目的 冠状动脉旁路移植术(Coronary Artery Bypass Grafting,CABG)后ICU监护时间延长的危险因素分析.方法 选取我院2017年2月至2018年2月共68例行CABG术患者作为研究对象,根据ICU住院时间,分为研究组(ICU时间>3d)和对照组(ICU时间<3d)各34例.分析术后ICU监护时间延长的危险因素.结果?68例患者中,ICU监护时间延长共24例,发生率35.29％.单因素分析显示术后低心排、心律失常、呼吸衰竭、急性肾衰竭、急诊手术及左房内径为危险因素.多因素分析显示术后呼吸衰竭是独立危险因素.结论 影响冠状动脉旁路移植术后ICU监护时间延长的因素包括术后低心排、心律失常、呼吸衰竭、急性肾衰竭、急诊手术及左房内径等,其中术后呼吸衰竭属于独立危险因素.通过对危险因素的监控,能有效降低术后患者ICU监护的时间,促进患者康复.

Objective By ways of evaluating mice pulmonary embolism models induced by different methods,to screen the method to establish the acute pulmonary embolism mice models that is easy to operate and affordable with the high success rate.Methods The pre-operated whole blood emboli or white emboli were separately infused into the right jugular vein to induce acute thromboembolic mice models,and then the physiological parameters were tested at different time points.Results The successful rate of pulmonary embolism model constructing by the two kinds of emboli was up to 100%.Most emboli laid in the level of segments or subsegments of pulmonary arteries,and most importantly,the obvious fibrinolysis of the thrombi in white-autologous thrombi pulmonary embolism models was largely improved than the whole blood group.Conclusion By comparing two groups of models induced by different ways,we find that the white-emboli induced acute pulmonary embolism mice maintains a much more stable pathological state,and our way to establish models of acute pulmonary thromboembolism simulates its real physiological process to a great extent.Our work has laid a solid foundation for further studies of pathogenesis of pulmonary embolism and drug screening.

Objective To evaluate pulmonary embolism in mice induced by whole blood thrombus or white thrombus,in order to provide a basis for choosing murine model of acute pulmonary embolism,which is easy to reproduce,less expensive,closer to the real pathological state,and with a high success rate.Methods A total of 122 healthy and clean male C57BL/6J mice were divided randomly into normal control group(n=6),sham-operation group(n=12),whole blood thrombus group(H group,n=30),and white thrombus group(W group,n=30).After the mice were anesthetized,the right jugular vein was isolated and exposed.The prepared white or whole blood autologous thrombi were introduced into the jugular vain(40 thrombi for each animal;each 1mm in length,1.05mm in diameter) to reproduce acute pulmonary thromboembolism.For the sham-operation group physiological saline of the same volume was infused.The systemic blood pressure,heart rate,right ventricular systolic pressure(RVSP),and TNF-α of the peripheral blood of each animal were then determined,and pathological examination was performed to check the effects of the embolism.Results The success ratio of the reproduction of the murine model of pulmonary embolism is 100%.After the introduction of the embolus,the blood pressure(BP) of W group,H group and sham-operation group was 55.5±4.8,58.2±4.2 and 67.2±2.6mmHg,respectively,which was significantly lower compared with that of the normal control group(71.3±3.0mmHg,P0.01).There was no difference in BP between the W and H group(P0.05).After injecting the emboli,the heart rate of the W,H,and sham-operation group was 372±38,360±39 and 370±38b/min,respectively,and they were significantly lower compared with the normal control group(440±25b/min,P0.01);there was no difference between the first 3 groups.After 12h of embolization,the RVSP of W and H groups(29.6±1.7 and 30.9±1.9mmHg,respectively) was significantly higher than that of the sham-operation group and normal control group(19.3±1.9 and 19.6±1.6mmHg,respectively,P0.01).After 48h of embolization,there was no difference in the RVSP(28.5±3.1mmHg) compared with that of 12h after embolization in the W group(P0.05),However,there was a significant increase compared with the sham-operation group(21.1±1.2mmHg,P0.01) and normal control group(19.6±1.6mmHg,P0.01).In H group,RVSP 48h after embolization(21.0±1.5mmHg) showed a significant lowering compared with that of 12h after embolization,but there was no difference(P0.05) compared with that of the sham-operation group and normal control group.The TNF-α content in peripheral blood showed no difference among the sham-operation group,W group,and H group at 1,6,12,and 24h after embolization(P0.05).Mallory phosphotungstic acid haematoxylin and HE staining showed that most emboli were localized in the branches or sub-branches of pulmonary arteries,and embolization was authentic.Further,the autolysis rate of the emboli in W group(30%) was obviously lower than that in the H group(100%) after 48h.Conclusions The murine model of acute pulmonary embolism reproduced with white thrombus exhibits a more steady pathological state,and is better than that induced by whole blood thrombus.

Objective This study was focus to observe the influence of extracorporeal circulation(ECC) on circulating endothelial progenitor cells(EPCs) in infants with congenital heart disease by measuring the EPCs amount.Methods Between July 2010 and December 2010,40 infants with congenital heart disease and pulmonary arterial hypertension were divided into ECC group and off-pump group.In off-pump group,20 cases received ligation of patent ductus arteriosus and closure of artrial sepectal defect without cardiopulmonary bypass.In ECC group,20 cases had open heart operations with cardiopulmonary bypass.The amount of circulating EPCs counted by flow cytometer at anesthesia completion(T1),the end of surgery(T2),4 h(T3),24 h(T4) and 72 h(T5) after operations.The relation of ECC and EPCs amount was analyzed.Results The amount of circulating EPCs in the two groups had no statistically significant differences at T1(P>0.05).The amount of circulating EPCs in ECC group was significantly higher than that in off-pump group at T3(P<0.01).The amount of circulating EPCs at T2,T4,T5 in ECC group was significantly lower than that at T1 and those time points in off-pump group(P<0.01).Conclusion The levels of circulating EPCs reduce after ECC.

<正>随着人们生活水平的不断提高,冠状动脉粥样硬化性心脏病的发病率正逐年提高,其已经转变为目前严重危害人类健康的三大主要疾病之一。目前的主要治疗方法有内科药物治疗、经皮冠脉支架置入术(PCI)、激光心肌再血管化、冠状动脉旁路移植术(CABG)。尽管近期发现的新生鼠心肌细胞可以完

目的对比不同微创技术在继发孔房间隔缺损治疗中的应用结果,分析其优缺点,探讨最佳手术适应证。方法 2005年1月到2010年11月我院采用微创技术治疗继发孔房间隔缺损患者140例,年龄0.3～50岁,其中经皮导管封堵术60例,非体外循环下经胸封堵术30例,常温体外循环心脏不停跳腋下小切口修补术50例。观察和比较三种微创技术治疗房间隔缺损的手术成功率、切口长度、费用等。结果经皮导管封堵术、非体外循环下经胸封堵术、腋下小切口修补术的成功率分别为95、96.7及100,三组间无显著差别（P＞0.05）,无住院死亡。三组手术切口长度分别为（0.25±0.06）cm、（4.53±1.32）cm和（10.43±2.57）cm,差异有统计学意义（P＜0.01）;手术费用分别为（24146±3073）元,（24811±3255）元,（23300±4799）元,差异无统计学意义（P＞0.05）。结论三种手术方式均是继发孔型房间隔缺损安全有效和小创伤的治疗方法。