ObjectiveTo study the changes of levels of α subunits of stimulatory (Gsα) and inhibitory guanine nucleotide binding protein (Giα) in newborn guinea pig (0 2 days old) myocardium undergoing global ischemic reperfusion, and influences on the changes by St.Thomas Ⅱ and cold blood cardioplegic solution.MethodsThirty newborn guinea pigs were randomly assigned to three groups. GroupⅠ ( n = 10): the newborn hearts suffered by hypothermic global ischemia; group Ⅱ( n =10): the newborn hearts arrested by St. Thomas Ⅱ , and group Ⅲ ( n = 10): the newborn hearts arrested by cold blood cardioplegic solution. Levels of Gsα and Giα were investigated with Western blot analysis.ResultsNo differences of levels of Gsα and Giα were found in three groups before ischemia ( P gt;0.05). The level of Gsα after ischemia was significantly decreased than before ischemia in groupⅠand group Ⅱ ( P lt; 0 01), whereas no pronounced changes in group Ⅲ ( P gt;0.05) were noted after ischemia. The level of Gsα in group Ⅲ was not significantly changed after reperfusion compared with before ischemia( P gt;0 05), and it was much higher than those in groupⅠand group Ⅱ ( P lt; 0 01). Level of Giα was found not markedly changed in group Ⅲ after reperfusion compared with that before ischemia, but was notable higher in groupⅠand group Ⅱ( P lt;0.01). ConclusionsSignificant decrease of level of Gsα, whereas marked increase of level of Giα are found in myocardium of newborn guinea pig undergoing hypothermic (20℃) ischemic reperfusion. No impact of St. Thomas Ⅱ on these changes is verified, but recovery to the level of Gsα and Giα before ischemia is achieved by cold blood cardioplegic solution after ischemia and reperfusion. Unbalance between Gsα and Giα is the one of the mechanisms of ischemic reperfusion injury for immature myocardium.
摘要:目的: 在风湿性心脏病患者瓣膜置换术中,评价罗库溴铵在麻醉诱导期间对患者心肌氧供和氧耗平衡的影响。 方法 :选择86例在中低温体循环下行瓣膜置换术的患者,采用随机双盲法分配成罗库溴铵组(n=42例)和维库溴铵组(n=41例)。给予咪唑安定(005～01 mg/kg)及芬太尼(10～15μg/kg)及等效剂量的罗库溴铵06 mg/kg或维库溴铵01 mg/kg(Org. Comp)进行麻醉诱导。监测麻醉诱导前至插管后10分钟(1次/1分)期间两组患者心肌氧供和氧耗的变化。 结果 :与基础值相比,罗库溴铵组患者在插管后5分钟期间心率增加了174%～135%,动脉收缩压增加了1694%～143%,平均动脉压增加了151%～132%。同期心率收缩压乘积增加了2267%～1396% (〖WTBX〗P lt;005)。心率和动脉血压在插管后1～7分钟期间明显高于同期的维库溴铵组患者(〖WTBX〗P lt;005)。 结论 :在ASA ⅢⅣ级、心功ⅡⅢ级风心病瓣膜病变患者进行瓣膜置换术中, 06 mg/kg罗库溴铵有潜在增加患者心肌耗氧量的作用。Abstract: Objective: To evaluate the effects of rocuronium on myocardial oxygen supplydemand in patients with rheumatic heart disease (RHD) during induction. Methods : 86 patients of either sex (ASA status ⅢⅣ; New York Heart Association classes ⅡⅢ) scheduled for valve replacement surgery were included in this randomized clinical trial (RCT). SwanGanz catheter was placed via right internal jugular vein before the induction of anaesthesia. Anaesthesia was induced with midazolam 00501mg.kg-1 and fentanyl 1015 μg·kg-1. The patients were randomized to receive either rocuronium 06 mg·kg-1 (group R, 〖WTBX〗n= 42) or vecuronium 01 mg·kg-1 (group V, 〖WTBX〗n= 41) to facilitate tracheal intubation when bispectral index (BIS) value dropped to 60 All data were recorded at the time before anaesthesia (Tb), loss of consciousness (Ts), administration of muscle relaxant (Tm), 1 min after administration of muscle relaxant (T1), when trainoffour stimulation (TOF) reached 0 (T2) and 1,2,3,4,5,7,10 min after tracheal intubation (T39).〖WTHZ〗Results : Heart rate (HR) increased by 174%135%, systemic arterial systolic pressure (SAP) increased by 1694%143%, mean arterial systolic pressure (MAP) increased by 151%132% and product of heart rate and arterial systolic pressure(RPP) increased 2267%1396% respectively during 5 minutes after intubation as compared with baseline in group R, which were significantly higher than those in group V during 5 minutes after intubation (〖WTBX〗P lt;005). Conclusion : An intubation dose of rocuronium should be used cautiously in patients with rheumatic heart disease (ASA status ⅢⅣ; NYHA classes IIⅢ).
