目的 观察臭氧对大鼠角膜碱烧伤后的氧化应激损伤的抑制效应.方法 使用NaOH建立大鼠角膜碱烧伤模型,30只SD大鼠随机分为空白对照组、模型组、低浓度(2 mg/L)臭氧处理组,中浓度(3 mg/L)臭氧处理组,高浓度(4 mg/L)臭氧处理组,每组6只.ELISA法测定角膜组织中SOD的活性和MDA含量.结果 与低、高浓度组相比,中等浓度的臭氧可有效降低角膜溶解面积、减轻角膜混浊度、抑制角膜新生血管面积,并降低角膜MDA的生成(P＜0.05),增加SOD的生成(P＜0.05).结论 臭氧能有效改善大鼠角膜碱烧伤后的氧化应激反应,其中3 mg/L的臭氧是较为合适的剂量范围.

目的:探讨薄荷醇作为促透剂对臭氧治疗大鼠角膜碱烧伤的治疗效果.方法:建立大鼠角膜碱烧伤模型,36只SD大鼠随机分为对照组、模型组、臭氧组、0.08％薄荷醇臭氧滴眼液组、0.10％薄荷醇臭氧滴眼液组、0.12％薄荷醇臭氧滴眼液组,每组6只.方法:ELISA法测定角膜组织中SOD的活性和MDA含量,HE染色及电镜观察角膜形态变化.结果:与臭氧组相比,0.10％薄荷醇臭氧滴眼液组可减轻角膜浑浊度,降低角膜溶解面积(3.15±0.52 vs 2.45±0.24,P＜0.05)、抑制角膜新生血管面积(18.05±2.32 vs 16.77±3.94,P＜0.05),并降低角膜MDA的生成(5.06±1.04 vs 4.03±1.03,P＜0.05),增加SOD的活性(265.26±163.28 vs 369.15±116.05,P＜0.05).HE染色结果显示:与模型组相比,0.10％薄荷醇臭氧滴眼液组角膜上皮较完整,水肿及基质胶原纤维排列紊乱程度较模型组减轻.电镜结果显示,与模型组相比,0.10％薄荷醇臭氧滴眼液组角膜上皮细胞层次略完整,细胞间有半桥粒连接.结论:薄荷醇作为促透剂可以增加臭氧滴眼液的生物利用度,提高其治疗效果.

体外循环(cardiopulmonary bypass,CPB)是一种非生理模式,当血液暴露在"异物表面"或非生理性条件下(机械应力、高温/ 低温、湍流、气穴等现象)会发生血细胞损伤,最明显的红细胞(red bloodcells,RBCs)损伤表现为立即或者延迟性"溶血",另一种状况就是发生"亚致死性损伤(sublethal redblood cells trauma,SRBCsT)".溶血导致RBCs 破碎、数量减少,RBCs 比容降低,携氧量下降,降低组织与细胞的供氧.亚损伤虽然没有导致RBCs 直接破碎,血红蛋白(hemoglobin,Hb)漏出,但会使RBCs变形性降低、携氧能力受到影响,无法顺利通过微毛细血管输送氧气,从而影响微循环血供,最终导致低氧、贫血等不良事件.临床上"溶血"容易认知,相关研究较多,但是SRBCsT 因为辨别困难,目前有关的文献报告较少.

目的 探讨急性StanfordA型主动脉夹层患者体外循环术后发生急性肾损伤的相关危险因素.方法 回顾性分析2016年7月至2018年12月哈尔滨医科大学附属第一医院心脏大血管外科收治的急性StanfordA型主动脉夹层手术患者的临床资料.根据KDIGO标准分为AKI组及非AKI组,将两组资料进行对比分析,探讨急性StanfordA型主动脉夹层患者术后发生AKI的危险因素.结果 共入选患者134例,未发生AKI患者68例(50.7％);发生AKI患者66例(49.3％),其中24例(17.9％)患者需要肾脏替代治疗.AKI组病死率明显高于非AKI组(13.6％比1.5％),AKI组术后ICU停留时间明显长于非AKI组[(13.27±22.87)d比(4.44±3.49)d,P=0.03].单因素分析结果显示,患者性别、术前血红蛋白以及高血压史、体外循环时间、主动脉阻断时间、术后ICU停留时间、术后气管插管时间及术后病死率差异有统计学意义.Logistic回归分析显示,女性患者(OR=3.943)、高血压史(OR=2.978)、术后气管插管时间(OR=2.969)为急性StanfordA型主动脉夹层患者体外循环术后发生AKI的独立危险因素.结论 女性患者、高血压史、术后气管插管时间为急性Stanford A型主动脉夹层患者体外循环术后发生AKI的独立危险因素.

