Objective To investigate the protective effects of metallothionein （MT） for immature myocardium and myocardial interstitium.Methods Twenty-four rabbits （aged 14-21 days） were divided into 4 groups with random number table, 6 each group. Distilled water was injected intraperitoneally in control group and 3.6% ZnSO4 （1.5 ml/kg） was injected intraperitoneally in group 1, group 2 and group 3. Control group, group 1, group 2 and group 3 isolated working rabbit heart model were used in 24h, 12h, 24h and 48h after intraperitoneally respectively. The MT content, recovery of hemodynamics, biochemistry and myocardial ultrastructure were tested. Results The MT content, hemodynamics recovery, adenosine triphosphate （ATP） content, superoxide dismutase activity, Ca2＋-ATPase activity, synthesizing ATP activity of mitochondria, hydroxyproline in group 2 and group 3 were higher than those in control group and group 1 （P 〈 0. 01）. The myocardial watery content, creatine kinase and dehydrogenase leakage, malondialdehyde content, endothelin, mitochondrial Ca2＋ content in group 2 and group 3 were lower than those in control group and group 1（P〈0.01）. The myocardial ultrastructure injuries were less in group 2 and group 3 than that in control group and group l. Conclusion This study demonstrates that myocardial MT prolonged expression can be induced by ZnSO4 and the ischemia-reperfusion injury of immature myocardium and myocardial interstitium could be reduced by MT.
Objective To investigate the protection effects of different pH N 2 hydroxyethyl piperazine N′ 2 ethanesulfonic acid (HEPES) Krebs Henseleit (KH) reperfusate solutions on immature myocardium and myocardial interstitium. Methods Isolated perfused Langendorff model from immature rabbit hearts were performed. Twenty four rabbits were divided into control group, ischemia reperfusion group and acidic reperfusate group. The left ventricular function recovery, myocardial water content(MWC), lactate dehydrogenase (LDH) and creatine kinase (CK) leakage, malondialdehyde(MDA) and adenosine triphosphate (ATP) content, superoxide dismutase(SOD) activity , hydroxyproline(HP) and endothelin(ET) content were tested. Results The left ventricular functional recovery, ATP content, SOD activity and HP content in acidic reperfusate group were higher than those of ischemia reperfusion group( P lt;0.05).MWC, MDA content, CK and LDH leakage, and ET content in acidic reperfusate group were lower than those of ischemia reperfusion group( P lt;0.05). Conclusion These results suggest pH paradox might be one of important mechanisms for immature myocardium and myocardial interstitium ischemia reperfusion injury,and acidic perfusate, at the beginning of reperfusion ,might attenuate pH paradox and ameliorate functional recovery in isolated perfused immature rabbit hearts.
ObjectiveTo evaluate the clinical effect of modified mini-root operation on aortic root diseases with the short and middle term follow-up results. MethodsWe retrospectively analyzed the data of thirty-one patients of modified mini-root operations between March 2008 to September 2012. There were 22 male and 9 female patients with mean age of 47.2±21.3 years(ranged from 28 to 71 years). Fifteen patients were diagnosed with acute aortic dissection(Standford A). Thirteen patients were of Marfan syndrome including 8 patients with aortic dissection and 3 patients of bi-leaflet aortic valve malformation with aortic dissection. The patients were followed up for 6 months to 50 months. Thirteen patients of mini-root operation without other procedure(mini-root operation group) were selected to compare with 8 patients of Bentall operation(Bentall operation group). Some clinical indexes were compared between the two groups. ResultsThree patients died in hospital, in which 1 died from low cardiac out-put syndrome and multiple organ failure, 1 from descending aortic aneurysm rupture, and 1 from acute cerebral infarction. Three patients suffered with acute renal insufficiency and received hemodialysis. During the follow-up, 1 patient received continuous kidney dialysis treatment, and 3 patients performed reoperation. Compared with the Bentall group, the cardiopulmonary bypass time was shorter (108.5±20.8 min vs. 138.5±19.0 min), postoperative blood transfusion volume in the first 24 h was less(661.6±135.0 ml vs. 1 381.2±517.5 ml) than those in the mini-root group. ConclusionModified mini-root technique can significantly shorten the operation time and reduce the amount of blood transfusion in the treatment of aortic root diseases. The modified mini-root technique has obvious effect on selected aortic root diseases during perioperative period.
