间歇微温血心脏停搏液改善心肌保护

目的 研究微温血心脏停搏液的心肌保护效果。方法 前瞻性收集 15 33例体外循环病人的临床资料进行分析。微温血组 :5 82例病人于 1998年 7月至 2 0 0 0年 7月用间歇微温血心脏停搏液 (2 8℃ ) ;冷血组 :95 1例病人于 1994年 9月至 1997年 11月用冷血心脏停搏液 (4℃ )。用χ2 检验、两样本均数 t检验和多变量 L o-gistic回归分析对 2 7项病人相关变量和 18项预后相关变量进行分析。对高危和常规冠状动脉旁路移植的病人进行进一步的分析。结果 两组临床资料相似 ,但微温血组病人症状重、有更多的再次手术和复合手术、更多的手术在急性心肌梗死 7d以内。微温血组术后需要主动脉内球囊反搏率 (2 .2 % vs4 .4 % ,P=0 .0 2 4 )和房颤率 (2 0 .6 %vs2 5 .7% ,P=0 .0 2 6 )明显较冷血组少。死亡率、围术期心肌梗死、脑血管事件和血管活性药物应用两组无明显区别。

微温血停搏液连续灌注保护心肌的临床应用

报告１０９例体外循环心内直视手术中采用微温（２９℃）血停搏液连续灌注保护心肌的方法，包括７１例瓣膜置换和３８例法乐四联症手术。微温血停搏液经恒温水浴锅加温至２９℃，配制的微温血停搏液以三份氧合血加二份晶体停搏液混合，保持血球压积（ＨＣＴ）１５±％，钾浓度９ｍｍｏｌ／Ｌ，ｐＨ７．６０，术中采用首次冷晶体停搏液顺灌，然后用氧合血顺灌或逆灌的方法进行连续灌注。术中心肌红润松弛，主动脉开放后，除１例电除颤复律外，其余１０８例心脏立即自动复跳（９９．１％），复跳后心功能稳定，无须用升压药维持循环。术后无低心排或严重心律失常，心功能恢复顺利。作者认为，将晶体停跳液作首次灌注可使心脏迅速停跳，最大限度地保存心肌能量；而在心脏停跳后用２９℃微温血连续顺灌或逆灌，可维持心肌在停跳阶段的正常代谢。

持续微温血灌注与间断冷晶体灌注的临床对比观察

目的：对比持续微温血灌注与间断冷晶体灌注的心肌保护效果。方法：记录两组病人术中、术后的临床资料，进行统计学处理。结果：持续微温血灌注在复跳情况、辅助时间／阻断时间、正性肌力药物应用方面均优于间断冷晶体灌注组。结论：持续微温血灌注对心肌的保护作用较以往间断冷晶体灌注为佳。

不同心肌保护方法对心肌细胞膜流动性影响的临床对比研究

目的 应用心肌细胞膜流动性评价间断冷晶体灌注、持续微温血灌注及微温不停跳直视手术技术的心肌保护效果。方法 将我科 30例先心病患者 ,随机分成持续微温血灌注组 (CT组 )、微温心不停跳组 (OB组 )、间断冷晶体灌注组 (IC组 ) ,于开放升主动脉前取心肌标本 ,对照组 (C组 )取自前三组中随机 10例转流前心肌标本。测每组的心肌细胞膜流动性 ,将测得结果进行统计学方差分析。结果 冷晶体组细胞膜流动性明显低于其他三组 (P值均小于 0 .0 0 1) ;温血组与不停跳组无差别 (P >0 .0 5 ) ;温血组与对照组无差别 (P >0 .0 5 ) ;不停跳组低于对照组 (P <0 .0 5 )。结论 持续微温血灌注组的心肌细胞膜保护效果最为满意 ,微温不停跳组次之 ,二者均明显优于冷晶体技术。

三例原位心脏移植的疗效分析

自1992年4月以来我们成功地实施了3例原位。心脏移植。术中供。心保护采用经冠状静脉窦连续灌注含钾微温血。2例采用原位心脏移植的标准术式，1例采用全心脏原位移植术。采用连续血管内股外翻缝合。术后患者恢复佳，无并发症，心功能Ⅰ级，已分别有活5年、3年和1年半。我们认为微温血持续逆灌可使供心提前得到氧和血的供应，改善供心保护效果。正确的手术方法、早期发现急性排斥反应和正确的处理等是提高移植后近、远期疗效的重要因素。

Correlation of the Cerebral Microvascular Blood Flow with Brain Temperature and Electro-Acupuncture Stimulation

