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冠状动脉旁路移植术的发展与前景

小口径人工血管的研究进展

摘要 为提高小口径人工血管的远期通畅率，一方面需要寻找顺应性更好的材料；另一方面则是在现有人工血管内壁种植内皮细胞。这包括单期种植法，二期种植法以及自体静脉碎片快速种植法。用于种植的内皮细胞可来源于自体静脉、人脐静脉和皮下脂肪微血管。通过在人工血管内壁上衬附可吸收的细胞外黏附蛋白、细胞生长刺激因子，利用生物素与抗生物素蛋白的特异结合能力，或改变植入的内皮细胞的带电性，以及在体外对植入的内皮细胞进行流体切应力锻炼等方法，可以提高内皮细胞的黏附力。植入基因工程改造过的内皮细胞，也是提高小口径人工血管通畅率的一种新尝试。

心外管道全腔静脉肺动脉吻合术治疗复杂性先天性心脏病

目的 评价心外管道全腔静脉肺动脉吻合术(TCPA)治疗复杂先天性心脏病的临床应用价值. 方法 1998年6月～2002年7月,26例先天性心脏病复杂畸形的患者接受了心外管道TCPA,包括单心室伴完全型大动脉转位16例,三尖瓣下移畸形2例,右心室双出口伴大动脉转位3例,三尖瓣闭锁伴右心室发育不良5例. 19例在全身麻醉低温体外循环下手术,7例在非体外循环下手术. 结果 无手术死亡,全部患者治愈出院.术后随访1～47个月,无晚期死亡.所有患者症状消失,无静脉压明显升高现象,超声心动图检查示心外管道血流通畅,无血栓形成,心电图检查示无严重的心律失常,血氧饱和度0.93～0.96,心功能均达Ⅰ～Ⅱ级. 结论 心外管道TCPA是一种较为简单的手术方式,易于掌握;术后疗效满意,优于其他术式.

Ross 手术治疗先天性主动脉瓣膜疾病

目的 总结Ross 手术治疗先天性主动脉瓣膜疾病的临床经验和手术结果. 方法 自1998年3月至2002年7月,16例主动脉瓣膜疾病患者(平均年龄14.0±9.9岁)接受Ross手术,即自体肺动脉瓣移植术.诊断为主动脉瓣二瓣化畸形,主动脉瓣狭窄9例,主动脉瓣发育不良呈穹隆状狭窄2例;主动脉瓣脱垂5例,其中合并室间隔缺损和动脉导管未闭各1例. 结果 无手术死亡,全部患者治愈出院.随访1～48个月,平均30±13个月 ,无远期死亡,无瓣膜相关并发症.所有患者心功能Ⅰ级.超声心动图提示主动脉瓣及同种肺动脉瓣功能良好,仅1例患者主动脉瓣有极少量反流;所有患者主动脉瓣跨瓣压差2.1±0.8 mmHg(1 kPa=7.5 mmHg),左心室流出道及主动脉瓣环随着年龄的生长而增长,平均瓣环直径较术后增加4.0±2.1 mm. 结论 Ross 手术治疗主动脉瓣膜疾病安全,效果好, 随机体发育而生长,可适于某些主动脉瓣瓣膜疾病,尤其适于小儿及年轻患者.

冠状动脉旁路移植术患者的临床分析

目的 分析冠心病患者行冠状动脉旁路移植术(CABG)的临床资料,了解目前CABG患者的流行病学、相关临床特征和变化趋势. 方法 分析2000～2001年间行CABG 651例患者的年龄分布、相关疾病、心肌梗死、冠状动脉造影、心电图与超声心动图表现以及血管旁路移植情况等,并与1974～1995年我院CABG患者资料比较.结果 冠状动脉造影显示93.2%(607/651)的患者有左前降支病变,3支、2支和单支病变者各占64.1%(417/651)、24.1%(157/651)和11.8%(77/651).有高血压、糖尿病和高血脂症史的患者,在心肌梗死、移植血管支数等方面与无此类病史者差别具有显著性意义(P＜0.005,P＜0.001和P＜0.001).行CABG的患者仍以61～70岁者为多,占45%(293/651).移植血管支数以4支及以上较多,为55.6%(362/651),93.7%(610/651)的患者采用左乳内动脉作为血管移植材料. 结论 近年来CABG患者的病情较以前复杂,但手术疗效有明显提高.