目的 观察不同浓度超氧对主动脉夹层(aortic dissection,AD)患者围术期体外血液样本中红细胞氧化应激以及能量代谢的影响,为临床应用超氧自体血疗法(ozonated autohemotherapy,ozone-AHT)提供实验基础.方法 收集哈尔滨医科大学附属第一医院2016年3～8月20例AD患者[男16例、女4例,平均年龄(48.51±10.21)岁]手术前后的血液标本进行不同浓度(0 μg/ml,40μg/ml,60μg/ml,80 μg/ml,160 μg/ml)的超氧(ozone)预处理.酶联免疫吸附剂测定法(ELISA)测定氧化/抗氧化指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]以及能量代谢指标[Na+-K+-ATP、2,3二磷酸甘油酸(2,3-DPG)].结果 在对照组(0μg/ml)中,术后MDA含量比术前含量显著增加(P＜0.05),术后SOD、Na+-K+-ATP、2,3-DPG较术前组显著减少(P＜0.05).40 μg/ml、60 μg/ml、80 μg/ml组术后MDA含量比术前组增加(P＞0.05),SOD、Na+-K+-ATP、2,3-DPG较术前组减少(P＞0.05);术前三个浓度组组间(40 μg/ml、60 μg/ml、80 μg/ml)与术后三个浓度组组间(40 μg/ml、60 μg/ml、80 μg/ml) MDA、SOD、Na+-K+-ATP、2,3-DPG数值变化差异无统计学意义(P＞0.05);160 μg/ml浓度组与其它所有浓度组相比,术前、术后MDA含量均增加,术前、术后SOD、Na+-K+-ATP、2,3-DPG均减少,差异有统计学意义(P＜0.05).结论 40～80 μg/ml的ozone可以提高AD患者血液样本中红细胞膜抗氧化能力、降低氧化应激反应、提高红细胞膜的能量代谢,因此该浓度范围的ozone应用于AD围术期ozone-AHT是安全可行的.

目的 应用显微影像技术观察主动脉夹层患者体外循环术后红细胞超微形态学变化,为红细胞损伤和亚损伤提供超微形态学证据.方法 收集本中心2016年3月到2016年8月20例主动脉夹层患者手术前后的血液标本.使用不同显微技术(扫描电镜、原子力显微镜和激光共聚焦显微镜)观察红细胞超微形态学改变(红细胞畸形率、红细胞长度、宽度、高度、洞深、表面粗糙度等)以及红细胞膜的完整性(丝状激动蛋白分布).结果 与健康成人对照组相比,主动脉夹层患者的红细胞微观形态学参数除表面粗糙度外,其它微观形态学参数(高度、宽度、洞深、粗糙度)没有明显变化.在经历体外循环术后红细胞形态发生明显变化,部分红细胞出现肿胀、固缩、变形、破裂以及红细胞碎片,出现各种异常形态的红细胞(棘型、口型、靶型、椭圆形、薄型等).红细胞膜表面光滑度改变,细胞表面出现高低起伏大小不等的凸起颗粒使细胞膜表面粗糙度增加,同时细胞表面丝状激动蛋白分布改变,细胞结构呈现解聚状态,不能形成完整的荧光环,红细胞膜结构的完整性受到破坏.结论 超微形态学改变为夹层疾病和体外循环引起红细胞损伤提供了新的形态学证据.红细胞表面粗糙度可以作为新的参数来评估红细胞损伤以及亚损伤.