目的 分析75歲以上高齡冠心病患者行冠狀動脈旁路移植術（CABG）的治療效果和臨床經驗。 方法回顧性分析山東省濰坊市人民醫院和青島市市立醫院自2005年1月至2014年1月109例75歲以上行CABG術患者的臨床資料。其中，男63例、女46例，平均年齡（78.1±4.2）歲，均為多支血管病變。術前心功能分級（NYHA） Ⅳ級23例、Ⅲ級57例、Ⅱ級29例。術中行非體外循環CABG （OPCABG） 92例，體外循環下行CABG （on pump CABG）術9例，體外循環輔助心臟不停跳下CABG （on pump beating heart CABG） 術8例。 結果 平均移植血管（2.5±1.4）支，圍術期死亡4例，死亡率3.7%。其中，低心排血量綜合征死亡1例，心律失常心室顫動死亡1例，腎衰和胃腸道并發癥導致多器官衰竭死亡2例。術后主要并發癥為心律失常、低心排血量綜合征和肺部感染。105例生存患者95例獲得隨訪，隨訪6～90 （45±26）個月，隨訪率90.5%。隨訪期間心源性死亡1例，非心源性死亡4例。患者心功能分級（NYHA）Ⅰ級81例，Ⅱ級18例，Ⅲ級2例，心絞痛消失。 結論 75歲以上冠心病患者行冠狀動脈旁路移植術可改善患者癥狀，緩解心絞痛，提高生活質量，具有良好的近中期效果。
Objective To identify the predictors of prolonged stay in the intensive care unit (ICU) in patients undergoing surgery for acute aortic dissection type A. Methods We retrospectively analyzed the clinical data of 80 patients who underwent surgery for acute aortic dissection type A in Qingdao Municipal Hospital from December 2009 through December 2013. The mean age of the patients was 48.9±12.5 years, including 54 males (67.5%) and 26 females (32.5%). The patients were divided into two groups based on their stay time in the ICU. Prolonged length of ICU stay was defined as 5 days or longer time in the ICU postoperatively. There were 67 patients with length of ICU stay shorter than 5 days, 13 patients with length of ICU stay 5 days or longer time. Univariate and multivariate analysis (logistic regression) were used to identify the predictive risk factors. Results The length of ICU stay was 63.2±17.4 hours and 206.9±25.4 hours separately. Overall in-hospital mortality was 3.0% and 15.4% respectively in the two groups. In univariate analyses, there were statistically significant differences with respect to the age, the European system for cardiac operative risk evaluation (EuroSCORE), the preoperative D-dimmer level, total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA), inotropes and occurrence of postoperative stroke, acute renal failure and acute respiratory failure, ICU stay duration and hospital stay duration between the patients with length of ICU stay shorter than 5 days and longer than 5 days. Multivariate logistic analysis showed that CPB time, occurrence of postoperative stroke, acute renal failure, or acute respiratory failure were independent predictors for prolonged ICU stay. Conclusion The incidence of prolonged ICU stay is high after surgery for acute aortic dissection type A. It can be predicted by CPB time, occurrence of postoperative stroke, acute renal failure, and acute respiratory failure were independent predictors for prolonged ICU stay. For patients with these risk factors, more perioperative care strategies are needed in order to shorten the ICU stay time.
ObjectiveTo summarize the clinical experience of aortic valve replacement surgery with minimally invasive procedure. MethodsWe retrospectively analyzed the clinical data of 72 patients underwent isolated aortic valve replacement in our hospital between January 2011 and August 2013. The patients undergoing minimally invasive procedure were as a minimally invasive group(30 patients with 18 males and 12 females at age of 60.2±13.4 years). The patients undergoings conventional procedure were as a control group(42 patients with 27 males and 15 females at age of 61.3±14.5 years). The outcomes of the two groups were compared. ResultsThere was no death and severe complication in both groups. Postoperative echocardiography showed no paravalvular leakage, no valve dysfunction in both groups. There were no significant statistically differences between the two groups in cardiopulmonary bypass time, aortic crossclamping time, ventilation time, postoperative left ventricle ejection fraction, the length of ICU stay and hospital stay (P>0.05). Blood transfusion ratio, blood transfusion volume and blood loss volume were lower in the minimally invasive group than those in the control group (P<0.05). The length of incision, chest closure time, operative duration were shorter in the minimally invasive group than those in the control group (P<0.05). ConclusionUpper median sternotomy is a safe and feasible procedure for minimally invasive aortic valve replacement surgery. Compared with conventional aortic valve replacement, its advantages include less surgical trauma, stable sternum, rapid recovery, less blood loss and blood transfusion, and cosmetic outcomes.