Objective To observe the influence of hypotherrnic circulatory arrest （HCA） on the apoptotic processes of neurons in the hippocampus and the expression of the related genes Bcl-2 and Bax, and compare to the intermit...Objective To observe the influence of hypotherrnic circulatory arrest （HCA） on the apoptotic processes of neurons in the hippocampus and the expression of the related genes Bcl-2 and Bax, and compare to the intermittent antegrade cerebral perfusion. Methods Eighteen dogs were randomly divided into three groups： control group （6 animals, underwent normal temperature cardiopulmonary bypass, NCPB）, HCA group （6 animals, underwent HCA for 1 h）, and HCA ＋ IACP group （6 animals, underwent HCA for 1 h, combined with intermittent antegrade cerebral perfusion （IACP） every 15 min）. The hippocampus tissue was retrieved 2h after the CPB discontinued The expression of Bcl-2 and Bax were examined with immunohistochemistry method. The cytomorphologic changes of the hippocampus tissue were investigated with transmission electron microscopy （TEM）. Results The immunohistochemical staining showed that Bax protein levels were significantly higher in HCA group than in the other two groups （P〈0.01）, while Bcl-2 protein levels were significantly higher in HCA ＋ IACP group than that of the other two groups （P〈0.01）. Meanwhile, the TEM results showed that there was no apoptosis of neurons in control group, but neuronal apoptotic changes could be clearly observed in HCA group, and only a small amount of apoptotic neurons were seen in HCA ＋ IACP group. Conclusions HCA alone can induce neuronal apoptosis in the hippocampus. IACP during the HCA period has a protective effect on the cerebral tissue through suppressing apoptosis by decreasing Bax expression and increasing Bcl-2 expression.展开更多
Objective To investigate the changes in plasma concentrations of IL - 6 and IL - 10, pHi and the difference between tissue and arterial PCO2[P(t - a)CO2] during pulmonary surgery and the effects of thoracic epidural a...Objective To investigate the changes in plasma concentrations of IL - 6 and IL - 10, pHi and the difference between tissue and arterial PCO2[P(t - a)CO2] during pulmonary surgery and the effects of thoracic epidural anesthesia on cytokine production and gut mucosal perfusion. Methods Twenty ASA class Ⅰ - Ⅱ patients undergoing elective pulmonary surgery, were randomly assigned to be operated upon under general anesthesia (group GA, n = 10) or under general anesthesia combined with thoracic epidural anesthesia (group GEA, n = 10 ). Premedication in both groups consisted of pethidine 50 mg and scopolamine 0. 3 mg im 30 min prior to surgery and oral ranitidine 150 mg the night and 1 h before operation. Anesthesia was induced with fentanyl 2 pg · kg -1, droperidol 1 mg, propofol 1.5-2. 5 mg · kg-1 and succinylcholine 1-2 mg · kg-1 and mainatained with inhalation of 1 % - 2.5 % isoflurane and 50% N2O in oxygen and intermittent iv boluses of fentanyl and vecuronium. In GEA group epidural catheter was展开更多
目的观察深度低体温停循环技术对脑组织代谢及结构的影响。方法18只实验犬随机分为3组,深度低体温停循环(deep hypothem ic c ircu latory arrest,DHCA)组,深度低体温停循环结合逆行脑灌注(retrograde cerebralperfusion,RCP)组,深度低...目的观察深度低体温停循环技术对脑组织代谢及结构的影响。方法18只实验犬随机分为3组,深度低体温停循环(deep hypothem ic c ircu latory arrest,DHCA)组,深度低体温停循环结合逆行脑灌注(retrograde cerebralperfusion,RCP)组,深度低体温停循环结合顺行间断脑灌注(interm ittent antegrade cerebral perfusion,IACP)组,每组6只。3组动物体外循环开始后将鼻咽温降至18℃,随后停循环90m in;开放循环后逐步复温至鼻咽温到36℃,随后停机。3组动物在停循环前(T1),停循环后45 m in(T2)、90 m in(T3)及开放循环后15 m in(T4)和30 m in(T5)分别由股动脉和颈静脉插管留取血液标本进行pH值和乳酸测定。手术结束时取脑海马组织作透射电镜检查,观察脑组织及神经细胞超微结构的变化。结果3组动物在停循环前脑组织的pH值无显著差异;停循环后DHCA组和RCP组脑组织pH值比停循环前显著降低,而IACP组pH值无显著差异。3组动物在停循环前动脉血和颈静脉血的乳酸含量无显著差异;停循环后DHCA组和RCP组颈静脉乳酸含量比停循环前显著升高,也比IACP组显著升高;IACP组颈静脉乳酸含量仅在停循环90 m in(T3)时比停循环前有显著升高,恢复循环后很快降至停循环前水平。DHCA组及RCP组神经细胞及细胞核肿胀明显,而IACP组水肿不明显。结论单纯DHCA时间较长时,脑组织内产生大量乳酸,使脑组织呈酸性状态;RCP对脑组织有一定的保护作用,但易发生脑组织及神经细胞水肿;IACP的脑保护效果较为理想。展开更多
文摘Objective To observe the influence of hypotherrnic circulatory arrest （HCA） on the apoptotic processes of neurons in the hippocampus and the expression of the related genes Bcl-2 and Bax, and compare to the intermittent antegrade cerebral perfusion. Methods Eighteen dogs were randomly divided into three groups： control group （6 animals, underwent normal temperature cardiopulmonary bypass, NCPB）, HCA group （6 animals, underwent HCA for 1 h）, and HCA ＋ IACP group （6 animals, underwent HCA for 1 h, combined with intermittent antegrade cerebral perfusion （IACP） every 15 min）. The hippocampus tissue was retrieved 2h after the CPB discontinued The expression of Bcl-2 and Bax were examined with immunohistochemistry method. The cytomorphologic changes of the hippocampus tissue were investigated with transmission electron microscopy （TEM）. Results The immunohistochemical staining showed that Bax protein levels were significantly higher in HCA group than in the other two groups （P〈0.01）, while Bcl-2 protein levels were significantly higher in HCA ＋ IACP group than that of the other two groups （P〈0.01）. Meanwhile, the TEM results showed that there was no apoptosis of neurons in control group, but neuronal apoptotic changes could be clearly observed in HCA group, and only a small amount of apoptotic neurons were seen in HCA ＋ IACP group. Conclusions HCA alone can induce neuronal apoptosis in the hippocampus. IACP during the HCA period has a protective effect on the cerebral tissue through suppressing apoptosis by decreasing Bax expression and increasing Bcl-2 expression.
