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先天性心脏病儿体外循环的再氧合损伤 被引量:6
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作者 祝忠群 朱德明 +3 位作者 苏肇伉 徐志伟 杨艳敏 蒋祖明 《中国体外循环杂志》 2005年第3期131-133,共3页
目的研究高氧分压体外循环对先天性心脏病儿的再氧合损伤。方法选择20例先天性心脏病患者,按照病种随机分成2组,第一组:非紫绀型先天性心脏病(n=10);第二组:紫绀型先天性心脏病(n=10)。体外循环均采用100%氧气预充和转流,在体外循环开... 目的研究高氧分压体外循环对先天性心脏病儿的再氧合损伤。方法选择20例先天性心脏病患者,按照病种随机分成2组,第一组:非紫绀型先天性心脏病(n=10);第二组:紫绀型先天性心脏病(n=10)。体外循环均采用100%氧气预充和转流,在体外循环开始前、1min、5min和10min,分别测定颈内静脉血心肌肌钙蛋白(cTnI)、S100β蛋白(S100)和丙二醛(MDA)含量,同时观察临床指标。结果体外循环前,两组cTnI、S100β和MDA含量均在正常水平,无显著差别。体外循环开始三者均明显上升,血清cTnI含量在体外循环开始1min,5min时,紫绀型组升高水平均高于非紫绀型组,差异具有极显著性(P<0.01);血清S100β含量在体外循环开始1min、5min和10min时,紫绀型组均高于非紫绀型组,5min和10min差异具有显著性(P<0.05);血清MDA含量在体外循环开始1min、5min和10min时,紫绀型组均高于非紫绀型组,1min、5min和10min差异均具有显著性(P<0.05)。临床指标无明显差异。结论高氧分压体外循环再氧合可导致心肌和脑组织氧自由基介导的再氧合损伤;而且紫绀型先天性心脏病患者再氧合损伤比非紫绀型先天性心脏病患者更严重。 展开更多
关键词 先天性心脏病 体外循环 再氧合损伤
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发绀型先天性心脏病体外循环再氧合损伤的研究进展 被引量:2
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作者 丁晓晨 董培青 《心肺血管病杂志》 CAS 2013年第3期374-376,共3页
目前,越来越多的发绀型先天性心脏病(CCHD)患者接受体外循环下的心脏外科手术。在体外循环期间,通常向人工肺内吹入高浓度氧气,以保持动脉血较高的氧分压(应用膜式人工肺时多为200~300 mmHg(1 mmHg=0.133 kPa),应用鼓泡肺更会高达... 目前,越来越多的发绀型先天性心脏病(CCHD)患者接受体外循环下的心脏外科手术。在体外循环期间,通常向人工肺内吹入高浓度氧气,以保持动脉血较高的氧分压(应用膜式人工肺时多为200~300 mmHg(1 mmHg=0.133 kPa),应用鼓泡肺更会高达500~600 mmHg)。 展开更多
关键词 体外循环 先天性心脏病 发绀型 再氧合损伤
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未成熟心肌再氧合损伤的研究进展 被引量:2
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作者 徐树彬 《医学综述》 2009年第6期864-866,共3页
体外循环中的心肌保护问题一直是研究的热点。未成熟心肌在结构、代谢和功能上有其特殊性,对于未成熟心肌体外循环中的再氧合损伤的研究也越来越多。本文就未成熟心肌再氧合损伤的问题结合国内外文献,通过再氧合损伤的细胞生物学研究... 体外循环中的心肌保护问题一直是研究的热点。未成熟心肌在结构、代谢和功能上有其特殊性,对于未成熟心肌体外循环中的再氧合损伤的研究也越来越多。本文就未成熟心肌再氧合损伤的问题结合国内外文献,通过再氧合损伤的细胞生物学研究和大量的动物模型试验研究和医学临床研究,认识到再氧合损伤是发绀型先天性心脏病术后心肺功能紊乱的根源。 展开更多
关键词 未成熟心肌 再氧合损伤 体外循环
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再氧合损伤——紫绀先心病手术中的”杀手” 被引量:2
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作者 李功宋 《中国体外循环杂志》 2003年第2期65-65,71,共2页
关键词 再氧合损伤 手术治疗 复杂紫绀先天性心脏病 体外循环
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发绀型先天性心脏病体外循环再氧合损伤的研究
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作者 梁荣鑫 钟志敏 +1 位作者 王建华 李伯海 《当代医学》 2014年第8期44-45,共2页
目的评价发绀型先天性心脏病体外循环再氧合损伤程度,探讨有效给氧方法减轻再氧合损伤的疗效。方法选取2011年4月-2013年2月广东省第二人民医院心脏外科收治的50例法洛四联征患儿,随机分为实验组和对照组,各25例。体外循环初期,实验组... 目的评价发绀型先天性心脏病体外循环再氧合损伤程度,探讨有效给氧方法减轻再氧合损伤的疗效。方法选取2011年4月-2013年2月广东省第二人民医院心脏外科收治的50例法洛四联征患儿,随机分为实验组和对照组,各25例。体外循环初期,实验组静脉血氧饱和度值控制在65%左右,复温阶段静脉血氧饱和度值调整在70%左右。对照组体外循全程静脉血氧饱和度值控制在70%左右。观察比较两组患儿围手术期左心室射血分数、血清半胱氨蛋白酶抑制蛋白C、血清心肌钙蛋白I。结果两组患儿术后血清半胱氨蛋白酶抑制蛋白C及血清肌钙蛋白I均有所升高,实验组患儿两种血清蛋白升高水平明显低于对照组,差异有统计学意义(P<0.05)。结论发绀型先天性心脏病患儿术中体外循环控制中心静脉氧饱和度,可安全、有效地降低术后再氧合损伤程度,值得临床推广应用。 展开更多
关键词 先天性心脏病 发绀型 体外循环 再氧合损伤
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紫绀型先天性心脏病患儿的体外循环再氧合损伤 被引量:4
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作者 丁晓晨 董培青 《中华胸心血管外科杂志》 CSCD 北大核心 2013年第9期532-536,共5页
