保留冠状动脉的猪心螺旋形心室肌带的解剖

Objective Based on the Helical Ventricular Myocardial Band (HVMB) theory proposed by Torrent-Guasp,the ventricular myocardial hand extends from the root of the pulmonary artery to the root of the aorta with two helical coils.This new theory is considered as a revolutionary concept for further understanding the global, three-dimensional and functional architecture of the ven- tricular myocardium. No repot had described techniques for disecting HVMB while keepin～ the integrity of the coronmy artery sys- tern. We explored techniques for dissecting HVMB in swine.Methads 33 fresh swine hearts were randomly divided intoll groups, 3 bearts in each. 160% barium sulfate (type I)suspmmion was injected into the coronary artery system. The coronary arteries were li- gated. The strial tissue was removed following puuing the hearts in boiling water then cooling for several hours. The superficial coro- nary vessels and fat tissue around the atrio-ventricular taxi inter-ventricular sulcus we～'e preserved. Some branches of the left anterior descending artery, distal segment, of posterior descending branch, and middle and distal segment of obtuse marginal branches were mu- tilated appropriately. HVMB dissection was completed with fingers in accordnce with Torrent Guasp' s technique. Results A contin- ued bundle of muscle, originated at the root of pulmonary artery and ended at the root of aorta, was unwrapped along the major dire- tion of the cardiac muscle fiber in all of the 33 hearts with spating of the coronary artery. The swine hearts' ventricular myocandium was cumosed of two loops, with basal loop firm the root of the pulmonart artery to the anterior papillary muscle and apical from the beginning of the anterior papillary muscle to the root tithe aorta. Each loop consisted of two segments: the right segment-coincid- ing with the right ventricular free wall and the left segment-coinciding with the basal d the left ventricular free wall. Posterior papillary muscle, which belongs to the descendant segment, denmrcated the border between the descendent and the ascendant of the HVMB's apical loop. Conclusion Although controversies about the theory of the HVMB remain, we have dissected the HVMB in the swine hearts' ventricular myocardium successfully with sparing of the coronary artery systems. This dissection procedure provides technical information for the studies of associated diseases based on the theory of HVMB.     

阿司匹林剂量对非体外循环下冠状动脉旁路移植术后获得性阿司匹林抵抗的影响

目的：应用血栓弹力图（TEG）评价非体外循环下冠状动脉旁路移植（OPCAB）术后早期（14 d内）100 mg/d和200 mg/d阿司匹林治疗下血小板聚集抑制率（ INHAA）及获得性阿司匹林抵抗（ AR）的发生率,探讨增加阿司匹林剂量对术后早期获得性AR的影响。方法前瞻性连续选取行OPCAB术的患者60例,按术后服用阿司匹林剂量的不同随机分为两组：阿司匹林200 mg组、阿司匹林100 mg组,分别于停药前（Ta）、手术前（Tb）、术后应用阿司匹林治疗后6 h（T1）、第5天（T2）、第14天（T3）进行TEG血小板功能检测。结果术后T1、T2时200 mg组 INHAA显著高于100 mg 组（ P ＜0.05）, T3时两组差异不显著（ P＞0.05）。 T1时AR发生率200 mg组显著低于100 mg组（P＜0.05）,T2、T3时AR发生率两组差异不显著（P＞0.05）。结论 OPCAB术后早期（14 d内）200 mg/d阿司匹林抗血小板治疗可以增加INHAA,减少获得性AR的发生率,有益于术后早期抗血小板治疗。     

保留冠状动脉的猪心螺旋形心室肌带的解剖

Objective Based on the Helical Ventricular Myocardial Band (HVMB) theory proposed by Torrent-Guasp,the ventricular myocardial hand extends from the root of the pulmonary artery to the root of the aorta with two helical coils.This new theory is considered as a revolutionary concept for further understanding the global, three-dimensional and functional architecture of the ven- tricular myocardium. No repot had described techniques for disecting HVMB while keepin～ the integrity of the coronmy artery sys- tern. We explored techniques for dissecting HVMB in swine.Methads 33 fresh swine hearts were randomly divided intoll groups, 3 bearts in each. 160% barium sulfate (type I)suspmmion was injected into the coronary artery system. The coronary arteries were li- gated. The strial tissue was removed following puuing the hearts in boiling water then cooling for several hours. The superficial coro- nary vessels and fat tissue around the atrio-ventricular taxi inter-ventricular sulcus we～'e preserved. Some branches of the left anterior descending artery, distal segment, of posterior descending branch, and middle and distal segment of obtuse marginal branches were mu- tilated appropriately. HVMB dissection was completed with fingers in accordnce with Torrent Guasp' s technique. Results A contin- ued bundle of muscle, originated at the root of pulmonary artery and ended at the root of aorta, was unwrapped along the major dire- tion of the cardiac muscle fiber in all of the 33 hearts with spating of the coronary artery. The swine hearts' ventricular myocandium was cumosed of two loops, with basal loop firm the root of the pulmonart artery to the anterior papillary muscle and apical from the beginning of the anterior papillary muscle to the root tithe aorta. Each loop consisted of two segments: the right segment-coincid- ing with the right ventricular free wall and the left segment-coinciding with the basal d the left ventricular free wall. Posterior papillary muscle, which belongs to the descendant segment, denmrcated the border between the descendent and the ascendant of the HVMB's apical loop. Conclusion Although controversies about the theory of the HVMB remain, we have dissected the HVMB in the swine hearts' ventricular myocardium successfully with sparing of the coronary artery systems. This dissection procedure provides technical information for the studies of associated diseases based on the theory of HVMB.     

