Abnormal ACT in a Patient with Prekallikrein Deficiency Undergoing Cardiopulmonary Bypass

Prekallikrein deficiency is a disorder that often remains undiagnosed. Prekallikrein activates factor XII, which initiates the intrinsic coagulation pathway. Prekallikrein deficiency results in prolonged Partial Thromboplastin Time and Activated Clotting Time in absence of anticoagulants or active bleeding. This case report describes the anesthesia management of a patient with Prekallikrein deficiency who underwent cardiac surgery with Cardiopulmonary Bypass for correction of a congenital cardiac malformation. We highlight the importance of understanding the different tests available for the diagnosis of coagulation factors deficiency during administration of heparin in the setting of cardiovascular procedures under general anesthesia.

老年CPB下心脏手术患者的rSO_(2)监测及其与术后早期POCD的相关性

目的监测老年心肺转流术(CPB)下心脏手术患者的局部脑氧饱和度(rSO_(2))的变化,并分析其与术后认知功能障碍(POCD)发生的相关性。方法回顾性分析2022年9月至2023年12月于河南省胸科医院接受CPB下心脏手术的100例老年患者的临床资料,根据患者术后7 d内是否发生POCD分为POCD组39例和非POCD组61例。比较两组患者吸氧前rSO_(2)、CPB前期rSO_(2)平均值(rSO_(2mean))、CPB中期rSO_(2mean)、CPB后期rSO_(2mean)、术中最低rSO_(2),并采用Pearson法分析rSO_(2)与术后早期POCD发生的相关性。结果两组患者吸氧前的rSO_(2)、CPB前期rSO_(2mean)比较差异均无统计学意义(P>0.05);POCD组患者CPB中期rSO_(2mean)、CPB后期rSO_(2mean)、术中最低rSO_(2)分别为(64.00±5.37)%、(67.19±5.25)%、(60.07±5.99)%,明显低于非POCD组的(70.44±6.75)%、(72.38±5.70)%、(69.48±6.17)%,差异均有统计学意义(P<0.05);Pearson相关性分析结果显示,CPB中期rSO_(2mean)、CPB后期rSO_(2mean)、术中最低rSO_(2)与术后早期POCD均呈负相关(r=-0.453、-0.420、-0.605,P<0.05)。结论老年CPB下心脏手术患者术中rSO_(2)可出现降低,且CPB中期rSO_(2mean)、CPB后期rSO_(2mean)、术中最低rSO_(2)与术后早期POCD的发生均具有相关性,应受到临床关注。

Anesthesia with ciprofol in cardiac surgery with cardiopulmonary bypass:A case report

BACKGROUND Ciprofol is a novel agent for intravenous general anesthesia.In February 2022,it was approved by the National Medical Products Administration for general anesthesia induction and maintenance.It has the advantages of fast onset,fast elimination,stable circulation,and few adverse reactions.However,the efficacy and safety of ciprofol in cardiac surgery with cardiopulmonary bypass have not been reported.Here we describe a case where ciprofol was successfully used for anesthesia in cardiac surgery with cardiopulmonary bypass.CASE SUMMARY A 72-year-old man(height 176 cm;weight 70 kg)was diagnosed with coronary atherosclerotic cardiomyopathy requiring coronary artery bypass grafting and left ventricular aneurysmectomy.Ciprofol was administered for induction(0.4 mg/kg)and maintenance(0.6-1.0 mg/kg/h)of general anesthesia.During the entire operation,the bispectral index,hemodynamics,and blood oxygen saturation were maintained at normal levels.The patient recovered well after surgery,with no serious adverse events related to ciprofol.CONCLUSION Ciprofol is safe and effective for anesthesia in cardiac surgery with cardiopulmonary bypass.

