体外循环期间钙动态变化的研究

观察32例患者体外循环期间血浆及红细胞内钙的动态变化。目的在于揭示其变化规律，为更好的保护心肌提供新的措施和理论依据。结果：麻醉后体外循环前血浆钙较术前显著升高，体外循环开始显著下降；40min恢复至术前水平；停机时显著升高至停机8h。术前、中、后红细胞内钙无显著变化。体外循环期间钙变化与血液稀释、应激反应、预充液及心脏停跳液中含钙离子有关。高钙可导致心肌缺血及再灌注时大量钙进入心肌细胞，引起心肌细胞损伤。所以，体外循环期间，特别是复灌期适当降低钙浓度，对术中、后心肌功能恢复具有重要作用。     

圭嘎拉高海拔隧道施工人员体力劳动强度评价

为探究圭嘎拉高海拔隧道施工人员体力劳动强度水平,评价施工工序劳动强度,选择圭嘎拉隧道进口段（海拔4 300 m）及1#斜井段（海拔4 560 m）的施工人员作为测试对象,分别测量不同工序下施工人员的生理指标（心率、血氧饱和度、耗氧量）。基于耗氧量计算能量代谢率,进而计算各工序的劳动强度指数。结果表明： 1）260 m的海拔高差造成的施工综合劳动强度指数差异具有统计学意义（P<0.05）; 2）二次衬砌钢筋绑扎是所测施工工序中劳动强度最大的工序,该工序下施工人员的心率、血氧饱和度和平均能量代谢率都出现超过卫生限值的情况,劳动强度指数达到35（极重）; 3）海拔为4 300~4 560 m时,隧道各施工工序劳动强度大部分为中度-极重度。     

体外循环过程中红细胞免疫功能的改变

应用红细胞酵母花环试验和红细胞免疫调节因子一步测定法 ,对 30例体外循环过程中红细胞免疫功能及其调节因子进行测定。结果 :体外循环开始后红细胞C3b受体花环率明显升高 ,30 min时达到高峰 ,以后逐渐降低 ,但仍较转流前高 ,红细胞免疫复合物花环率无明显变化 ;红细胞免疫促进因子明显升高 ,而抑制因子明显降低 ,表现为红细胞免疫功能及调节功能紊乱。     

体外循环期间钙动态变化的研究

观察32例患者体外循环期间血浆及红细胞内钙的动态变化。目的在于揭示其变化规律，为更好的保护心肌提供新的措施和理论依据。结果：麻醉后体外循环前血浆钙较术前显著升高，体外循环开始显著下降；40min恢复至术前水平；停机时显著升高至停机8h。术前、中、后红细胞内钙无显著变化。体外循环期间钙变化与血液稀释、应激反应、预充液及心脏停跳液中含钙离子有关。高钙可导致心肌缺血及再灌注时大量钙进入心肌细胞，引起心肌细胞损伤。所以，体外循环期间，特别是复灌期适当降低钙浓度，对术中、后心肌功能恢复具有重要作用。     

THE STUDY ON THE CHANGES OF ZINC, COPPER, CALCIUM AND MAGNESIUM IN PLASMA AND ERYTHROCYTES DURING CARDIOPULMONARY BYPASS

Objective To study the changes and their influence factors involved of zinc, copper, calcium and magnesium in plasma and erythrocytes during cardiopulmonary hypass(CPB). Methods Zinc, copper, calcium and magnesium values in plasma and erythrocytes were measured by atomic absorption spectrophotometer during CPB. Results Zinc and copper levels in plasma were significantly elevated above preinduction level before perfusion, hut calcium and magnesium levels did not change significantly; zinc, copper and calcium levels in plasma were significantly below preoperation level during CPB, hut magnesium level in plasma was significantly increased above preoperation; zinc level in plasma was increased to preoperation level after CPB and began to decrease again at 8 hours after CPB,copper level in plasma was increased to preoperation level at 20 hours after CPB, calcium in plasma was increased significantly from beginning to 8 hours after CPB, magnesium level in plasma was decreased to preoperation level at 8 hours afterCPB. Concentration of zinc , copper, calcium and magnesium in erythrocytes did not change significantly. Conclusion During CPB, the changes of zinc, copper, calcium and magnesium had relation to hemodilution, operative wound, carrier protein, stress and component of priming Solution and cardioplegic solution, hut no relation to transferfrom plasma erythrocytes. The results indicate that it is beneficial to patient‘s recovery to supplement zinc, copper, calcium and magnesium properly by different ways during cardiac perioperation.     

