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非体外循环冠状动脉旁路移植术后呼吸功能衰竭的治疗

目的 总结非体外循环冠状动脉旁路移植术（OPCAB）后呼吸功能衰竭的治疗经验。 方法 回顾性分析2006 年6 月至2009 年12 月期间济宁市第一人民医院收治31 例OPCAB 后呼吸功能衰竭患者的临床资料，其中男19 例，女12 例；年龄（62±11）岁。术前临床诊断：稳定型心绞痛9 例，不稳定型心绞痛13 例，急性心肌梗死4例，陈旧性心肌梗死5 例。术前心功能分级（NYHA）Ⅰ级2 例、Ⅱ级11 例、Ⅲ级16 例，Ⅳ级2 例，合并慢性阻塞性肺病患者13 例。术后24 h 内发生呼吸功能不全2 例，48 h 内9 例，72 h 内15 例，72 h 后5 例。术后48 h 因低氧血症不能脱离呼吸机的患者主要采用高呼气末气道正压（PEEP）的方法，拔除气管内插管6 h 后出现呼吸衰竭的患者给予糖皮质激素、利尿剂、呼吸机辅助呼吸，对血流动力学不稳定的患者酌情给予血管活性药物、磷酸二酯酶抑制剂、抗心律失常药物和使用主动脉内球囊反搏等。 结果 31 例患者中29 例痊愈，2 例死亡，其中1 例死于多器官功能衰竭，1 例死于急性呼吸窘迫综合征。术后随访29 例，随访时间6 个月～ 4 年，随访率100%。1 例术后1 年死于脑出血，1 例术后2 年死于食管癌；3 例患者有哮喘发作，1 例患者NYHA Ⅲ～Ⅳ级，2 例轻度活动后有气促症状，其余患者NYHA Ⅰ～Ⅱ级，无心绞痛发作，生活质量明显改善。 结论 对OPCAB 后呼吸功能衰竭患者，积极改善心功能，消除肺间质性水肿，恰当使用呼吸机支持是治疗成功的关键。

The Effect of Allogeneic Canine Cord Blood Mesenchymal Stem Cells Transplantation on Distribution of CD4+T and CD8+T in Infarcted Regions of Hearts.

Objective To study the effect of allogeneic canine cord blood mesenchymal stem cells（cbMSC）transplantation on the distribution of CD4+T and CD8+T in infracted area of hearts. Methods Mononuclear cells of cord blood were isolated by density gradient centrifugation and amplified by adherent culture. 36 adult male dogs were divided into experimental group and control group. Animal models of acute myocardial infarction were established by ligating anterior descending coronary artery. The fourth generations of mesenchymal stem cells (MSC) were transplanted into infarcted area of hearts by left anterior descending coronary artery after 72h induced by 5-aza and transfected by LacZ. The survival of transplanted cells in hearts can be confirmed by βgal expression. CD4+T and CD8+T cells distributed in infarcted area were detected by immunohistochemical staining method. The ImagePlus 5.1 software was used to analyze the images. Results Cells transplanted into infarcted area could survive for a long time. 2, 4, 8 weeks after transplantation, the IOD of CD4+T in experimental group were 44.35±7.03, 19.29±4.11 and 20.27±3.51 respectively, and the CD4+T/CD8+T ratios were 0.63±0.12, 0.51±0.15 and 0.66±0.08. In control group, the IOD of CD4+T at 2, 4, 8 weeks after transplantation were 65.78±10.27, 28.02±2.59, 29.79±6.83, and the CD4+T/CD8+T ratios were 1.28±0.20, 1.34±0.09 and 1.50±0.16. The IOD of CD4+T and CD4+T/CD8+T ratio in experimental group were significantly lower than that in control group. In experimental group the IOD of CD8+T at 2, 4, 8 weeks after transplantation were 69.88±7.84 , 37.80±8.83 and 30.81±7.42, higher than that in control group which were 51.28±10.01, 20.87±4.50 and 19.91±2.87. Conclusion The preliminary results indicated that allogeneic cbMSC transplanted in infarcted area can escape from immune rejection, its mechanism may be associated withdecreasing the amount of CD4+T cells infiltrated in periphery of infarcted area and maintaining CD4+T/CD8+T ratios at a lower level.

微创冠状动脉旁路移植术治疗左前降支心肌桥一例

The Cellcell Junction after Implantation of the Myocardiumlike Cell Derived from the Canine Umbilical Cord Blood

Abstract: Objective To study the integration of transplanted cells and host cells by detection of the cellcell junction after transplantation of the myocardiumlike cell derived from the canine umbilical cord blood. Methods The mesenchymal stem cell(MSCs) was transfected by Laz-Z after harvest, culture, induced by 5-azacytidine(5-aza). Thirty-six adult hybrid dogs were randomly divided into cell transplantation group and control group. The canine of myocardium infarction was established. 107 MSCs were transplanted into dogs with acute myocardium infarction by coronary artery infusion and local injection in cell transplantation group and physiologic saline was used in the control group. The specimens were harvested and detected by immunofluorescence for 2, 4 and 8 weeks respectively. Results The umbilical cord blood MSCs were fusiform or spindleshaped. They presented clonal and knittinglike growth.The MSCs could differentiate into myocardium-like cell by the induction of 5-aza and express α-actin, desmin, connexin43.The transplanted cells could survive more than 8 weeks after transplantation. Cadherin and connexin 43 were found in the position of cellcell junction of transplanted cells group and between transplanted cells and host cells. Cadherin and connexin 43 were found in the hose cells of the control group. Conclusion The umbilical cord blood MSCs is able to differentiate into myocardiumlike cell in vitro and form cellcell junction in vivo to communicate with surrounding cells.