文摘Objective To investigate the changes in plasma concentrations of IL - 6 and IL - 10, pHi and the difference between tissue and arterial PCO2[P(t - a)CO2] during pulmonary surgery and the effects of thoracic epidural anesthesia on cytokine production and gut mucosal perfusion. Methods Twenty ASA class Ⅰ - Ⅱ patients undergoing elective pulmonary surgery, were randomly assigned to be operated upon under general anesthesia (group GA, n = 10) or under general anesthesia combined with thoracic epidural anesthesia (group GEA, n = 10 ). Premedication in both groups consisted of pethidine 50 mg and scopolamine 0. 3 mg im 30 min prior to surgery and oral ranitidine 150 mg the night and 1 h before operation. Anesthesia was induced with fentanyl 2 pg · kg -1, droperidol 1 mg, propofol 1.5-2. 5 mg · kg-1 and succinylcholine 1-2 mg · kg-1 and mainatained with inhalation of 1 % - 2.5 % isoflurane and 50% N2O in oxygen and intermittent iv boluses of fentanyl and vecuronium. In GEA group epidural catheter was
文摘目的观察深度低体温停循环技术对脑组织代谢及结构的影响。方法18只实验犬随机分为3组,深度低体温停循环(deep hypothem ic c ircu latory arrest,DHCA)组,深度低体温停循环结合逆行脑灌注(retrograde cerebralperfusion,RCP)组,深度低体温停循环结合顺行间断脑灌注(interm ittent antegrade cerebral perfusion,IACP)组,每组6只。3组动物体外循环开始后将鼻咽温降至18℃,随后停循环90m in;开放循环后逐步复温至鼻咽温到36℃,随后停机。3组动物在停循环前(T1),停循环后45 m in(T2)、90 m in(T3)及开放循环后15 m in(T4)和30 m in(T5)分别由股动脉和颈静脉插管留取血液标本进行pH值和乳酸测定。手术结束时取脑海马组织作透射电镜检查,观察脑组织及神经细胞超微结构的变化。结果3组动物在停循环前脑组织的pH值无显著差异;停循环后DHCA组和RCP组脑组织pH值比停循环前显著降低,而IACP组pH值无显著差异。3组动物在停循环前动脉血和颈静脉血的乳酸含量无显著差异;停循环后DHCA组和RCP组颈静脉乳酸含量比停循环前显著升高,也比IACP组显著升高;IACP组颈静脉乳酸含量仅在停循环90 m in(T3)时比停循环前有显著升高,恢复循环后很快降至停循环前水平。DHCA组及RCP组神经细胞及细胞核肿胀明显,而IACP组水肿不明显。结论单纯DHCA时间较长时,脑组织内产生大量乳酸,使脑组织呈酸性状态;RCP对脑组织有一定的保护作用,但易发生脑组织及神经细胞水肿;IACP的脑保护效果较为理想。
文摘目的:探讨肺动脉灌注4℃含氧冷血和间断肺通气对体外循环(cardiopulmonary bypass,CPB)肺损伤的保护作用。方法:将30例符合条件的心脏手术患者采用随机数字表法分为两组:肺保护组(n=15):CPB期间经肺动脉间断灌注4℃含氧冷血,并在灌注期间给予间断肺通气;对照组(n=15):常规行心脏手术。记录呼吸机支持时间;分别在CPB前和CPB结束及结束后1、6 h测算氧合指数(OI)、呼吸指数(RI)、肺气道阻力(Raw)和肺静态顺应性(Cstat)。结果:术后肺保护组呼吸机支持时间明显短于对照组(P<0.05),肺保护组CPB结束后1、6 h OI、Cstat均显著高于对照组(P<0.05或P<0.01),而RI、Raw均显著低于对照组(P<0.05和P<0.01)。结论:肺动脉含氧冷血间断灌注及间断肺通气对CPB肺损伤有良好的保护作用。