目的通过控制体外循环启动时的吸入氧浓度,研究不同给氧浓度对紫绀型先天性心脏病再氧合损伤的影响及安全性。方法紫绀型先天性心脏病患儿30例及非紫绀型先天性心脏病患儿10例,根据体外循环初始氧浓度分为4组:紫绀组1(G1),氧分压... 目的通过控制体外循环启动时的吸入氧浓度,研究不同给氧浓度对紫绀型先天性心脏病再氧合损伤的影响及安全性。方法紫绀型先天性心脏病患儿30例及非紫绀型先天性心脏病患儿10例,根据体外循环初始氧浓度分为4组:紫绀组1(G1),氧分压(PaO2)〈120mmHg(1mmHg=0.133kPa);紫绀组2(G2),PaO2120~〈180mmHg;紫绀组3(G3),PaO2180~〈250mmHg;非紫绀组(G4),PaO2〉200mmHg。体外循环前、体外循环开始后5min、10min、开放升主动脉后5min、术后2h、24h检测血清心肌酶(CK—MB)、肌钙蛋白(cTnI)、白介素6(IL-6)、肿瘤坏死因子“(TNF-α)、超氧化物歧化酶(SOD)、8-异构前列腺素(8-ISO)和S10013蛋白(SLOOβ)浓度,同时记录相应临床指标。结果CK—MB、cTnI、IL-6、TNF-α、8-ISO、S100β术前4组间差异无统计学意义。体外循环开始后均上升,于体外循环停机前后达峰值,之后逐渐下降,在各时间点指标增高趋势为G3〉G2〉G1〉G4,4组间差异有统计学意义(P〈0.05)。SOD在术前G4高于其他3组,差异有统计学意义(P〈0.05);体外循环开始后各组SOD水平均降低,于升主动脉开放后达最低值,之后逐渐升高,体外循环开始后5min、10min、开放升主动脉后5min、术后2h4个时间点G3〈G2〈G1〈G4,组间差异有统计学意义(P〈0.05),术后24hG1、G2和G3组均低于G4组(P〈0.05),但3组间差异无统计学意义。SvO2、Lac、正性血管活性药物使用情况、机械通气时间和ICU住院时间3个紫绀组间差异无统计学意义,与非紫绀组相比差异有统计学意义(P〈0.05)。4组患儿全部生存并顺利出院。结论低氧启动体外循环可明显降低紫绀型先天性心脏病的再氧合损伤,在常规浅、中低温体外循环结合其他措施可有效降低再氧合损伤;对脑组织氧代谢有可能的潜在影响,在深低温及长时间体外循环供氧方式上还需进-步深入研究。 展开更多
关键词 心肺转流术 心脏缺损 先天性 发绀 再氧合损伤
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体外循环前空氧混合通气在紫绀型先天性心脏病患儿术中应用的意义 被引量:4
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作者 章征兵 明腾 +1 位作者 谢维炎 胡华琨 《实用医学杂志》 CAS 北大核心 2012年第9期1474-1476,共3页
目的:评价体外循环前空氧混合通气在紫绀型先天性心脏病患儿术中应用的意义。方法:选择20例紫绀型先天性心脏病患儿,随机分为两组,每组10例,分别在从气管插管到体外循环开始前吸入纯氧(P组)和空氧混合气体(M组)。两组麻醉诱导及维持用... 目的:评价体外循环前空氧混合通气在紫绀型先天性心脏病患儿术中应用的意义。方法:选择20例紫绀型先天性心脏病患儿,随机分为两组,每组10例,分别在从气管插管到体外循环开始前吸入纯氧(P组)和空氧混合气体(M组)。两组麻醉诱导及维持用药相同,均按常规行体外循环。在麻醉诱导前,诱导后10、20、30min时抽动脉血测定氧分压(PO2),抽中心静脉血测定心肌肌钙蛋白(cTnI)、过氧化物歧化酶(SOD)和丙二醛(MDA)含量,同时观察临床指标。结果:诱导前各项指标无统计学差异,在诱导后10、20、30min时M组PO2、cTnI及MDA较P组低,而SOD较P组高,差异有统计学意义(P<0.05);临床指标无明显差异。结论:紫绀型先天性心脏病患儿在体外循环前空氧混合通气可以缩小机体与术前的氧分压差,从而减少机体氧自由基的产生,减轻再氧合损伤,发挥心肌保护作用。 展开更多
关键词 心脏缺损 先天性 体外循环 紫绀型 再氧合损伤
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体外循环前空氧混合通气对紫绀型先天性心脏病患儿术后肺功能的影响 被引量:5
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作者 章征兵 明腾 《山东医药》 CAS 2013年第1期86-88,共3页
目的评价体外循环前空氧混合通气对紫绀型先天性心脏病患儿术后肺功能的影响。方法将进行手术治疗的40例紫绀型先天性心脏病患儿随机分为两组各20例,分别在从气管插管到体外循环开始前吸入纯氧(P组)和空氧混合气体(M组)。两组麻醉诱导... 目的评价体外循环前空氧混合通气对紫绀型先天性心脏病患儿术后肺功能的影响。方法将进行手术治疗的40例紫绀型先天性心脏病患儿随机分为两组各20例,分别在从气管插管到体外循环开始前吸入纯氧(P组)和空氧混合气体(M组)。两组麻醉诱导及维持用药相同,均按常规行体外循环。在麻醉诱导前(T1),体外循环前(T2),体外循环后2 h(T3)、6 h(T4)记录各项呼吸指标,抽动脉血测定血气,根据公式计算出氧合指数、呼吸指数,采用化学法测定血清过氧化物歧化酶(SOD)和丙二醛(MDA)含量,同时观察患儿术后临床指标。结果诱导前两组各项指标无统计学差异,在T2、T3、T4时点P组气道峰压、呼吸指数、MDA较M组高,氧合指数、SOD低于M组(P均<0.05)。结论紫绀型先天性心脏病患儿在体外循环前空氧混合通气可以减少机体氧自由基的产生,减轻术后肺的损伤。 展开更多
关键词 心脏病 先天性 体外循环 再氧合损伤 肺功能不全
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Gender differences in hepatic ischemic reperfusion injury in rats are associated with endothelial cell nitric oxide synthase-derived nitric oxide 被引量:6
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作者 PingLu FangLiu +5 位作者 Chun-YouWang Dao-DaChen ZhongYao YuanTian Jing-HuiZhang Yi-HuaWu 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第22期3441-3445,共5页
