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find Author "耿希刚" 3 results
  • Heparin-free Cardiopulmonary Bypass and Early Systemic Inflammatory Response

    Abstract: Objective To explore the feasibility of using protamine-agarose gel to achieve heparin-free cardiopulmonary bypass (CPB). Methods A total of 12 healthy adult dogs were chosen, the dogs were between 2-3 years old,either male or female, with their mean body weight of 23.3±3.7 kg (ranging from 20 to 28 kg). All the dogs were randomly divided into two groups with 6 dogs in each group. In the heparinized group, conventional CPB technique was used; in the non-heparinized group, protamine-agarose gel column was used to absorb plasma clotting factors in CPB without use of heparin. At the beginning of CPB and 1 h, 2 h, 3 h after CPB, arterial blood samples were collected from dogs in both groups. The expression levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured by enzyme-linked immunosorbent assay(ELISA)and compared. Results There was no thrombus formation in the membrane oxygenators during CPB by naked eye observation in both groups. Activated coagulation time (ACT) was always greater than 480 s during CPB. The vital signs of the dogs were all stable during CPB. At the beginning of CPB, there was no statistical difference in plasma concentrations of TNF-α, IL-6, IL-8 between the two groups. At 1 h, 2 h and 3 h after CPB, the expression levels of TNF-α and IL-8 of the non-heparinized group were significantly higher than those of the heparinized group (CPB 3 h TNF-α:156.48±16.65 ng/L vs. 115.87±15.63 ng/L, t=4.356, P=0.001;CPB 3 h IL-8:365.38±46.18 ng/L vs. 299.29±34.50 ng/L, t=2.808, P=0.019). There was no statistical difference in the expression level of IL-6 between the two groups (P>0.05). Conclusion Using protamine-agarose gel to absorb plasma clotting factors is an effective technique to establish heparin-free CPB. But this method can induce significant systemic inflammatory response.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 急诊外科手术治疗危重心瓣膜病192例

    目的 总结危重心瓣膜病患者行急诊手术的临床经验,以提高其疗效和治愈率。 方法 自1996年10月至2007年11月对192例危重心瓣膜病患者施行了急诊手术。所有患者均为心瓣膜病合并严重心力衰竭,心功能分级(NYHA)为Ⅲ~Ⅳ级。经内科治疗2~7 d无效时采取急诊手术治疗;行二尖瓣置换术76例次,主动脉瓣置换术64例次,双瓣膜置换术43例次,三尖瓣置换术4例次,三尖瓣成形术45例次,左心房血栓清除和左心房减容 术各5例次,冠状动脉旁路移植术5例次,其他心血管手术9例次。 结果 术中和术后早期分别死亡3例和8例,总手术死亡率为5.7%(11/192),主要死亡原因为术中不能脱离体外循环机、术后发生低心排血量综合征和突发心室颤动等。随访168例,随访时间1个月~11年,失访13例。随访期间死亡8例,主要死于左心衰竭、瓣周漏或心内膜炎复发、尿毒症、夹层动脉瘤等。长期生存160例,心功能恢复至Ⅰ级132例,Ⅱ级15例,Ⅲ级13例;生活质量较术前有所提高。 结论 危重心瓣膜病患者经内科治疗无效时急诊手术具有良好的疗效,是较好的治疗选择。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 二尖瓣、主动脉瓣联合置换术后左心辅助循环成功一例

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
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