心脏瓣膜疾病在我国是一种非常普遍的心脏疾患,其中风湿热导致的瓣膜损害是最为常见原因之一,我国成人风湿性心脏瓣膜病的发病率为2.34‰～2.72％‰.随着人口老龄化加重,老年性瓣膜病以及冠心病心肌梗死后引起的瓣膜病变也越来越常见.这些瓣膜病变不但危害生命安全、影响生活质量,同时给家庭和社会带来沉重的负担和压力.瓣膜手术能够有效地纠正病理性瓣膜结构和功能异常,缓解病人的症状和体征,是目前最有效的治疗方法[1].随着临床患者数量的增加,老龄患者人数的增多,手术难度逐渐提高,心肌保护对于改善患者预后效果开始得到大家的肯定并逐渐引起重视.目前瓣膜手术手术过程中普遍采用心肌麻痹液来进行心肌保护.传统的心肌麻痹液技术存在一定的不足,更多的临床医师开始在手术中应用空搏心脏灌注技术.现就这一技术在瓣膜手术中的应用做一综述.

心脏移植是治疗终末期心脏病最有效的方法[1],然而由于供体的短缺及脑死亡尚无法律依据,目前中国每年心脏移植例数仅300余例,大量受体在等待供体时死亡.中国是乙型肝炎(乙肝)大国,如何选取合适的乙型肝炎阳性供体作为器官供体亟待解决,本文从哈尔滨医科大学附属第一医院心脏大血管外科1例乙肝阳性(小三阳患者)供体心脏移植给乙肝阴性受体治疗过程结合相关文献复习,探索适合中国国情的乙肝供体心脏应用之路.

目的:回顾性分析清醒体外膜肺氧合(ECMO)在心脏外科围术期应用的临床效果. 方法:自 2013-12 至 2017-04 我院心外科共有 31 例患者使用 ECMO 进行循环呼吸支持,其中清醒 ECMO 5 例(心脏移植过渡等待供体患者 1 例,心脏移植术后右心衰 2 例,心脏移植术后心包压塞误认为右心衰 1 例;成人 ASD 术后急性左心衰 1 例).5 例清醒 EMCO 患者全部采用静脉-动脉(V-A)模式并常规放置股动脉远端灌注管(7F 鞘管),除建立和撤除 ECMO 支持系统外,全程保持清醒状态,经口进食,温度维持在 35~36.5℃,流量维持在 2.5~4.0 L/min,全血激活凝固时间(ACT)维持在 180~220 s,转流过程中根据具体情况调节内环境,稳定血流动力学.

目的：探讨婴幼儿主动脉弓中断或主动脉缩窄合并其他心内畸形的一期矫治的体外循环管理及灌注方法。方法总结41例主动脉弓离断或缩窄合并其他心内畸形的病例。年龄8 d～5岁，体质量2．8～16．0 kg。均经胸骨正中切口在深低温（深低温停循环组21例）或中度低温（中度低温停循环组20例）体外循环下行一期矫治术。结果深低温和中度低温停循环组体外循环时间[（151．25±42．12） min与（127．33±35．46） min，t＝3．748，P＝0．034]差异有统计学意义，两组主动脉阻断时间[（67．74±37．42） min与（65．43±36．74） min，t＝1．364，P＝0．061]、脑灌注时间[（22．42±7．34） min与（23．25±6．74） min，t＝0．412，P＝0．074]、术后插管时间[（90．74±65．30） h 与（85．13±42．28） h，t＝0．158，P＝0．055]、ICU滞留时间[（6．92±3．80） d与（6．65±3．23） d，t＝0．142，P＝0．059]差异均无统计学意义。两组患儿均无神经功能并发症的发生。结论婴幼儿深低温或中度低温停循环结合选择性脑灌注技术应用的体外循环管理应全程精细化控制，两种温度管理均取得良好的效果，且中度低温组可明显缩短体外循环时间。

