Abstract： Objective To investigate the effect of salvianolate on myocardium against ischemiareperfusion injury (IRI) in valve replacement with cardiopulmonary bypass (CPB), its outcome and mechanism, and the applicability and safety of salvianolate as a protection agent for CPB central muscles. Methods Thirty patients undergoing cardiac valve replacement were randomly divided into two groups by lot. In the control group, there were 15 patients including 5 males and 10 females, while in the 15 patients in the trial group, 7 were male and 8 were female. Salvianolate of 200 mg was given to the patients in the trial group intravenously. Hemodynamic parameters, blood gas analysis results, recovery of heartbeat, the dosage of dopamine used, and assisted ventilation time were recorded for both groups before aorta clamping, 2 h, 8 h, and 24 h after aorta declamping. Besides, ICU detention time, the amount of urine in 24 hours, and the amount of drainage in 24 hours after operation were also recorded. Blood samples were taken to determine serum cardial troponin I(cTnI), creatine kinase MB isoenzyme (CK-MB), malondialdehude (MDA), and superoxide dismutase (SOD) in both groups respectively at different times including after the induction of anesthesia, aorta opening, termination of CPB, end of operation, and one day after operation. Results There was no significant difference in hemodynamic parameters, the dosage of dopamine used, spontaneous recovery of heartbeat, and the amount of urine in 24 hours and drainage after operation for 24 hours between the two groups (Pgt;0.05). The rate of ventricular rhythm, blood lactic acid level, the time of assisted ventilation and ICU detention time for the trial group were significantly lower than those for the control group (Plt;0.05), while partial pressure of oxygen in artery(PaO2) was significantly lower in the trial group 8 h after aorta declamping (Plt;0.05). The levels of serum CK-MB, cTnI, and MDA after operation for both groups were higher than those before operation; and those levels for the trial group were significantly lower than the control group at various time points (Plt;0.05). The concentration of SOD decreased after operation in both groups (Plt;0.05), and it was higher in the trial group than the control group at different time points. The decrease of SOD level in the trial group was less than that in the control group. Conclusion Salvianolate can protect myocardium from ischemiareperfusion injury in cardiac valve replacement with CPB effectively, through promoting the activity of antioxidative enzymes and eliminating oxygen free radicals. Patients can be treated with salvianolate for antimyocardial ischemia reperfusion injury.
Objective To analyze the clinical features and treatment of severe H1N1 influenza.Methods The clinical data of 34 patients with severe H1N1 influenza admitted to intensive care unit from October to December 2009 were reviewed. Results The patients aged 3 months to 60 years with an average of ( 13. 9 ±4. 5) years, of which 24 patients were younger than 7 years old. Fever( 30 cases) , cough( 32 cases) , progressive shortness of breath( 19 cases) were the main symptoms. White blood cell count was normal in 21 cases, increased in 6 cases, and decreased in 7 cases. Lymphocyte count was normal in 16 cases, increased in 12 cases, and decreased in6 cases. Chest X-ray films showed bilateral or unilateral patchy pulmonary fuzzy shadows in28 cases. Chest CT showed diffuse interstitial lesion in1 case, pleural effusion in 2 cases, and bronchiectasis in 1 case. The hepatic and myocardial enzymogramparameters were all abnormal.30 cases were treated by oseltamivir and ribavirin, 4 cases by methyllprednisolone, and 6 cases by gamma globulin. 8 cases underwent routine intubation and mechanical ventilation, and 5 cases received non-invasive mechanical ventilation. All 34 patients were cured. Conclusions Lung, heart, and liver are the major target organs in severe H1N1 influenza. Mechanical ventilatory support is an important treatment for severe H1N1influenza.