抑肽酶在体外循环心脏直视手术中的肺保护作用研究

目的 :体外循环中 ,血液与异物表面直接接触 ,导致许多炎性介质和血管活性物质的形成及释放 ,形成的肺损伤是手术患者的一个重要而危险的并发症。本文总结了CPB中应用抑肽酶进行肺保护的研究和临床应用。方法 :2 0 0 1年 1月至 11月 ,在本院施行二尖瓣置换手术的患者随机分为研究组和对照组 ,手术中应用抑肽酶的患者作为研究组 ,未用抑肽酶的患者作为对照组。记录两组患者术前、麻醉诱导时、体外循环结束时的气道压力 (Paw)、肺泡———动脉血氧分压差 [(A a)DO2 ]、两组患者回病房后的机械通气时间。结果 :两组患者的术前、前中情况均无显著性差异。而研究组患者体外循环结束时的气道压力和肺泡 动脉血氧分压差的升高幅度明显小于对照组患者 (P <0 0 5 ) ,预示着研究组患者的肺功能在体外循环过程中受到的损伤程度显著小于对照组患者。研究组患者的机械通气时间比对照组患者显著减少 (P <0 0 5 ) ,说明研究组患者术后肺功能比对照组患者恢复得快。结论 :在体外循环心内直视手术中应用抑肽酶 ,充分发挥其血液麻醉作用 ,可有效减轻肺损伤 ,促进术后恢复 ,取得良好的肺保护效果 ,而且简便易行、安全实用 ,对医患双方都有着积极意义     

大鼠体外循环模型的建立及改进

目的对现有大鼠体外循环模型予以改进,降低模型复制难度,并使之更适合用于研究体外循环对肺功能的影响。方法成年雄性SD大鼠16只,体重300～350g,各8只分别用于建模和供血。经右颈静脉、左股静脉引流,右股动脉人工灌注建立体外循环,血气分析监测内环境变化。实验过程中,保留大鼠自主呼吸,不进行机械通气。结果成功建成8只大鼠体外循环模型并按计划顺利脱离人工循环。体外循环期间转流量为70～80mL/（kg·min）,血流动力学监测和血气分析结果基本正常。结论进一步简化了建立大鼠体外循环模型的操作,最显著的改进之处在于避免了机械通气对大鼠肺功能潜在的不良效应,从而更加适合用于研究体外循环对肺功能的影响。     

Role of root hydrophobic barriers in salt exclusion of a mangrove plant Avicennia officinalis

Salt exclusion at the roots and salt secretion in the leaves were examined in a mangrove, Avicennia officinalis. The non‐secretor mangrove Bruguiera cylindrica was used for comparative study of hydrophobic barrier formation in the roots. Bypass flow was reduced when seedlings were previously treated with high salt concentration. A biseriate exodermis was detected in the salt‐treated roots, along with an enhanced deposition of hydrophobic barriers in the endodermis. These barriers reduced Na⁺ loading into the xylem, accounting for a 90–95% salt exclusion in A. officinalis. Prominent barriers were found in the roots of B. cylindrica even in the absence of salt treatment. A cytochrome P450 gene that may regulate suberin biosynthesis was up‐regulated within hours of salt treatment in A. officinalis roots and leaves, corresponding with increased suberin deposition. X‐ray microanalysis showed preferential deposition of Na⁺ and Cl^? in the root cortex compared with the stele, suggesting that the endodermis is the primary site of salt exclusion. Enhanced salt secretion and increased suberin deposition surrounding the salt glands were seen in the leaves with salt treatment. Overall, these data show that the deposition of apoplastic barriers increases resistance to bypass flow leading to efficient salt exclusion at the roots in mangroves.     

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。     

斑点追踪技术评价冠状动脉搭桥术后心肌功能的临床价值研究

目的:探讨超声斑点追踪成像技术定量评价冠状动脉搭桥术前、后心肌功能的临床价值。方法:选择2012年1月~2013年1月在我院心脏外科行体外循环下冠状动脉旁路移植术的患者,对冠状动脉搭桥术术前1周、术后1月、3月、6月进行常规超声心动图检查,然后应用斑点追踪技术进行分析。结果:所有患者的纵向应变值仅在术后3个月和6个月显著增加,与术前、术后1个月比较差别有统计学意义(P0.01)。圆周应变值在术后1个月、3个月和6个月均显著增高,与术前比较差别有统计学意义(P0.05)。老年组术后6个月的纵向应变值和圆周应变值与术后3个月比较差别有统计学意义(P0.05)。手术前、后常规超声心动图检查结果比较差别无统计学意义(P0.05)。结论:超声斑点追踪技术用于评估CABG术后缺血心肌的功能变化的敏感性高于常规超声心动图检查,为临床评价CABG的疗效提供了一种新方法。     

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated.     