Using Pharmacokinetic Modeling and Electronic Health Record Data to Predict Clinical and Safety Outcomes after Methylprednisolone Exposure during Cardiopulmonary Bypass in Neonates

Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(CPB)frequently receive intraoperative methylprednisolone(MP)to suppress CPB-related inflammation;however,the optimal dosing strategy and efficacy of MP remain unclear.Methods:We retrospectively analyzed all infants under 90 days-old who received intra-operative MP for cardiac surgery with CPB from 2014–2017 at our institution.We combined real-world dosing data from the electronic health record(EHR)and two previously developed population pharmacokinetic/pharmacodynamic models to simulate peak concentration(Cmax)and area under the concentration-time curve for 24 h(AUC24)for MP and the inflammatory cytokines interleukin-6(IL-6)and interleukin-10(IL-10).We evaluated the relationships between post-operative,safety,and other clinical outcomes obtained from the EHR with each predicted exposure using non-parametric tests.Results:A total of 142 infants with median post-natal age 8(interquartile range[IQR]:5,37)days received a total dose of 30(19,49)mg/kg of MP.Twelve(8%)died,37(26%)met the composite post-operative outcome,114(80%)met the composite safety outcome,and 23(16%)had a major complication.Predicted median Cmax and AUC24 IL-6 exposure was significantly higher for infants meeting the composite post-operative outcome and those with major complications.Predicted median Cmax and AUC24 MP exposure was significantly higher for infants requiring insulin.No exposure was associated with death or other safety outcomes.Conclusions:Pro-inflammatory IL-6,but not MP exposure,was associated with post-operative organ dysfunction,suggesting current MP dosing may not adequately suppress IL-6 or increase IL-10 to impact clinical outcomes.Prospective study will be required to define the optimal exposure-efficacy and exposure-safety profiles in these infants.

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Purpose:This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury(AKI)in children undergoing congenital cardiac surgery.Methods:We conducted a prospective nested case-control study in children(age<18 years)undergoing congenital heart surgery with cardiopulmonary bypass(CPB)at the Fuwai Hospital between April 01,2022 and July 30,2022.Cases were individuals who developed AKI within the first postoperative 7 days(AKI group)and controls were those without AKI(Non-AKI group)according to KDIGO criteria.AKI and Non-AKI groups unmatched and 1:1 matched by age,sex,and baseline serum creatinine were separately analyzed.Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI.Results:688 consecutively approached patients were included in the final analysis.On multivariate analysis,intra-CPB(adjusted odds ratio[OR]0.802;95%confidence interval[CI],0.706 to 0.912;p=0.001)and post-CPB(adjusted OR 0.830;95%CI,0.744 to 0.925;p=0.001)blood glucose levels were associated with postoperative AKI.There were no significant differences in pre-CPB blood glucose(adjusted OR 0.926;95%CI,0.759 to 1.129;p=0.446)or intraoperative glycemic fluctuations(adjusted OR 0.905;95%CI,0.723 to 1.132;p=0.382)between AKI and Non-AKI groups.Results based on matched cases and controls were consistent with those from the unmatched analyses.Conclusion:Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

不同剂量右美托咪定对CPB心脏瓣膜置换术患者手术结局及心肌损伤情况的影响

目的分析行体外循环(CPB)心脏瓣膜置换术患者采用不同剂量右美托咪定对手术结局及心肌损伤情况的影响。方法选取我院2021年1月至12月收治的202例行CPB心脏瓣膜置换术患者作为研究对象,并以右美托咪定使用剂量将其分为0.2μg组(101例,0.2μg右美托咪定)和0.4μg组(101例,0.4μg右美托咪定)。比较两组的麻醉效果。结果两组患者的CPB时长、主动脉阻断时长和心脏自动复跳率比较,差异无统计学意义(P>0.05)。术前及术后,两组的脑利钠肽(BNP)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、可溶性生长刺激表达基因2蛋白(sST2)、心型脂肪酸结合蛋白(hFABP)水平比较,差异均无统计学意义(P>0.05)。两组患者的术中心动过缓、低血压、呼吸抑制和术后头晕发生率比较,差异无统计学意义(P>0.05);0.4μg组的术后恶心呕吐、认知障碍发生率显著高于0.2μg组(P<0.05)。结论对行CPB心脏瓣膜置换术患者采用0.2μg右美托咪定进行手术麻醉可取得更佳的手术预后保障。