[ Abstract]:Objective The purpose of this study is to retrospectively analyze the effectiveness of autologous platelet separation and transfusion on the blood coagulation function and allogeneic blood products in patients with aortic dissection during perioperative period. Methods Between Jan 2014 and Jan 2016, forty aortic dissection cases who underwent deep hypothermic circulation arrest ( DHCA) aortic dissection repair were collected and divided into two groups:autologous platelet separation and transfusion group ( sep?aration and transfusion group, n=20) and no autologous platelet separation and transfusion group ( control, n=20) . In control group:allogeneic blood was transfused according to the situation. In autologous platelet separation and transfusion group:one to two treatment unitsof autologous platelet were extracted before operation, and was stored at 22℃ with constant oscillation.The platelets weretransfused back into the body when the protamine neutralization was achieved. The platelet (Plt) , prothrombin time (PT), activated partial thromboplastin time ( APTT) and fibrinogen ( FIB) were measured at 1,2 and 3 days after operation, postoperative drainage at 1 h and 24 h was measured. The CPB time and aortic-clamping time, perioperative transfusion required and perioperative adverse events were recorded. Results Autologous platelet separation and transfusion group,the volume of the whole blood processed for Plt was (2889.4± 510.50) ml, acquisition of autologous platelet (214.3±63.12)ml, anticoagulant dosage (262.8±49.64)ml, Plt count (2.54±0.49)× 1011/L,and time needed (127.9±36.39)min. Comparedwith control group,reduction ofallogeneic RBC(6.21±3.02 unit vs 9.37±3.71 unit, P =0.005), allogenetic platelet (5.5±5.4 unit vs 12.85±4.6 unit, P<0.001),allogenetic plasma (552.46±175.63 ml vs 850.35 ±243.58 ml, P<0.001),allogenetic cryoprecipitate (10.7±2.4 unit vs 18.3±9.6 unit, P =0.001)were transfused( P<0.05). No sta?tistically significant differences in the volume of postoperative drainage and perioperative adervse events( P>0.05) . Conclusion Au?tologous platelet separation and transfusion as a kind of blood protection method can reduce allogeneic blood transfusion.

目的：回顾性分析在A型主动脉夹层顺行性脑灌注中应用脑氧饱和度监测仪（NIRS）指导单/双侧脑灌注的临床结果。

目的：回顾性分析体外膜肺氧合（ECMO）在心脏移植围术期的支持方法与策略。

本科在体外循环下成功实施了一例支气管异物导致二氧化碳潴留、窒息昏迷病情危重患儿的异物取出术，现报告如下。<br>　　1资料与方法<br>　　1．1临床资料患儿，女，5岁，25 kg，因玩耍时不慎将一大小约2 cm ×1 cm塑料圆球吸入气管内，立即出现呼吸困难，烦躁伴口唇发绀，急诊送入医院， X线显示：支气管右移，右肺不张，听诊右肺呼吸音弱，结合病史考虑异物在右侧，因患儿呼吸困难、窒息，给予气管插管呼吸机辅助通气，但症状未缓解，后因无纤支镜转入我院。入院后患儿病情危重，意识模糊，呼吸机辅助通气下血氧饱和度难以维持，最低降至40％～50％，经耳鼻喉科、胸外科、麻醉科等科室会诊后认为无法安全取出异物，后转入我科，入科后患儿昏迷状态，血气 pH 6．90， PCO2高至测不出，立即急诊手术，紧急建立体外循环，心脏跳动下并行循环，拔出气管插管，纤支镜下见气管内大量脓性分泌物，给予清除后发现异物位于右主支气管内，镜下钳夹取出，大小约为1 cm×0．8 cm，吸痰后重新插管。体外循环采用儿童用氧合器、管道，中号微栓，预充液为勃脉力500 ml，菲克血浓500 ml，白蛋白20 g，红细胞1 U，5％碳酸氢钠30 ml，转中根据血气情况，调节内环境稳定，流量80～100 ml／（ kg · min），转机开始降温至34℃，头部加带冰帽，进行脑保护，同时给予甲泼尼龙（30 mg／kg），乌司他丁（1万 U／kg），速尿10 mg ，25％甘露醇（3 ml／kg）等，转中行平衡超滤，停机行改良超滤，改良超滤后红细胞比容（ Hct）为0．35。

