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改良超濾對心瓣膜置換術后心肺功能的影響

目的 探討改良超濾對成人心臟瓣膜置換術后心肺功能的影響，以改善術后心肺功能。 方法 67例成人心瓣膜置換術患者隨機分為改良超濾組(超濾組，n=33)和無超濾對照組(對照組，n=34), 動態觀察體外循環(CPB)前、CPB停機及改良超濾結束時（對照組在CPB停機20min）氧分壓(PO2)及二氧化碳分壓(PCO2)、術后呼吸機輔助呼吸時間、血管活性藥物用量及使用時間、左心室射血分數(LVEF)等心肺功能指標。 結果 兩組的PO2 CPB前與CPB停機時相比均明顯下降；超濾組在改良超濾結束時PO2明顯回升，接近CPB前水平，而對照組PO2僅輕度回升，但仍明顯低于CPB前；CPB停機20min時超濾組PO2高于對照組(P=0.044). CPB停機后兩組PCO2輕度升高，改良超濾后PCO2輕度下降，但組內、組間比較差異無統計學意義。術后超濾組呼吸機輔助時間、血管活性藥物用量及使用時間明顯低于對照組(P=0.005,0.001, 0.012)。術后1周心臟超聲心動圖檢查提示兩組LVEF均較術前明顯提高，但組間比較差異無統計學意義(t=0.91, P=0.367). 結論 改良超濾有利于改善成人心瓣膜置換術后早期心、肺功能。

Effects of Haemopoietic Stem Cell Mobilization on Improving Vein Graft Patency

Abstract: Objective To investigate the effects of haemopoietic stem cell mobilization on vein graft patency and intimal hyperplasia of anastomosis. Methods Twentyfour New Zealand rabbits were randomly divided into experimental group and control group, 12 rabbits in each group. A double side of carotid arteryvein transplantation model was made in each rabbit. One side of vein graft was digested by 0.25% trypsin for complete endothelial denudation before transplantation. Recombinant human granulocyte colonystimulating factor was given by subcutaneous injection 24 hours after operation, once per day in successive 10 days in experimental group, saline was given in the same way in control group. Bone marrow stem cells mobilization was observed after operation, including karyote counts and mononuclear cell proportion in peripheral blood. The patency rate of vein grafts and the degree of anastomosis intimal hyperplasia were observed too. Results The karyote counts (t=8.406,P=0.000)and mononuclear cell proportion(t=31.267,P=0.000) in peripheral blood of experimental group increased significantly 5 days after operation than those in control group. The vein grafts with intact endothelium had higher patency rate in both groups. In the vein grafts with complete endothelial denudation, the patency rate were obviously lower, but it was higher in experimental group than those in control group (67% vs. 30%). In the end of experiment, the pulsatility index of the vein grafts anastomosis with complete endothelial denudation was lower in experimental group than that in control group(t=2.958,P=0.009). Pathological examination showed that various degrees of intimal hyperplasia in all anastomoses of vein grafts were observed 4 weeks after operation. The degree of anastomosis intimal hyperplasia was more severe in vein grafts with complete endothelial denudation. Compared with control group, re-endothelization occurred completely in vein grafts with complete endothelial denudation of experimental group and the degree of anastomosis intimal hyperplasia was relatively lower (Plt;0.05). Conclusion Haemopoietic stem cell mobilization can provide protective effects on vein grafts by accelerating reendothelization which might increase vein grafts patency rate in the near future after operation and reduce anastomosis restenosis caused by intimal hyperplasia.

魚精蛋白毒性反應的防治