右美托咪定对CPB心脏瓣膜置换术患者术后认知功能及脑氧代谢功能的影响

目的 探讨右美托咪定对心肺转流(cardiopulmonary bypass,CPB)心脏瓣膜置换术患者术后认知功能及脑氧代谢功能的影响。方法 选择2021年1月—2023年6月本院收治的CPB心脏瓣膜置换术患者72例作为研究对象,依据随机数表法分为对照组和观察组两组,每组各36例。对照组给予等速等量生理盐水,观察组患者给予右美托咪定。两组均术后观察7 d。比较两组平均动脉压(MAP)、心率(HR)、收缩压(SBP)、舒张压(DBP)、人高迁移率族蛋白1(HMGB-1)、心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)、肺泡动脉氧分压差(AaDO_(2))、氧合指数(OI)、静脉血氧饱和度(SjvO_(2))、动脉-静脉血氧含量差(Da-jvO_(2))、脑氧摄取率(CERO_(2))、简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-1β(IL-1β)、不良反应。结果 与术前比,术毕两组MAP、SBP、DBP、Da-jvO_(2)、CERO_(2)水平均降低,且观察组低于对照组;术毕两组HR、SjvO_(2)升高,且观察组高于对照组;术后24 h两组HMGB-1、H-FABP、cTnI、CK-MB、AaDO_(2)水平均升高,观察组均低于对照组(P<0.05);术后24 h两组OI水平均降低,观察组高于对照组(P<0.05);术后3~7 d两组MMSE、MoCA评分为先降低后升高的趋势,观察组均高于对照组(P<0.05);术后24 h两组TNF-α、IL-6、IL-1β水平均升高,观察组均低于对照组(P<0.05);术后观察组不良反应总发生率低于对照组(P<0.05)。结论 CPB心脏瓣膜置换术下,应用右美托咪定可以稳定患者机体血流动力学,减轻其心肌损伤,促进脑能量代谢及脑组织氧供需平衡,改善术后认知功能障碍,抑制血清炎性因子水平,且可降低不良反应发生风险。

The Topical Use of Aprotinin in Cardiac Surgery with Cardiopulmonary Bypass

Objective To investigate the effects of the topical use of aprotinin on thebasis of comprehensive blood conservations in cardiopulmonary bypass (CPB). Methods In a prospectiveclinical trial, 20 patients were randomly divided into 2 groups. Control group: placebo was usedtopically. Aprotinin group: aprotinin was poured into the pericardial cavity before closure of thesternotomy. Before and 24h after surgery, hemoglobin (Hb), hematocrit (Hct), bleeding time (BT),clotting time (CT) and prothrombin time (PT) were measured. Meanwhile, amounts of the mediastinaldrainage and the hemoglobin loss were observed at 0, 2, 6 and 24h after operation. The samples fromthe mediastinal drainage were also collected to measure D-Dimer (D-D), tissue type plasminogenactivator (t-PA) activity, plasminogen activator inhibitor (PAI) activity and protein C (PC).Results In Aprotinin group, D-D, t-PA activity and PC were significantly reduced, compared withthose in Control group (P<0.05, P<0.05, P<0.01). On the contrary, PAI activity was significantlyincreased, compared with that in Control group. Amounts of the mediastinal drainage and thehemoglobin loss were decreased by 43% and 52%, compared with those in Control group. Conclusion Ourresults suggest that the topical use of aprotinin can have better effects on the basis ofcomprehensive moderate blood conservation.