Changes in anti-heat shock protein 27 antibody and C-reactive protein levels following cardiac surgery and their association with cardiac function in patients with cardiovascular disease

The relationship between serum anti-heat shock protein (Hsp)27 antibody and high sensitive C-reactive protein (hs-CRP) levels and indices of cardiac function were investigated in patients undergoing coronary artery bypass grafting (CABG) or heart valve replacement. The changes in anti-Hsp27 antibody titers and hs-CRP levels were compared among patients undergoing off-pump and on-pump CABG or valvular heart replacement. Fifty-three patients underwent off-pump, on-pump CABG, and heart valvular replacement in each group. Serum anti-Hsp27 titers and hs-CRP values were measured 24 h before and after the operation and at discharge. Echocardiography was performed before surgery and before discharge. The results were compared with values from 83 healthy controls. hs-CRP levels increased and anti-Hsp27 antibody decreased following surgery (P < 0.001 and P < 0.05, respectively), although these changes were independent of operative procedure (P = 0.361 and P = 0.120, respectively). Anti-Hsp27 antibody levels were higher at the time of discharge (P = 0.016). Only in coronary patients were anti-Hsp27 antibody levels negatively associated with E/E′ (r = −0.268, P = 0.022), a marker of pulmonary capillary wedge pressure. In conclusions, anti-Hsp27 antibody levels are associated with indices of cardiac function in coronary patients. Cardiopulmonary bypass had no significant effect on the induction of changes in anti-Hsp27 levels. Moreover, anti-Hsp27 antibody levels fell in all groups postoperatively; this may be due to the formation of immune complexes of antigen–antibody, and antibody levels were higher at the time of discharge.

Electronic supplementary material

The online version of this article (doi:10.1007/s12192-012-0358-y) contains supplementary material, which is available to authorized users.     

Directing vanillin production from ferulic acid by increased acetyl-CoA consumption in recombinant Escherichia coli

The amplification of gltA gene encoding citrate synthase of TCA cycle was required for the efficient conversion of acetyl-CoA, generated during vanillin production from ferulic acid, to CoA, which is essential for vanillin production. Vanillin of 1.98 g/L was produced from the E. coli DH5alpha (pTAHEF-gltA) with gltA amplification in 48 h of culture at 3.0 g/L of ferulic acid, which was about twofold higher than the vanillin production of 0.91 g/L obtained by the E. coli DH5alpha (pTAHEF) without gltA amplification. The icdA gene encoding isocitrate dehydrogenase of TCA cycle was deleted to make the vanillin producing E. coli utilize glyoxylate bypass which enables more efficient conversion of acetyl-CoA to CoA in comparison with TCA cycle. The production of vanillin by the icdA null mutant of E. coli BW25113 harboring pTAHEF was enhanced by 2.6 times. The gltA amplification of the glyoxylate bypass in the icdA null mutant remarkably increased the production rate of vanillin with a little increase in the amount of vanillin production. The real synergistic effect of gltA amplification and icdA deletion was observed with use of XAD-2 resin reducing the toxicity of vanillin produced during culture. Vanillin of 5.14 g/L was produced in 24 h of the culture with molar conversion yield of 86.6%, which is the highest so far in vanillin production from ferulic acid using recombinant E. coli.     

乌司他丁对非停跳冠脉搭桥术患者的心肺保护作用研究

目的:探讨乌司他丁对非停跳冠脉搭桥术患者的心肺保护作用。方法:选取2017年12月-2019年4月我院收治的非停跳冠脉搭桥术患者76例,根据使用的药物不同分为两组,对照组应用常规方法,研究组应用乌司他丁,在麻醉之后切皮之前为T1,旁路血管开放时时间点为T2,手术结束为T3,手术之后的8 h为T4。比较两组治疗前后的心肺功能指标、动脉血气分析及血浆炎症因子、氧合指数术后恢复。结果:和T1进行对比时,两组T3、T4中的气道阻力(Air way Resistance,Raw)、呼吸指数(Respiratory Index,RI)、肺泡-动脉血氧分压差P(A-a)DO2均有所升高,在T2、T4中(PVR)有所升高,在T2、T3、T4中肺顺应性(Compliance of Lung,CL)有所降低。和对照组进行对比时,研究组在T3、T4中肺循环阻力(pulmonary vascular resistance, PVR)、RI、P(A-a)DO2有所降低,在T2、T3、T4中通气死腔百分比(VD/VT)有所降低(P0.05),在T2中CL有所升高(P0.05);治疗前,两组BNP、TNF-α、IL-6、IL-8无统计学意义(P0.05),治疗后BNP、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素-6 (Interleukin-6,IL-6)、白细胞介素-8 (Interleukin-8,IL-8)在T1、T2、T3、T4中低于对照组(P0.05),肌钙蛋白(cardiac troponin,cTnI)在T1中和对照组没有明显差异(P0.05),T2、T3、T4中研究组明显低于对照组(P0.05),研究组氧合指数高于对照组(P0.05);研究组T1、T2、T3、T4时平均动脉压(mean artery pressure,MBP)均高于对照组(P0.05),T1、T2、T3、T4时心率均低于对照组(P0.05);研究组ICU停留时间、ICU带气管插管时间、ICU机械通气时间、肺部并发症均低于对照组(P0.05)。结论:乌司他丁用于非停跳冠脉搭桥术的效果较好,可以保护患者的心肺功能。     

长时间左心辅助循环成功经验探讨

目的：对长时间左心辅助循环成功经验进行探讨。方法：于2002年7月9日对一例冠状动脉搭桥术加二尖瓣置换术后出现严重低心排的患者施行左心辅助,共23小时40分,抢救成功。结论：左心辅助作为一种安全有效和可信的救治衰竭心脏的方法,其成功应用有以下4要素：应用时机和病人选择、装置的选择及其表现、操作左心辅助医生对左心辅助理论的理解和对临床情况的判断力、左心辅助并发症的防治。