体外循环期间微量元素锌、铜动态变化的研究

观察32例患者体外循环期间血浆及红细胞内锌、铜的动态变化。结果:麻醉后体外循环前血浆锌较术前显著升高,而铜无显著变化;体外循环期间,血浆锌、铜较术前显著降低;血浆锌停机后恢复近术前水平,停机8h又出现下降,血浆铜停机20h恢复近术前水平。红细胞内锌、铜无显著变化。体外循环期间锌、铜变化与血液稀释、手术创伤、载体蛋白及应激因素有关。适量增高锌、铜浓度,有利于提高超氧化物歧化酶等的活性,减轻心肌缺血及再灌注损伤。     

室间隔缺损并肺动脉高压体外循环转流102例

作者总结了102例空间隔缺损并肺动脉高压体外循环转流的体会。为了减少术后并发症提高治愈率,应加强以下几点:转流平稳:灌流量2.4L/m~2,灌注压在5.3～10.6kPa。加强围术期全方位心肌保护。中度血液稀释HCT20%～30%,减少血液破坏,应用微栓过滤器,常规使用扩血管及正性肌力药物,以降低心脏前后负荷,改善心肌有效收缩,增加心排出量。     

高氧液预处理对心脏瓣膜置换术患者血浆丙二醛和超氧化物歧化酶的影响

目的观察高氧液预处理对心脏瓣膜置换术患者血浆丙二醛(MDA)和超氧化物歧化酶(SOD)的影响。方法30例择期心脏瓣膜置换术患者随机分为试验组和对照组,在麻醉后切皮前(T0)至心肺转流(CPB)开始后10 min,对照组静滴复方氯化钠注射液10 mL/kg,试验组给予相等容量的高氧液。分别于麻醉后切皮前(T0)、CPB开始后1 h(T1)、主动脉开放后2 h(T2)、主动脉开放后24 h(T3)共4个时点,测定MDA和SOD。结果T0时点MDA质量浓度两组间无明显差异(P>0.05),T1时显著增高,T2时达高峰,T3仍显著高于术前(P<0.05)。两组间比较,T2时试验组明显低于对照组(P<0.01)。T0时点SOD活性两组间无明显差异(P>0.05),试验组各时点无明显变化(P>0.05)。对照组T1、T2时明显降低,与试验组相比有明显差异(P<0.05)。两组心脏自动复跳率、电除颤率、心律失常发生率、术中多巴胺用量相比均无明显差异(P>0.05),术后24 h多巴胺用量,试验组明显低于对照组(P<0.01)。结论高氧液预处理能使MDA质量浓度明显下降,SOD活性保持不变,减轻心肌缺血/再灌注损伤。     

ACUTE RENAL FAILURE AFTER OPEN-HEART OPERATION

ＡＣＵＴＥＲＥＮＡＬＦＡＩＬＵＲＥＡＦＴＥＲＯＰＥＮ－ＨＥＡＲＴＯＰＥＲＡＴＩＯＮ（贺定超）（秦志端）（鲁舒林）ＨｅＤｉｎｇｃｈａｏ；ＱｉｎＺｈｉｄｕａｎ；ＬｕＳｈｕｌｉｎ；（ＤｅｐａｒｔｍｅｎｔＯｆＴｈｏｒａｃｉｃＳｕｒｇｅｒｙ，ＦｉｒｓｔＡｆｆｉ...     

先天性冠状动脉左右心室瘘的外科治疗

本文报告4例少见的先天性冠状动脉左或右室瘘。1例为左冠状动脉前降枝右室瘘,行双结扎贯穿缝合;1例为右冠状动脉后降枝瘘入左室;2例为右冠状动脉后降枝瘘入右室;后3例在体外循环（CPB）下,切开瘤样扩张之冠状动脉（其中1例并切开右室）关闭瘘口。4例随诊平均7.8年均获满意疗效。文中重点讨论了诊断、手术适应证及手术方法的选择。