Objective To study the effect of hypothermia mechanical perfusion (HMP) preservation on microcirculation injury of isolated pig small intestine.Methods Ten healthy Bama miniature pigs were selected.The experimental animals were randomly divided into two groups.In HMP group (n =5),the intestine of 200 cm in length and corresponding blood vessels were cut and then connected to HMP storage device at 4 ℃ for 6 h.In UW group (n =5),the intestine of 200 cm in length and corresponding blood vessels were cut and then preserve in 4 ℃ UW solution for 6 h.Situ small intestine transplantation was performing when preservation finished.The serum NO and ET-1,the dry-wet ratios of intestine tissue,blood flow velocity of intestinal microcirculation and pathological changes of tissues were detected before and after preservation.Results There was no significant difference in serum ET-1 and NO between HMP group and UW group (P＞0.05) before laparotomy.The levels of serum ET-1 increased and serum NO decreased after 30 min of blood flow opening in the transplanted intestine in both groups,more significantly in UW group.There was no significant difference in dry-wet ratio of small intestine before transplantation between the two groups (P＞ 0.05).When the blood flow was opened for 30 min,the dry wet ratio of small intestine in UW group was significantly lower than that in HMP group.There was no significant difference in blood flow velocity of intestinal microcirculation between the two groups before transplantation (P＞0.05),and the blood flow velocity of the two groups decreased significantly after 30 min of blood flow opening,more significant in UW group (P＜0.05).When the blood flow was opened for 30 min,there was mild edema of the lamina propria in the small intestinal tissue of the HMP group,scattered infiltration of the lymphocytes,no exuviation on the surface of the villi and no capillary congestion;In the small intestinal tissue of the UW group,there were edema and congestion of the intrinsic membrane,infiltration of the lymphocytes,the partial exuviation of the villi epithelial cells,focal erosion of the office,and capillary congestion.Conclusion Compared with cold preservation of UW solution,preservation of pig small intestine by HMP can reduce microvascular damage and alleviate the edema and injury caused by ischemia and hypoxia.

Objective To detect the protective effect of extracorporeal membrane oxygenation (ECMO) on Maastricht type Ⅱ donation after cardiac death (DCD) liver transplantation in pigs.Methods Twenty mini-pigs were randomized into ECMO group (n =10) and control group (n =10).Then 10 pigs in each group were randomized into donors and recipients.Maastricht type Ⅱ DCD model was induced in all of the 10 donors.Donors of ECMO group received 2-h ECMO after cardiac death,then underwent liver graft procurement.The donors of control group underwent liver procurement directly after cardiac death.Recipients of two groups underwent orthotopic liver transplantation without venovenous bypass.During this procedure,vital signs were monitored continuously,lactate and liver biochemistry were tested,and 5-day survival rate was observed.Results Maastricht type Ⅱ DCD model was successfully built in all of the donors with consequent dark liver.For donors of ECMO group,liver turned sanguinous and soft quickly after treatment of ECMO.There were no significant differences in operation time,anhepatic time and anhepatic hemodynamic changes between these two groups (P ＞ 0.05).As compared with control group,ECMO group had better hemodynamic parameters 30 min after reperfusion,lower lactate,ALT and AST levels 30 min after reperfusion and before closing the abdomen,and higher 5-day survival rate (P ＜ 0.05).Conclusion ECMO may improve the quality of Maastricht type Ⅱ DCD liver graft,and increase the survival rate of DCD liver transplantation.

人感染H7N9禽流感是由H7N9亚型禽流感病毒引起的急性呼吸道传染病.重症患者可以出现肺炎合并呼吸衰竭(呼衰)或其他器官功能衰竭,病死率很高.至2013年4月底,本院共集中收治确诊人感染H7N9禽流感重症病例3例,均痊愈出院,证明了我们的重症护理管理体系经受住了突发事件的考验.现将本院短期内组建人感染H7N9禽流感重症患者重症监护病房(ICU)的组织与护理管理体会总结如下。

OBJECTIVE:To study the clinical factors and treatment that related to early prognosis of patients after orthotopic liver transplantation (OLT), in order to improve peri-operative care and raise the survival rate in patients undergoing this operation.METHODS:Clinical records of 1,510 patients who had undergone OLT in our center were retrospectively analyzed. Twenty variables in pre-operative, intra-operative or post-operative periods were included, and several risk factors which affected the early prognosis after OLT were screened.RESULTS:With univariate analysis, the following variables showed significant difference between the survival group and the dead group: acute pathology and chronic health evaluation III (APACHE III) score, volume of transfusion and oxygen delivery (DO(2)) of tissue during operation, incidence of infection, and demand of blood purification.CONCLUSION:During peri-operative periods of OLT, combined therapy should be used, and attention should be paid to the risk factors.