Objective To investigate the protective effects of antitumor necrosis factor-α antibody （TNF-αAb） on lung injury after cardiopulmonary bypass （CPB） and their mechanisms. Methods Forty healthy New Zealand white rabbits，weighting 2.0-2.5 kg，male or female，were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ，the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ，the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ，the rabbits received CPB only. In group Ⅳ，the rabbits only received sham surgery. Neutrophils count，TNF-α and malondialdehyde （MDA） concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content，TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ，after CPB，the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count，TNF-α and MDA（P＜0.05），higherTNF-α mRNA expression，apoptosis index and water content of the lung tissues （P＜0.05），and significantly lower oxyg-enation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ，after CPB，the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α （5 minutes after aortic declamping，220.43±16.44 pg/ml vs.185.27±11.78 pg/ml，P＜0.05；249.99±14.09 pg/ml vs.185.27±11.78 pg/ml，P＜0.05），significantly higher apoptosis index （at the time of CPB termination，60.7‰±13.09‰ vs. 37.9‰±7.78‰，P＜0.05；59.6‰±7.74‰ vs. 37.9‰±7.78‰，P＜0.05），significantly higher blood levels of neutrophils count and MDA （P＜0.05），significantly higher TNF-α mRNA expression and water content of the lung tissues （P＜0.05），and significantly loweroxygenation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ，rabbits in group Ⅲ had significantly higher above parameters （P＜0.05） but lower oxygenation index （P＜0.05） only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.
目的观察微创体外循环（minimal extracorporeal circulation，MECC）对主动脉瓣置换术临床效果的影响。 方法回顾性分析我院2010年3月至2012年10月共25例应用MECC方法行单纯主动脉瓣置换术（AVR）的临床资料，其中男15例、女10例，年龄40（19～58）岁。 结果总体外循环时间67（51～89）min、主动脉阻断时间42（33～63）min、转流中最低血红蛋白（Hb）9.6（8.3～12.6）g/dl、流转后Hb 9.5（7.7～12.6）g/dl，体外循环中无1例患者因Hb低而输入红细胞。所有患者均顺利拔除胸腔引流管，顺利出院，无院内死亡。 结论MECC系统应用于主动脉瓣置换安全可行，比传统心肺旁路系统具有更好的生物相容性和良好的临床结果，值得推广。
目的:探讨自体血液回收技术对循环、血细胞和凝血功能的影响及应用效果。方法: 选择急诊大失血手术患者27例,采用ZITI-2000型血液回收机回收血液,经过滤、离心、清洗后回输给患者。分不同时点观察HR、SBP、MAP、DBP、SPO2的变化,并监测RBC、Plt、HB、Hct、FIB、PT、APTT的变化。计算输血量和异体输血率。随机选择8例进行回收原血和回输 血血细胞学比较。结果:(1)术前血压较低,心率较快,回输血液后,HR显著降低(Plt;0.01),SBP和MAP显著升高(Plt;0.01)。(2)术前RBC、HB和Hct均低于正常水平,回输后各时点均升高明显(Plt;0.01)。术前FIB和Plt低于正常水平,回输后各时点增高,但无显著意义。PT、APTT无明显变化。(3)回收原血平均每例3735mL,回输血平均每例1589mL,异体输血率为25％。(4)回输血RBC、HB和Hct均显著高于回收原血(Plt;0.01)。结论:自体血液回收技术用于临床安全可靠,能有效维持循环的稳定,对凝血功能无明显影响,节约血源,减少异体输血。
Objective To study the advances in microcirculation after islets of Langerhans transplantation (ILT). Methods The literature in the recent years on the study of the relationship between ILT and microcirculation was reviewed. Results The process of angiogenesis and revascularization of the islet grafts was in progress within 1 week after transplantation, and was completed within 10-14 days after transplantation, exhibiting a microangioarchitecture similar to pancreatic islets in situ. The sequence of vascular intraislet cellular perfusion was from β cells outward to α-and δ-cell cortex, with the majority of α cells perfused before the majority of δ cells. Freely transplanted islet grafts were revascularized from the hostderived microvascular bed. The interstitial pressure in the islet transplants was markedly lower than the capillary pressure. There were clearly differences in microcirculation between syngeneic and xenogeneic islet grafts. The phenomena of microcirculation failure were observed in xenografts. The influential factors of microcirculation after ILT were ①culture temperature of isolated islets, ②cultured time and cryopreserved method of islets, ③blood glucose, ④immunosuppressive agents, ⑤angiogenesis factors. Conclusion Microvascularization of freely islet grafts is one of the essential requirements for successful engraftment, guaranteeing sufficient nutritional blood supply to the tissue and establishing blood drainage for adequate liberation of the endocrine hormones. Through the studies of the microcirculation after ILT, it is helpful to recognize the mechanism of the survival of islet grafts.
OBJECTIVE: To study the forms of microcirculation of arterialized venous flap. METHODS: Twenty New Zealand rabbits were equally divided into two groups, arterialized venous flap group (group A) and control group (group B). The microcirculatory haemodynamic of arterialized venous flap was studied through observation of transparent chamber in rabbit’s ears with aspecial TV set with manification of 1000. RESULTS: The blood of arterilized venous flap flowed through venule anastomosis and drained to another venule. CONCLUSION: It is the main form of microcirculation in early stage that blood flows from venule to draining venule by way of communicating networks between venules.
The velocity of blood in vessels is an important indicator that reflects the microcirculatory status. The core of the measurement technology, which is based on spatiotemporal (ST) image, is to map the cell motion trace to the two-dimensional ST image, and transfer the measurement of flow velocity to the detection of trace orientation in ST image. This paper proposes a trace orientation measurement algorithm is based on Randomized Hough Transformation and projection transformation, and it is able to estimate trace orientation and flow velocity in noisy ST images. Experiments showed that the agreement between the results by manual and by the proposed algorithm reached over 90%.
Objective To investigate the effects of exogenous pulmonary surfactant （PS） on ventilation weaning and respiratory mechanics in infants with acute lung injury（ALI） after cardiopulmonary bypass （CPB）.Methods Twelve infants underwent cardiopulmonary bypass cardiac surgery committed with ALI and difficulty in weaning from ventilation were included in this study.Exogenous PS was used in the treatment via intra-tracheal administration.The changes of blood gas，respiratory mechanics and the conditions of ventilation weaning were observed.Results After intra-tracheal PS administration，spontaneous breath remained steady；spontaneous respiratory rate significantly decreased from，tidal volume of spontaneous breath increased significantly.Three concave sign disappeared and koilosternia was alleviated.PaCO2 value decreased significantly and peak inspiratory pressure（PIP） decreased from （36.18±10.25）cm H2O to （25.11±5.14）cm H2O （Plt;0.01）.Static lung compliance （Cstat） increased from （1.49±0.65）mL·cm H2O-1·kg-1 before treatment to （1.95±0.50） mL·cm H2O-1·kg-1 6 h after treatment （Plt;0.01）；and airway resistance （Rstat）decreased from （128.17±26.34） cm H2O·L-1·s-1 before treatment to （78.56±18.22） cm H2O·L-1·s-1 6 h after treatment （Plt;0.01）.All 12 infants weaned from ventilator successfully.Conclusion Combined with PS intra-tracheal treatment，lung protective ventilation strategy can significantly improve parameters of respiratory mechanics，increase dynamic lung compliance，decrease airway resistance，which can decrease the breathing effort of the infants and make it easy to wean from ventilator.