深低温停循环时不同脑保护方法对猪大脑组织含水率的影响

目的：观察试验用小型猪脑海马头部组织含水率，揭示深低温停循环时不同脑保护方法对脑水肿的影响。方法：①实验于1998—10／2000—02在解放军总医院动物实验中心完成。选用北京农业大学实验用小型猪16头。随机将猪分为4组：深低温停循环组，顺行脑灌注组，逆行脑灌注组，逆行脑灌注＋尼莫地平组，每组4头。②鼻咽温降至18℃时分别给予如下处理90min；深低温停循环组通过上、下腔静脉放血至氧合器的静脉储血罐，冰袋敷头；顺行脑灌注组阻断降主动脉，通过主动脉弓灌注头臂三支血管，维持灌注压在50mmHg（1mmHg=0．133kPa）左右；逆行脑灌注组阻断降主动脉，结扎奇静脉，通过上腔静脉逆行灌注，维持灌注压在25mmHg左右；逆行脑灌注＋尼莫地平组在体外循环开始10min内经氧合器的标本口加入尼莫地平注射液，其他操作同顺行脑灌注组。③复温120min至鼻咽温36℃。取左侧海马头部组织称湿质量，于110℃烘箱内干燥24h，测干质量，计算组织含水率。④多组比较采用单因素完全随机设计方差分析。结果：小型猪16只均进入结果分析。大脑组织含水率：逆行脑灌注组明显高于深低温停循环组、顺行脑灌注组和逆行脑灌注＋尼莫地平组[（83．60&;#177;0．68）％，（81．52&;#177;1．16）％，（81．04&;#177;0．59）％，（80．92&;#177;0．74）％，F=9．22，P=-0．0019]，而深低温停循环组、顺行脑灌注组、逆行脑灌注＋尼莫地平组间差异不明显（P〉0．05）。结论：①逆行脑灌注加重深低温停循环后的脑水肿，脑水肿可能是深低温停循环后神经功能障碍的一原因。②尼莫地平在深低温停循环时有降低逆行脑灌注引起的脑水肿的作用。     

保留冠状动脉的猪心螺旋形心室肌带的解剖

Objective Based on the Helical Ventricular Myocardial Band (HVMB) theory proposed by Torrent-Guasp,the ventricular myocardial hand extends from the root of the pulmonary artery to the root of the aorta with two helical coils.This new theory is considered as a revolutionary concept for further understanding the global, three-dimensional and functional architecture of the ven- tricular myocardium. No repot had described techniques for disecting HVMB while keepin～ the integrity of the coronmy artery sys- tern. We explored techniques for dissecting HVMB in swine.Methads 33 fresh swine hearts were randomly divided intoll groups, 3 bearts in each. 160% barium sulfate (type I)suspmmion was injected into the coronary artery system. The coronary arteries were li- gated. The strial tissue was removed following puuing the hearts in boiling water then cooling for several hours. The superficial coro- nary vessels and fat tissue around the atrio-ventricular taxi inter-ventricular sulcus we～'e preserved. Some branches of the left anterior descending artery, distal segment, of posterior descending branch, and middle and distal segment of obtuse marginal branches were mu- tilated appropriately. HVMB dissection was completed with fingers in accordnce with Torrent Guasp' s technique. Results A contin- ued bundle of muscle, originated at the root of pulmonary artery and ended at the root of aorta, was unwrapped along the major dire- tion of the cardiac muscle fiber in all of the 33 hearts with spating of the coronary artery. The swine hearts' ventricular myocandium was cumosed of two loops, with basal loop firm the root of the pulmonart artery to the anterior papillary muscle and apical from the beginning of the anterior papillary muscle to the root tithe aorta. Each loop consisted of two segments: the right segment-coincid- ing with the right ventricular free wall and the left segment-coinciding with the basal d the left ventricular free wall. Posterior papillary muscle, which belongs to the descendant segment, denmrcated the border between the descendent and the ascendant of the HVMB's apical loop. Conclusion Although controversies about the theory of the HVMB remain, we have dissected the HVMB in the swine hearts' ventricular myocardium successfully with sparing of the coronary artery systems. This dissection procedure provides technical information for the studies of associated diseases based on the theory of HVMB.     