术前人文关怀联合规范手术室配合在老年心外科CPB中的应用效果

目的分析老年心外科体外循环(CPB)术前人文关怀联合规范手术室配合效果。方法收集2019年2月至2022年2月进行心脏CPB手术治疗患者87例,根据患者干预措施不同分为对照组39例(常规干预)与观察组48例(人文关怀联合规范手术室配合干预)。对比2组恢复情况(下床活动时间、拔管时间、进食时间、住院时间);比较2组临床指标(术前和术后收缩压、舒张压心率);对比2组干预前、后心理状况[采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行评估];对比依从性及满意度。结果观察组下床活动时间、拔管时间、住院时间均短于对照组(P<0.05),进食时间早于对照组(P<0.05)。干预前2组收缩压、舒张压、心率、SAS评分、SDS评分比较差异无统计学意义(P>0.05)。干预后,2组收缩压、舒张压、心率均明显低于干预前(P<0.05),观察组低于对照组(P<0.05);2组SAS、SDS评分均降低(P<0.05),观察组干预后SAS、SDS评分均低于对照组(P<0.05)。观察组依从性、满意度评分均高于对照组(P<0.05)。结论人文关怀联合规范手术室配合可促进患者康复,提高患者满意度及依从性。

Effects of penehyclidine hydrochloride on rat intestinal barrier function during cardiopulmonary bypass

AIM:To test the ability of penehyclidine hydrochloride (PHC) to attenuate intestinal injury in a rat cardiopulmonary bypass (CPB) model.METHODS:Male Sprague-Dawley rats were randomly divided into six groups (eight each):sham-operated control;sham-operated low-dose PHC control (0.6 mg/kg);sham-operated high-dose PHC control (2.0 mg/kg);CPB vehicle control;CPB low-dose PHC (0.6 mg/kg);and CPB high-dose PHC (2.0 mg/kg).Blood samples were collected from the femoral artery 2 h after CPB for determination of plasma diamine oxidase (DAO),D-lactate and endotoxin levels.Spleen,liver,mesenteric lymph nodes and lung were removed for biochemical analyses.Intestinal tissue ultrastructure was examined by electron microscopy.RESULTS:In the sham-operated groups,high-and low-dose-PHC had no significant impact on the levels of DAO,D-lactate and endotoxin,or the incidence of intestinal bacterial translocation (BT).Serum levels of DAO,D-lactate,endotoxin and the incidence of intestinal BT were significantly increased in the surgical groups,compared with the sham-operated groups (0.543 ± 0.061,5.697 ± 0.272,14.75 ± 2.46,and 0/40 vs 1.038 ± 0.252,9.377 ± 0.769,60.37 ± 5.63,and 30/40,respectively,all P < 0.05).PHC alleviated the biochemical and histopathological changes in a dosedependent manner.Serum levels of DAO,D-lactate,and endotoxin and the incidence of intestinal BT in the high-dose PHC group were significantly lower than in the low-dose PHC group (0.637 ± 0.064,6.972 ± 0.349,29.64 ± 5.49,and 14/40 vs 0.998 ± 0.062,7.835 ± 0.330,38.56 ± 4.28,and 6/40,respectively,all P < 0.05).CONCLUSION:PHC protects the structure and function of the intestinal mucosa from injury after CPB in rats.

Preventive Effect of Gastrodin on Cognitive Decline after Cardiac Surgery with Cardiopulmonary Bypass:A Double-Blind,Randomized Controlled Study

Cognitive decline is a common complication after cardiac surgery with cardiopulmonary bypass（CPB）,but as such no pharmacological therapy has been shown to be efficacious in preventing the decline.However,gastrodin has been shown to have multi-pharmacological effects on neurological functions.We undertook this study to test the hypothesis that gastrodin would potentially prevent CPB-associated neurocognitive decline.We randomly assigned 200 patients undergoing mitral valve replacement surgery to receive either gastrodin（40 mg/kg） or saline after the induction of anesthesia and subsequently evaluated cognitive function before surgery,at discharge,and at 3rd month after surgery by using a battery of five neurocognitive tests,or adverse effects of gastrodin postoperatively.Neurocognitive decline in postoperative function was defined as a drop of 1 SD or more in the scores on tests of any one of the four domains of cognitive function.Cognitive decline occurred in 9% of the patients in the gastrodin group in contrast to 42% in the control group（P〈0.01） at discharge.Cognitive outcome could be determined at 3rd month in 87 patients in the gastrodin group and 89 in the control group.Cognitive decline was detected in 6% in the gastrodin group and 31% in the control group（P〈0.01）.The incidences of possible adverse effects were similar between two groups.These results indicate that gastrodin is an effective and a safe drug for the prevention of neurocognitive decline in patients undergoing mitral valve replacement surgery with CPB.