AIM: This study was designed to examine the hypothesis that gender differences in I/R injury are associated withendothelial cell nitric oxide synthase (eNOS)-derived nitric oxide (NO).METHODS: Wistar rats were randomi... AIM: This study was designed to examine the hypothesis that gender differences in I/R injury are associated withendothelial cell nitric oxide synthase (eNOS)-derived nitric oxide (NO).METHODS: Wistar rats were randomized into seven experimental groups (12 animals per group). Except for the sham operated groups, all rats were subjected to total liver ischemia for 40 min followed by reperfusion. All experimental groups received different treatments 45 min before the laparotomy. For each group, half of the animals (six) were used to investigate the survival; blood samples and liver tissues were obtained in the remaining six animals after 3 h of reperfusion to assess serum NO, alanine aminotransferase (ALT) and TNF-α levels, liver tissuemalondialdehyde (MDA) content, and severity of hepatic I/R injury.RESULTS: Basal serum NO levels in female sham operated (FS) group were nearly 1.5-fold of male sham operated (MS) group (66.7±11.0 μmol/L vs 45.3±10.1μmol/L, P<0.01). Although serum NO levels decreased significantly after hepatic I/R (P<0.01, vs sham operated groups), they were still significantly higher in female rat (F) group than in male rat (M) group (47.8±8.6 μmol/L vs 23.8±4.7 μmol/L, P<0.01). Serum ALT and TNF-α levels, and liver tissue MDA content were significantly lower in F group than in M group (370.5±46.4 U/L, 0.99±0.11 μg/L and 0.57±0.10 μmol/g vs668.7±78.7 U/L, 1.71±0.18 μg/Land 0.86±0.11 μmol/g, respectively, P<0.01). I/R induced significant injury to the liver both in M and F groups (P<0.01 vs sham operated groups). But the degree of hepatocyte injury was significantly milder in F group than in M group (P<0.05 and P<0.01). The median survival time was six days in F group and one day in M group. The overall survival rate was significantly higher in F group than in M group (P<0.05). When compared with male rats pretreated with saline (M group), pretreatment of male rats with 17-β- estradiol (E2) (M+E2 group) significantly increased serum NO levels and significantly decreased serum ALT and TNF-α levels, and liver tissue MDA content after I/R (P<0.01).The degree of hepatocyte injury was significantly decreased and the overall survival rate was significantly improved in M+E2 group than in M group (P<0.01 and P<0.05). TheNOS inhibitor Nw-nitro-L-arginine methyl ester (L-NAME) treatment could completely abolish the protective effects of estrogen in both male and female rats. CONCLUSION: The protective effects afforded to female rats subjected to hepatic I/R are associated with eNOSderived NO. 展开更多
关键词 Gender identity LIVER Reperfusion injury Endothelial constitutive nitric oxide synthase
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Protective effect of nitric oxide on hepatopulmonary syndrome from ischemia-reperfusion injury 被引量:7
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作者 Tong-Jin Diao, Xin Chen +7 位作者 Li-Hua Deng, Han-Xiang ChenI Yan Liang Xiao-Dong Zhao Qing-Hua Wang, Wei-Sheng Yuan Bai-Chun Gao Yong Ye 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第25期3310-3316,共7页