Objective:To investigate the relationship between the temperature and the microvascular blood flow of the cerebral cortex, and the influence of electro-acupuncture (EA) on the cortical microcirculation. Methods: High temperature spots on the anterior ectosylvian and low temperature spots on the posterior suprasylvian on the cortical surface of 20 cats were identified using cortical infrared thermography (CIT); the blood flow in the microcirculation on these spots was measured with laser-Doppler flowmetry. EA was given at Zusanli (ST 36) and changes in the blood flow in the cerebral cortex microcirculation were detected. Results: 1) The mean temperatures on the high (34.83±0.24°C) and low (32.28±0.27°C) temperature spots were significantly different (P<0.001); this was indicative of a temperature difference on the cortical surface; 2) The average blood flow in the microcirculation of the high (266.8±19.2 PU) and low (140.8±9.9 PU) temperature spots was significantly different (P<0.001). 3) On the cortical high temperature spots, the mean blood flow in the microcirculation significantly increased from 266.8±86.8 PU before EA, to 422.5±47.4 PU following 5 minutes of EA (58.35%; P<0.01), and 431.8±52.8 PU 5 minutes after ceasing EA (61.84%; P<0.01). 4) On the low temperature spots, there were no significant differences in blood flow following 5 minutes of EA (146.3±11.5 PU), and 5 minutes after ceasing EA (140.5±11.6 PU), when compared with that before acupuncture (140.8±9.9 PU; P>0.9). Conclusion: The high temperature spots of the cortex are active functional regions of neurons with higher blood flow and a stronger response to EA. EA induces a significant increase in blood flow in the high temperature spots of the cortex.

Exploring the effect of acupuncture plus mild hypothermia on miRNA-204 and its target gene expressions in CIRI rat brain tissues based on MAPK signal pathway

Objective:To explore the protective mechanism of acupuncture plus mild hypothermia for cerebral ischemia-reperfusion injury(CIRI)by observing the effects of acupuncture plus mild hypothermia on miRNA-204 and its target gene expressions in CIRI rat brain tissues.Methods:Sixty Sprague-Dawley rats were divided into a blank control group,a sham operation group,a model group,an acupuncture group,a mild hypothermia group and an acup un cture plus mild hypothermia group accordi ng to the random nu mbertable method(n=10).Except for the blank c on trol group an dthe sham operati on group,rats in the other 4 groups received CIRI modeling.After the model was successfully established,rats in the blank control group were bred routinely for 72 h without any interventions;rats in the sham operation group and the model group were bred routinely for 72 h,and only received bin ding without other interve ntions after surgery;rats in the acup un cture group were bred routinely for 72 h,and received acupuncture at Dazhui(GV 14),Baihui(GV 20)and Shuigou(GV 26)after binding;rats in the mild hypothermia group were bred routinely for 72 h,and received mild hypothermia intervention for 72 h after binding;rats in the acupuncture plus mild hypothermia group were bred routinely for 72 h,followed by receiving acupuncture as in the acup uncture group and mild hypothermia therapy as in the mild hypothermia group after bin ding.The n eurological impairme nt score,cerebral infarcti on area ratio,the expressions of miRNA-204 and its target genes in eluding Map3k8,Ntrk2 and Ppp3rl in the ischemic hippocampus of each group were observed after 72 h of intervention.Results:Before intervention,compared with the bgnk control group and the sham operation group,the neurological impairment scores and the infarction area ratios of the modelled rats were statistically significa ntly increased(all P<Q.Ql)f indicating that the model was successful.After intervention,compared with the model group,the neurological impairment scores of the three in tervention groups were sign ifica ntly reduced(all P<0.01);compared with the acupuncture group and the mild hypothermia group,the infarction area ratio in the acupuncture plus mild hypothermia group was signtiicantly reduced(both P<0.01);compared with the model group,the three intervention groups showed significant inhibition of miRNA-204 expression in brain tissues(all P<0.05),which was most significant in the acupuncture plus mild hypothermia group(P<0.01);compared with the acupuncture group and the mild hypothermia group,the Map3k8 expression in the acupuncture plus mild hypothermia group was significantly increased(both P<0.01),but there were no sign ificant d iff ere nces in Ntrk2 and Ppp3rl expressions between groups(all P>0.05).Conclusion:Acupuncture,mild hypothermia,and acupuncture plus mild hypothermia reduced the neurological impairment score and the cerebral infarction area in CIRI rats,while acupuncture plus mild hypothermia showed the most significant effect.In regulating miRNA-204 target gene expressions,acupuncture plus mild hypothermia showed the same effect on Ntrk2 and Ppp3rl expressions,while better effect on Map3k8 expression compared with either acupuncture or hypothermia.