Cardiopulmonary bypass induced microcirculatory injury of the small bowel in rats

AIM： To investigate microvascular injury quantitatively in the small bowel with respect to cardiopulmonary bypass （CPB） and related mechanisms. METHODS： In 10 male SD rats, normothermic CPB was established and continued with a flow rate of 100-150 mL/kg per minute for 60 min, while another 10 sham-operated animals served as controls. An approximate 10-cm loop of the terminal ileum was exteriorized for observation by means of intravital fluorescence microscopy. The small bowel microcirculatory network including arterioles, capillaries, and collecting venules was observed prior to CPB, CPB 30 min, CPB 60 min, post-CPB 60 min and post-CPB 120 rain. The intestinal capillary perfusion, microvascular permeability and leukocyte adherence were also measured. RESULTS： The systemic hemodynamics remained stable throughout the experiment in both groups. In CPB animals, significant arteriolar vasoconstriction, blood velocity reduction and functional capillary density diminution were found. As concomitances, exaggerated albumin extravasation and increased leukocyte accumulation were also noted. These changes were more pronounced and there were no signs of restitution at the end of the observation period. CONCLUSION： CPB induces significant microcirculatory injury of the small bowel in rats. The major underlying mechanisms are blood flow redistribution and generalized inflammatory response associated with CPB.

Effects of cardiopulmonary bypass on tight junction protein expressions in intestinal mucosa of rats

AIM： To investigate the tight junction protein expressions of intestinal mucosa in an experimental model of cardiopulmonary bypass （CPB） in rats. METHODS： Thirty anesthetized rats were randomly divided into two groups： Group S （n = 10） served as sham operation and group C （n = 20） served as CPB which underwent CPB for 1 h. Expression of occludin and zonula occludens-1 （ZO-1） were determined by Western blotting and immunotochemistry, respectively. Plasma levels of diamine oxidase （DAO） and d-lactate were determined using an enzymatic spectrophotometry. RESULTS： Immunohistochemical localization of occludin and ZO-1 showed disruption of the tight junctions in enterocytes lining villi at the end of CPB and 2 h after CPB. The intensities of the occludin and ZO-i at the end of CPB were lower than those of control group （76.4% ± 22.5% vs 96.5% ± 28.5% and 62.4% ± 10.1% vs 85.5% ±25.6%, P 〈 0.05） and were further lower at 2 h after CPB （50.5% ± 10.5% and 45.3% ± 9.5%, P 〈 0.05）. Plasma d-lactate and DAO levels increased significantly （8.688 ± 0.704 vs 5.745 ± 0.364 and 0.898 ± 0.062 vs 0.562 ± 0.035, P 〈 0.05） at the end of CPB compared with control group and were significantly higher at 2 h after CPB than those at the end of CPB （9.377 ± 0.769 and 1.038 ± 0.252, P 〈 0.05）. There were significant negative correlations between occludin or ZO-1 expression and DAO （r^2 = 0.5629,r^2 = 0.5424, P 〈 0.05） or d-lactate levels （r^2 = 0.6512,r^2 = 0.7073, P 〈 0.05） both at the end of CPB and 2 h after CPB. CONCLUSION： CPB markedly down-regulates the expression of occludin and ZO-1 proteins in intestinal mucosa of rats. The close correlation between expression of tight junctions （TJs） and plasma levels of DAO or d-lactate supports the hypothesis that intestinal permeability increases during and after CPB because of decreases in the expressions of TJs.