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
摘要:目的:探讨基层医院开展急诊经皮冠状动脉支架植入术(PCI)治疗急性心肌梗死(AMI)的可行性、安全性。方法:回顾分析2002年11月~2009年4月我院41例AMI患者的急诊PCI资料。结果:41例AMI患者,急诊开通梗死相关动脉(IRA)39例(即时成功率95.1%),开通IRA者中术后死亡2例(死亡率4.9%),总成功率90.2％。结论:在有条件的基层医院开展急诊PCI安全有效。Abstract: Objective: To explore the feasibility and safety of primary percutaneous coronary intervention in patients with acute myocardial infarction in elementary hospital. Methods: The clinical data of 41 AMI patients who underwent emergent PCI from November 2002 to April 2009 were retrospectively analyzed. Results: Among the 41 AMI patients referred to PCI, infarctrelated arteries were recanalized in 39 cases. The immediate success rate was 95.1%. 2 cases of them died. The total success rate was 90.2%.Conclusion: Emergent PCI is safe and effective in the hospitals which could carry out PCI.
ObjectiveTo investigate the role of kinase insert domain containing receptor (KDR) positive cells in the formation of cardiospheric structure, myocardium and vessels.MethodsTwenty-four Wistar rats weighting 250 g were selected. Cardiosphere-derived cells were isolated by enzymatic digestion of rat hearts, and their immunological phenotypes were analyzed by using fluorescence-activated cell sorting (FACS). The cardiomyogenic and vasculogenic potential was diagnosed by immunohistochemistry.ResultsKDR positive cells grew exponentially and formed cell clusters. It also could generate myocardial precursor cells (cardiac troponin T positive). And these cells can develop spontaneous contraction activity in vitro. Meanwhile, KDR positive cells formed many vessel-like structures through a budding process.ConclusionKDR positive cells form cardiospheric structure in vitro culture, and exhibit differentiation potential towards the cardiac and vascular cells. Therefore, KDR positive cells may have a broad prospect of clinical application as cell donors.
Objective To investigate the protective effects of metallothionein （MT） for immature myocardium and myocardial interstitium.Methods Twenty-four rabbits （aged 14-21 days） were divided into 4 groups with random number table, 6 each group. Distilled water was injected intraperitoneally in control group and 3.6% ZnSO4 （1.5 ml/kg） was injected intraperitoneally in group 1, group 2 and group 3. Control group, group 1, group 2 and group 3 isolated working rabbit heart model were used in 24h, 12h, 24h and 48h after intraperitoneally respectively. The MT content, recovery of hemodynamics, biochemistry and myocardial ultrastructure were tested. Results The MT content, hemodynamics recovery, adenosine triphosphate （ATP） content, superoxide dismutase activity, Ca2＋-ATPase activity, synthesizing ATP activity of mitochondria, hydroxyproline in group 2 and group 3 were higher than those in control group and group 1 （P 〈 0. 01）. The myocardial watery content, creatine kinase and dehydrogenase leakage, malondialdehyde content, endothelin, mitochondrial Ca2＋ content in group 2 and group 3 were lower than those in control group and group 1（P〈0.01）. The myocardial ultrastructure injuries were less in group 2 and group 3 than that in control group and group l. Conclusion This study demonstrates that myocardial MT prolonged expression can be induced by ZnSO4 and the ischemia-reperfusion injury of immature myocardium and myocardial interstitium could be reduced by MT.
Objective To summarize the experiences of donor heart procurement of heart transplantation so as to improve the efficiency of donor heart protection. [WTHZ]Methods [WTBZ]From April 2002 to October 2006, sixtyone patients with endstage heart disease had undergone orthotopic heart transplantation. Donors were all male brain deaths, aged from 21 to 53, and 5 of them were older than 40. There were 6 cases in which the weight difference between donor and recipient＞20%, and the rest ≤±20%. Fortyfive cases had the same ABO blood type, and 16 had matching ABO blood type. Four donor hearts were procured under the condition of stable hemodynamics and enough oxygen after brain death(typeⅠ), fortyfour donor hearts were procured under the condition of brain death with acute hemorrhage and hypovolemia (typeⅡ), and 13 donor hearts were procured under the condition of brain death with cardiac arrest (typeⅢ). Twenty cases underwent standard transplantation procedure, one underwent total heart transplantation procedure and 40 underwent bicaval transplantation procedure. The donor heart cold ischemic period ranged from 52 to 347 min（92±31 min）, and 13 cases were more than 240 min. Results Two cases died of low cardiac output syndrome on 7th and 9th day after operation respectively, and their donor heart cold ischemic period were 327 and 293 min respectively. The rest of patients all recovered and discharged. One died of acute rejection on 18th month after operation because of rejecting immunosuppressive agents, and 1 died in traffic accident on 23rd month after transplantation. The rest 57 cases survived 6-59 months(mean 35 months), and had good life quality with NYHA cardiac function classification in 0-I grade. Conclusions Heart transplantation with donor aged over 40 may also have satisfactory results. Patients with endstage dilated cardiomyopathy can procure donor heartsfrom donors with heavy weight. Using different techniques to procure donor hearts may furthest reduce myocardial injury. Donor hearts which have been protected by myocardium protecting liquid for a long time should be used with caution.