AIM: To evaluate immunological protection of nitric ox- ide (NO) in hepatopulmonary syndrome and probable mechanisms of ischemia-reperfusion (IR) injury in rat liver transplantation, METHODS: Sixty-six healthy m... AIM: To evaluate immunological protection of nitric ox- ide (NO) in hepatopulmonary syndrome and probable mechanisms of ischemia-reperfusion (IR) injury in rat liver transplantation, METHODS: Sixty-six healthy male Wistar rats were randomly divided into three groups (11 donor/recipi-ent pairs). In group 11, organ preservation solution was lactated Ringer's solution with heparin 10 000/μL at 4℃. In groups I and 111, the pLeservation solution added, respectively, L-arginine or Ng-L-arginine methyl ester (L-NAME) (1 mmol/L) based on group 11, and recipients were injected with L-arginine or L-NAME (50 mg/kg) in the anhepatic phase. Grafted livers in each group were stored for 6 h and implanted into recipi- ents. Five rats were used for observation of postopera- tive survival in each group. The other six rats in each group were used to obtain tissue samples, and execut- ed at 3 h and 24 h after transplantation. The levels of alanine aminotransferase (ALT), tumor necrosis factor (TNF)-a and NO metabolites (NOx) were detected, and expression of NO synthase, TNF-α and intercellular adhesion molecule 1 (ICAM-1) was examined by tri- phosphopyridine nucleotide diaphorase histochemical and immunohistochemical staining. RESULTS: By supplementing L-arginine to strengthen the NO pathway, a high survival rate was achieved and hepatic function was improved. One-week sur- viral rate of grafted liver recipients in group I was significantly increased (28.8 4±36.6 d ys 4 4±1.7 d, P 〈 0.01) as compared with groups 11 and Ill. Serum levels of ALT in group ] were 2-7 times less than those in groups 11 and 11I (P 〈 0.01). The cyclic guanosine monophosphate (cGMP) levels in liver tissue and NOx in group I were 3-4 times higher than those of group 11 after 3 h and 24 h reperfusion, while in group ]]], they were significantly reduced as compared with those in group ]1 (P 〈 0.01). The levels of TNF-(z in group I were significantly lower than in group Ⅱ after 3 h and 24 h reperfusion (P 〈 0.01), while being sig- nificantly higher in group Ⅲ than group Ⅱ (P 〈 0.01). Histopathology revealed more severe tissue damage in graft liver and lung tissues, and a more severe in- flammatory response of the recipient after using NO synthase inhibitor, while the pathological damage to grafted liver and the recipient's lung tissues was signifi-cantly reduced in group I after 3 h and 24 h reperfu- sion. A small amount of constitutive NO synthase (cNOS) was expressed in liver endothelial cells after 6 h cold storage, but there was no expression of inducible NO synthase (iNOS). Expression of cNOS was particularly significant in vascular endothelial cells and liver cells at 3 h and 24 h after reperfusion in group Ⅱ but expres- sion of iNOS and ICAM-1 was low in group I. There was diffuse strong expression of ICAM-1 and TNF-α in group Ⅱ at 3 h after reperfusion. CONCLUSION: The NO/cGMP pathway may be critical in successful organ transplantation, especially in treat- ing hepatopulmonary syndrome during cold IR injury in rat orthotopic liver transplantation. 展开更多
关键词 Nitric oxide Nitric oxide synthase Immu-noregulatory Hepatopulmonary syndrome Ischemia-reperfusion injury Orthotopic liver transplantation