The protective effect of N-acetyl-L-cysteine on donor rat lung in the period of reperfusion

Objective To observe the protective effect on rat lung by using N-acetyl-L-cysteine(NAC) a inhibiter of nuclear factor-kappa B (NF-κB) in the period of reperfusion. Methods Twenty-four rats were randomly divided into a control group and a trail group.The harvested lung blocks of 12 rats were flushed with and stored in the low-potassium-dextran (LPD) solution at 4℃ for 16 hours. The isolated rat lung reperfusion models were established and the donor lungs were perfused for 1 hour. NAC was used in the trail group but normal saline was used in control group. Partical pressure of oxygen in artery (PaO2), peak airway pressure (PawP) were measured at every 15 min intervals during reperfusion. After reperfusion, the lung tissue wet-to-dry(W/D)ratio, and myeloperoxidase(MPO) activity were obtained. The protein and mRNA expressions of intercellular adhesion molecule-1(ICAM-1), NF-κB were also observed by using immunohistochemistry and semi-quantitative RT-PCR at the end of reperfusion. Results The level of decreased PaO2 and increased PawP in trail group were lower than those in control group at every interval time the sample obtained after reperfusion in 60 min. (Plt;0.01 or lt;0.05). After reperfusion the W/D,MPO, the protein and mRNA expressions of ICAM-1, NF-κB were decreased evidently in trail group than those in control group(Plt;0.01 or lt;0.05). Conclusion Using NAC in the period of reperfusion, can effectively inhibit the expression of NF-κB and ICAM-1,further improve lung respiratory functions.

冠状动脉旁路移植术后心房颤动的相关因素分析

目的　了解冠状动脉旁路移植术(CABG)后心房颤动(Af)的发生率以及相关因素，并探讨可能的防治措施。　方法　回顾性地总结了连续322例单纯CABG病例，并将患者分为Af组和非Af组。收集术前、术中、术后资料进行统计分析。　结果　CABG术后Af的发病率为23.3%(75例)，最常见于术后第1～3天。年龄大于65岁、右冠状动脉近-中段狭窄大于50%、术后早期未服用β阻滞剂为独立危险因素。　结论　Af是CABG术后最常见的并发症，年龄和右冠状动脉病变可以影响Af的发生，应用β阻滞剂和补充镁可能是预防术后早期Af发生最经济、有效的方法。

冷脑保护液对大脑皮层组织丙二醛、血栓素A2及前列环素的影响

目的 研究深低温停循环间断灌注充氧脑保护液对大脑皮层组织丙二醛(MDA)、血栓素A2(TXA2)及前列环素(PGI2)的影响.方法 杂种犬10条,随机均分为两组.A组:单纯深低温停循环120分钟;B组:深低温停循环后间断灌注充氧脑保护液.两组动物分别于不同时相测定大脑皮层组织MDA,TXA2的代谢产物血栓素B2(TXB2)及PGI2代谢产物6-Keto-PGF1a的含量. 结果 恢复循环45分钟后,A组MDA和TXB2含量明显高于心肺转流术前(P＜0.01),6-Keto-PGF1a含量明显低于B组(P＜0.01). 结论 深低温停循环间断灌注充氧脑保护液能明显减少恢复循环后大脑皮层组织MDA和TXA2的生成,增加PGI2的生成,发挥其对大脑皮层组织的保护作用.

Effect on the Expression of C-myc and Proliferating Cell Nuclear Antigen of Vein Grafts Transferred by C-myc Antisense Oligodeoxynucleotides of Soluble Stent

Objective To investigate the effect on expression of c-myc and proliferating cell nuclear antigen （PCNA） of vein grafts transferred by c-myc antisense oligodeoxynucleotides（ODN） of soluble stent. Methods A rabbit model of common carotid arteries grafted by external jugular veins was constructed in 50 New Zealand rabbits and were randomly divided into five groups, 10 rabbits each group. Control group： no stents ; group 1： soluble stent ; group 2： soluble stent with sense-ODN; group 3： soluble stent with antisense-ODN; group 4.. soluble stent with mismatch-ODN. At 7 d, 28 d and 90 d after surgery, vein grafts were harvested. The expression of c-myc and PCNA were identified by immunochemistry methods. Results At 7d, 28d, 90d after surgery, the expression of c-myc and PCNA of the intima and media of vein grafts in control group, group 1, group 2, group 4 were higher significantly than that in group 3 （P〈0. 01）. At 28d, 90d after surgery, the expression of c-myc in five groups were higher than that in the same group at 7d after surgery （P〈0. 01）. Conclusion Soluble stent can transfer ODN effectively. C- myc antisense-ODN transferred by soluble stent can inhibit significantly the expression of c-myc and PCNA in the intima and media of vein grafts.

体外循环心内直视术后再次开胸止血

目的 通过分析体外循环心内直视术后再次开胸止血的临床结果,指导今后的临床工作.方法 回顾分析4 908例心内直视术后再次开胸止血的临床病例.结果 本组再次开胸止血的发生率为1.6%;再次开胸止血时未见活动性出血者为22.8%;不同疾病再次开胸止血的发生率不同,再次开胸止血可增加手术死亡率及手术切口并发症的发生率等.结论 正确掌握再次开胸止血的手术适应证及正确的手术技术可减少再次开胸止血的发生率.