低温停循环中的神经元死亡及其机制

低温停循环 (HCA)存在时间限制问题 ,超过 4 5～ 6 0min的停循环会使术后神经系统并发症增高 ,最易受影响的是脑的高级智力功能。这是由神经元死亡导致的。神经元死亡有坏死和程序性死亡 (凋亡 )两种形式 ,这两种形式在HCA中均有发生。HCA后坏死和凋亡有时间依赖现象 ,并且各自在脑内的分布也有区别。兴奋毒性可能是不同神经元死亡的共同通路 ,神经细胞内钙超载可看作是细胞死亡的共同通路。兴奋性氨基酸通过其受体使细胞内Ca2 积聚 ,继而NO合成增加 ,因而引起神经元凋亡、坏死     

在深低温停循环下行布加氏综合征根治术--附19例报告(摘要)

本文报道19例布加氏综合征(Budd-Chiarissyndrome)在深低温停循环(DHCA)下实施根治术并取得了良好效果。现报告如下:1　资料及方法　　1993年至1999年,19例我院住院的布加氏综合征患者在DHCA方法下施行了根治术;其中男性11例,女性8例;年龄3～44(平均30.2)岁(其中1例3岁男性患儿,其余均为成人);体重9～80(平均59)kg。其中14例肝大并伴有不同程度的下肢水肿及腹水。体外循环(CPB)时间98～231(154.4)分;肝素用量2.5～3mg/kg。全血活化凝固时间(ACT)500～900秒;最低咽温14.3～20.0(平均16.2)℃;最低肛温17.0～24.0(平均20.6)℃;CPB中平…     

保留冠状动脉的猪心螺旋形心室肌带的解剖

目的 探索保留完整冠状动脉的猪心螺旋形心室肌带(helical wentricular myocardial band,HVMB)的解剖方法.方法 取33只新鲜猪心,随机分成11组,每组3只,冠状动脉内分别选择性地注入160%硫酸钡(Ⅰ型)混悬液,猪心于水中煮沸、冷却后移除心房组织,但完整保留心脏表面的冠状动脉及房室沟和室间沟周围的脂肪组织,适当离断冠状动脉的主干及其分支,参考Torrera-Guasp等的HVMB解剖方法用手指行钝性解剖.结果 在冠状动脉保留完整的基础上,将猪心心室肌解剖出一条起点为肺动脉根部,终点到主动脉根部连续的肌肉带.结论 成功保留完整冠状动脉的猪心HVMB解剖有益于完善和加深HVMB理论的理解和认识,可为探求基于HVMB理论的冠状动脉疾病及其相关疾病的研究提供解剖上的技术支持.     

右心室双通道术治疗右心室流出道狭窄合并冠状动脉异常

目的探讨先天性右心室流出道狭窄合并冠状动脉横跨右心室流出道表面患者行右心室双通道术的方法及临床效果。方法 2006年4月至2008年8月,我中心连续收治6例右心室流出道狭窄合并冠状动脉横跨右心室流出道表面患者,男4例,女2例;年龄0.8～12.0岁,平均年龄5.5岁。法洛四联症2例,右心室双出口4例。手术在保留原来右心室肺动脉出口的同时,采用自体心包片或国产牛心包片建立右心室的第2个出口。结果围术期无死亡患者,术后右心室与肺动脉压差为24.17±6.18mmHg。出院前复查心脏超声心动图提示:2个出口均有血液,未见流出道阻塞。随访6例,随访时间3个月～1年,其中4例患者心前区闻及2/6级收缩期杂音,2例闻及3/6级杂音。超声心动图提示:所建的右心室通道通畅,右心室与肺动脉间的压差(24.67±5.32mmHg)与术后早期比较变化不大,远期效果尚待进一步观察。结论右心室双通道术可在保护横跨右心室流出道表面冠状动脉的情况下疏通右心室流出道。     

婴幼儿体外循环中监测胶渗压及红细胞压积在超滤中的作用

目的:探讨婴幼儿体外循环(CPB)期间超滤的应用及其与胶体渗透压(COP)和红细胞压积(Hct)的相互影响。方法:检测38例体质量10 kg以下先天性心脏病(CHD)患儿CPB中的COP,于转机前对预充液进行常规超滤(CUF)以适当提高COP。CPB中应用CUF,停机后依据COP及Hct加用改良超滤(MUF)。结果:CUF超滤量(407.63±165.11)mL。9例加用MUF,超滤量(88.89±34.06)mL,进一步浓缩血液,提高COP。结论:CUF用于预充液超滤可适当提高其COP,CUF及MUF可在婴幼儿心脏手术中单独或联合应用。综合COP及Hct可以决定超滤方式及超滤量,是否输入红细胞或胶体及输入量。