Lung injury after cardiopulmonary bypass:Alternative treatment prospects

Although the lung injury caused by cardiopulmonary bypass(CPB)has been extensively investigated,the incidence and mortality of lung injury after CPB remain a prominent clinical problem.The poor outcome has been attributed to multifactorial etiology,including the systemic inflammatory response and ischemia reperfusion(I/R)injury during CPB.Lung injury after CPB is a complex pathophysiological process and has many clinical manifestations of mild to severe disease.Which is associated with prognosis.To alleviate this lung injury,interventions that address the pathogenesis are particularly important.This review summarizes the pathogenesis,mechanism and treatment options of lung injury after CPB,such as lung protection with intralipid.

Urgent Tracheal Resection and Reconstruction Assisted by Temporary Cardiopulmonary Bypass:a Case Report

SEVERE tracheal stenosis can not only cause criti- cal medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on thephysicians, particularly the anesthesiologist. Life-threa- tening airway obstruction can make the patient＇s gas ex- change extremely difficult. Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis.1 Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists.

The Protective Effect of Propofol on Erythrocytes during Cardiopulmonary Bypass

To evaluate the relationship between erythrocyte injury and intracellular calcium ion overload, and the protective effect of propofol on erythrocytes during cardiopulmonary bypass (CPB), 40 children with congenital heart diseases who underwent surgical repair under CPB were studied. The patients were randomly divided into two groups: control group (group C) and propofol group (group P). Anesthesia was maintained in the patients in group P with 6 mg·kg -1 ·h -1 propofol, and those in the group C inhaled 1 %-2 % isoflurane. The blood samples were taken before CPB, at the 30th min of CPB, at the end of CPB, and 2 h and 24 h after CPB to measure the content of erythrocyte intracellular calcium ion (E Ca 2+ ), Ca 2+ Mg 2+ ATPase and Na + K + ATPase activities, index filtration of erythrocytes (IF), mean corpuscular volume (MCV) and the concentration of plasma free hemoglobin (F HB). Results showed that in the control group, E Ca 2+ , IF, MCV and F Hb were gradually increased and Ca 2+ Mg 2+ ATPase and Na + K + ATPase activities were decreased. The increase of E Ca 2+ was linearly paralleled to IF, MCV and F Hb. In propofol group, all the above mentioned parameters were significantly improved ( P <0.05). This study suggests that erythrocyte injury is related to elevation of intracellular calcium during CPB and propofol has a protective effect on erythrocyte injury.

Effects of Intraoperative Autologous Blood Donation and Tepid Temperature Cardiopulmonary Bypass on Blood System

The effects of the intraoperative autologous bind donation and tepid temperature cardiopulmonary bypass (CPB) on blood system were investigated. Twenty-four patients with rheumatic heart valve diseases scheduled for open heart surgery were selected and divided randomly into group A (intraoperative autologous blood donation and tepid temperature, nasopharyngeal temperature was at 32-34 ℃ during CPB) and group B (control, nasopharyngeal temperature was at 25-28 ℃ during CPB). The plasmatic concentrations of GMP-140 and D-Dimer and the plasmatic activities of 6- ketoPGF1α and AT- Ⅲ were measured by using ELISA or substrate luminescence techniques before operation, at the end of CPB, after discontinuation of CPB and postoperatively. Red blood cell count, platelet count, hematocrit, the amount of blood drainage and the amount of blood transfusion needed were measured or recorded postoperatively. The results showed the plasmatic concentrations of GMP140 and D-Dimer in group A were significantly less (P<0. 05) than those in group B during and after operation. The activity of 6-keto--PGF1α in group A was higher (P<0. 05) than that in group B during and after operation. The AT- Ⅲ activity in group A was less (P<0. 05) during CPB but higher 30 min after discontinuation of CPB than that in group B. The amount of postoperative blood loss (283± 166 versus 722± 194 ml, P<O. 01) and amount of blood transfusion (816±126 versus 1443± 678 ml, P<0. 01) in group A were significantly less than those in group B, respectively. The red blood cell count, platelet count and hematocrit in group A were significantly higher than those in group B after operation. The results suggests intraoperative autologous blood donation and tepid temperature have a good protection on blood system and can reduce postoperative non-surgical bleeding.

