterns should not be ignored but rather be used to update the surgical plan to better suit the intraoperative environment.     

右心导管法测大鼠肺动脉压力的改良

目的:目前常用的测量大鼠肺动脉压力的右心导管法存在一定的缺陷,且很难得到典型的压力曲线图。本实验对大鼠经颈外静脉插管与测压的方法进行改良,同时与已有报道的实验结果进行比较,并提供正常SD大鼠右心房、右心室及肺动脉的压力参考值及典型的压力曲线图,以协助研究人员判断导管位置,及时调整导管的深度和方向,快速测出肺动脉压力。方法:雌雄不分的清洁级SD大鼠共30只,体重180~230 g,6~7周龄。应用自制的末端呈一弧形的PE-10管,采用改良后的右心导管法,经颈外静脉插入大鼠心腔及肺动脉,检测并计算大鼠右心房、右心室和肺动脉的收缩压、舒张压及肺动脉平均压。结果:右心房压力波动较平缓,呈小波浪形;右心室压力曲线波动大,骤升骤降;肺动脉压力曲线有重搏波。正常SD大鼠右心房舒张压为(2.03±2.56)mmHg,收缩压为(2.82±1.85)mmHg;右心室舒张压为(5.72±3.99)mmHg,收缩压为(18.73±4.80)mmHg;肺动脉舒张压为(15.27±2.64)mmHg,收缩压为(18.49±2.53)mmHg,肺动脉平均压为(16.34±2.32)mmHg。右心室收缩压与肺动脉收缩压无明显差异(P0.05)。结论:改良后的方法可准确到达大鼠肺动脉,提供的压力参考值及曲线图有助于研究人员顺利完成测压实验。     

曲美他嗪对肺动脉栓塞所致右心衰竭的保护作用

目的：评价曲美他嗪（TrimetazidineTMZ）对肺动脉栓塞所致右心衰竭的保护作用,及其对MMP-2,MMP-9和TIMP-1mRNA在右心室中表达的影响。方法：雄性wistar大鼠随机分为三组：右心衰竭组（RHF）左侧股静脉注射1％玻球微粒3mV100g;等量生理盐水注射为对照组（CON）;曲美他嗪治疗组（TMZ）为肺动脉栓塞后给TMZl0mg／kg／天。6周后各组大鼠首先进行经胸超声评价右心功能后取材进行病理学检测,以及RT—PCR检测右心室MMP-2,MMP-9,TIMP-1mRNA表达水平。结果：RHF组大鼠超声检测发现右心室内径扩大并伴有三尖瓣反流,三尖瓣环收缩期峰值位移下降（TAPSE）;Masson染色显示右心室纤维化增加;RTPCR结果显示MMP-2,MMP-9和TIMP-1mRNA表达水平明显升高;经TMZ治疗组大鼠右心室内径减小,TAPSE增加,而MMP-2,MMP-9和TIMP-1mRNA表达水平下降。结论：曲美他嗪能够抑制右心室纤维化,改善右心功能,可能与调节MMP-2,MMP-9和TIMP-1表达水平有关。     

不停跳心内手术对先心病合并肺动脉高压患者的心肌保护

目的:探讨不停跳心内手术对先天性心脏病(CHD)合并不同程度的肺动脉高压(PH)患者心肌保护作用.方法:据平均肺动脉压/平均主动脉(Pp/Ps)比值,将73例CHD合并PH患者分成2组:轻、中度PH患者(0.300.75)为B组:2组再随机分为停跳组(A1组/B1组)和不停跳组(A2组/B2组).检测不同时点血清肌钙蛋白1(cTnI)、肌酸激酶-MB(CK-MB)含量;记录术后多巴胺用量、ICU时间、低心排血量综合症(LOCS)和心律失常发生率.结果:不停跳组cTnI、CK-MB含量显著低于停跳组(P<0.05);B2组多巴胺用量、ICU治疗时间、心律失常及LOCS发生率明显少于B1组(P<0.05).结论:不停跣心内手术对CHD合并PH惠者心功能具有较好的保护作用,尤其对重度PH患者的保护作用更明显.