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Protective effect of ischemic postconditioning on lung ischemia-reperfusion injury in rats and the role of heme oxygenase-1 被引量:19
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作者 夏中元 高瑾 Ameer Kumar Ancharaz 《Chinese Journal of Traumatology》 CAS 2009年第3期162-166,共5页
Objective: To investigate the effect of ischemic postconditioning (1PO) on acute lung ischemia-reperfusion (I/R) injury and the protein expression of haeme oxygenase-1 (HO-1), a cytoprotective defense against o... Objective: To investigate the effect of ischemic postconditioning (1PO) on acute lung ischemia-reperfusion (I/R) injury and the protein expression of haeme oxygenase-1 (HO-1), a cytoprotective defense against oxidative injury. Methods: After being anesthetized with chloralhydrate, forty-eight healthy SD rats were randomly divided into 6 groups (8 in each): sham operation group (S group); I/R group: left lung hilum was clamped for 40 minutes followed by 105 minutes of reperfusion; IPO group: left lung hilum was clamped for40 minutes and postconditioned by 3 cycles of 30 seconds of reperfusion and 30 seconds of reocclusion; Heroin (HM)+ I/R group: heroin, an inducer of HO-1 was injected intraperitoneally at 40 μmol·kg^-1·day^-1 for two consecutive days prior to 40 minutes clamping of left lung hilum; ZnPPIX+IPO group: zinc protoporphyrin IX, an inhibitor of HO-1 was injected intraperitoneally at 20 mg·kg^-1 24 hours prior to 40 minutes clamping of left lung hilum; and HM+S group: HM was administered as in the HM+I/R group without inducing lung I/R. Arterial partial pressure of oxygen (PaO2) and malondialdehyde (MDA) content in serum were assessed. The left lung was removed for determination of wet/dry lung weight ratio and expression of HO-1 protein by immuno-histochemical technique and for light microscopic examination. Results: The PaO2 was significantly lower in all the experimental groups compared with sham group (90 roan Hg ±11 mmHg). However, the values of PaO2in IPO (81 mm Hg±7 mm Hg) and HM+I/R (80 mm Hg±9 mm Hg) were higher than that in I/R (63 mm Hg±9 mm Hg) and ZnPPIX+IPO (65 mm Hg±8 mm Hg) groups (P〈0.01). The protein expression of HO- 1 in lung tissue was significantly increased in I/R group compared with S group (P〈0.01). While the HO-1 protein expression was higher in IPO and HM+I/R groups as compared with I/R group (P〈0.05, P〈0.01 ). The lung wet/ dry (W/D) weight ratio and MDA content in serum were significantly increased in I/R group as compared with S or HM+S groups (P〈0.01), accompanied by severe lung tissue histological damage, which was attenuated either by IPO or by HM pretreatment (P〈0.01, IPO or HM+I/R vs. I/R). The protective effect of IPO was abolished by ZnPPIX. Conclusion: Ischemic postconditioning can attenuate the lung ischemia-reperfusion injury through upregulating the protein expression of HO-I that leads to reduced postischemic oxidative damage. 展开更多
关键词 Ischemic postconditioning Reperfusion injury LUNG Heme oxygenase-1 MALONDIALDEHYDE
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