Effect of Xuebijing injection on myocardium during cardiopulmonary bypass:A prospective,randomized,double blind trial

BACKGROUND Cardiopulmonary bypass(CPB)is an essential procedure for maintaining the blood supply to vital organs in patients undergoing cardiac surgery.However,perioperative cardiac injury related to CPB remains a severe complication in these patients.Cardiac protection is important for patients undergoing CPB.AIM To evaluate the potential cardioprotective efficacy of the Chinese medicine preparation Xuebijing injection(XBJ)in patients undergoing CPB.METHODS Sixty patients undergoing cardiac surgery with CPB were randomly allocated to the XBJ and control groups(saline).XBJ was administered intravenously three times:12 h prior to surgery,at the beginning of the surgery,and 12 h after the second injection.Cardiac function was evaluated by echocardiography 48 h after surgery.Circulating inflammation-and oxidative-stress-related markers were measured.Clinical outcomes related to intensive care unit(ICU)stay were recorded.RESULTS Compared to control treatment,XBJ was associated with improved PaO2/FiO2 and cardiac systolic function,but reduced troponin I and creatine kinase fraction after surgery(all P<0.05).The circulating concentrations of tumor necrosis factor-α,interleukin(IL)-1βand IL-8 in the XBJ group were significantly lower than those in the control group(all P<0.05),whereas the circulating concentration of IL-10 was significantly higher in the XBJ group(P<0.05).In addition,the lengths of ICU stay and hospitalization after surgery tended to be shorter in the XBJ group than in the control group,although the differences were not significant.CONCLUSION Perioperative administration of XBJ was associated with attenuated cardiac injury during CPB,likely via anti-inflammatory and antioxidative mechanisms.

Protective Effect of Heparin-coated Circuits on the Platelets during Cardiopulmonary Bypass

To observe the protective effect of heparin coated circuits (HCC) on the platelet function during cardiopulmonary bypass (CPB). 23 patients with heart valve replacement were studied. The system heparin dose was 3 mg/kg in the control group ( n =15) and heparin coated circuits in the HCC group ( n =8). Platelet count, α granule membrane protein 140 (GMP 140) concentrations were determined before CPB, at 60 min of CPB, 30 and 60 min after protamine administration, first 12 h after CPB, respectively. At end of CPB the arterial filters in the circuits were observed by electron microscopy. The amount of first 12 h postoperative blood loss was measured. There was significant reduction in platelet loss during and after CPB in the HCC group in contrast to the control group during CPB ( P <0.05). During the first 12 h, postoperative blood loss was reduced in the HCC group as compared with that in the control group (218±61 ml, vs. 332±118 ml, P <0.05). Electron microscopy showed that in the HCC group the filter meshes and their fringes were clear and fragments of floccules were occasionally seen, without adherent cells or only few adherent cells on their surfaces, whereas several cellular and fibrous components were found to adhere to the surfaces of the filter meshes in the control group. This study indicates that heparin coated circuits might reduce the platelet loss and activation during CPB and improve hemocompatibility of cardiopulmonary bypass equipment.

Effect of Cardiopulmonary Bypass on Pulmonary Function in Infants

Objective To evaluate the effect of the cardiopulmonary bypass (CPB) on the pulmonary function in infants with or withoutpulmonary hypertension in congential ventricular septal defect (VSD). MethodsTwenty infants with VSD were enrolled in the study fromJan. to Dec.2004. They were divided into two groups: pulmonary hypertension group and non-pulmonary hypertension group, ten infantsrespectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following datawere recorded: duration for mechanical ventilation (Tmv) and staying in the cardiac intensive care unit (Tcicu) after cardiac surgery.Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hy-pertension group (P<0.01). By contraries, the pulmonary function parameters in every time stage after CPB statistically significant de-creased in non-pulmonary hypertension group (P<0.05), especially at 6, 9, and 15h after CPB (P<0.01). In pulmonary hyperten-sion group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical sig-nificance. But they had statistically significant decreased at9, 12, 15h after CPB (P<0.05). There was a similar change in pulmonaryfunction between two groups at 21, 24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgicalrepair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the neg-ative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonaryfunction. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemo-dynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.