[ Abstract]:Objective To summarize the management of cardiopulmonary bypass( CPB) in patients undergoing surgery with to?tal video thoracoscope. Methods A retrospective analysis of 58 patients undergoing cardiac surgery with total video thoracoscope from March 2012 to Auguat 2014 was conducted. 17 patients were male, 41 patients were female. The patient age was 35.19±14.51 years and weight was 57.64±11.47 kg. Twenty eight(48.27%)patients of atrial septal defect, 12(20.69%)patients of atrial septal defect and tricuspid valvuloplasty, 12(20.69%)patients of left atrial myxoma, 1(1.73%)patients of right atarial tumor, 1(1.73%)patient of par?tial atrioventricular canal defect, 3(5.17%)patients of atrial septal defect and pulmonary stenosis, 1(1.72%)patient of atrial septal defect and unroofed coronary sinus received surgery. The arterial catheter was placed in the right femoral vein, the venous catheter was placed in the superior vena cava to set up CPB. Middle–hypothermia, middle-hemodilution, middle-high flow rate perfusion were used during the CPB, the myocardium was protected by coronary perfusion with 4:1 cold oxygenated blood. Aortic corss-clamping was performed in 56 pantients and 2 patients had beating heart surgery. Results Cardiopulmonary bypass time ranged form 65 min to 178 min with a mean of 108.83±24.73 (min). Aortic cross-clamp time ranged from 20 min to 78 min with a mean of 52.46±17.29 (min). Fifty six patients had spontaneous cardiac rhythm recovery whereas 2 patients had ventricular fibrillation and recovery sinus rhythm by electric defibrillation. Four patients experienced inadequate venous drainage, and superior vena cava ( SVC) cannulation had to be per?formed to facilitate blood drainage.Three patients had excessively high femoral pressure and the left femoral artery cannula was required. Vascular injury happened in two cases from difficulty in removal of femoral artery cannulae fromone patient and piercing of the femoral artery by the guiding wire. The mechanical ventilation time was 6.13±2.33(h)andthe time of stay in ICU was 21.05±4.35(h). Thechest tube drainage was 142.07±52.07(mL).No complications was noted and all patients were cured and discharged. Conclusion It is very important to choose suitable cannula type and make sure they are put in the right way. Effective drainage and perfusion and good communication between surgeons and perfusionistsare also very important for the successful management of CPB for total videothoraco?scopic cardiac surgery.

Objective To comparatively study the myocardial protective effects of different dose of cold crystalloid hyperkalemic cardioplegia in infants with ventricular septal defect ( VSD) undergoing open heart surgery.Methods Forty-five infant patients ( weight≤10 kg) with VSD were randomly divided into three groups (15 cases of each group):1/3 dosage group (5 mL/kg), 1/2 dosage group (7.5 mL/kg), and total dosage group (15 mL/kg).Plasma levels of CK, CK-MB, LDH, cTnI, ET-1 were measured before aortic cross-clamp and after wean-off cardiopulmonary bypass (CPB).The ratio of spontaneous cardiac rhythm recovery, dose of inotropic drugs application, CPB time, aortic cross-clamp time, mechanical ventilation support time and ICU stay-time were recorded.Results All the patients were healed and dis-charged after heart re-beat.The ratio of spontaneous cardiac rhythm recovery, CPB time, aortic cross-clamp time, mechanical ventilation support time and ICU stay-time had no statistic differ-ence between three groups.Conclusion It is reliable and effective to use different dose of cold crystalloid hyperkalemic cardioplegia in infants with VSD undergoing open heart surgery.

Objective To study the application of autohemotransfusion and other methods in the paediatric congenital heart diseases.Methods Sixty cases were randomized divided into 2 groups:control group and experimental group,30 cases in each group.Comprehensive methods were taken in experimental group,including autotransfusion,application of ulinastatin and methyl-hydroprednisone,preoperative injection of vitamin K1,application of modified ultrafiltration.Surplus blood was retransfused,activitied prothrombin time(APT) was monitored.Hemoglobin(Hb),platelet(PLT),hematocrit(HCT),the volume of allogeneic blood transfusion and postoperative volume,hemoglobinuria,the time of respirator were compared between the two groups.Results There were significant differences between the two groups in postoperavtive HCT,Hb,PLT(P0.05),and the volume of allogeneic blood transfusion and postoperavitve drainage were significantly decreased compared with control group(P0.05).Conclusion Comprehensive mothods of blood conservation in the paediatric congenital heart diseases such as autohemotransfusion can significantly concentrate blood,protect blood,reduce the volume of blood loss during operation and allogeneic blood transfusion.