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Cardiac and vascular anesthesia: The requisites in anesthesiology 心脏和血管麻醉:麻醉学的必要条件
Pub Date : 2004-09-01 DOI: 10.1051/ject/2004363284
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引用次数: 0
Selected Abstracts for the Australasian Society of Cardio-Vascular Perfusionists Inc. 澳大利亚心血管灌注医师协会精选摘要。
Pub Date : 2004-09-01 DOI: 10.1051/ject/2004363294
H. Dando, N. Casey, A. Vuylsteke, T. Burns
Objective: Reports evaluating the efficacy of heparin-bonded circuits (HBC) to blunt inflammation, platelet dysfunction and thrombin generation in response to cardiopulmonary bypass (CPB) have varied. We hypothesized that this variability may, in part, be related to the use of cardiotomy suction (CS), which has been demonstrated to reintroduce pro-coagulant and pro-inflammatory factors into the systemic circulation during CPB. A prospective, randomized study was undertaken to evaluate the specific effects of CS. Methods: Thirty-six patients undergoing first-time, non-emergent, coronary artery bypass graft surgery with CPB were randomized to one of three treatment groups: I) non-heparin bonded circuits with the use of CS (n = 12), II) Duraflo-II HBC with CS (n = 12), or III) Duraflo-II HBC without CS (n = 12). Thrombin generation (PF1.2), neutrophil activation (PMN elastase, PMN-E), platelet activation ( (cid:1) -thromboglobulin, (cid:1) -TG) and neuronal injury (neuron-specific enolase, NSE) were analyzed by ELISA assays post CPB and compared to pre bypass levels. Results are presented as mean ± SEM. Results: Pre bypass levels of all markers were similar amongst treatment groups.
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引用次数: 0
Plateletworks™ Platelet Function Test Compared to the Thromboelastograph™ for Prediction of Postoperative Outcomes Plateletworks™血小板功能试验与Thromboelastograph™预测术后预后的比较
Pub Date : 2004-06-01 DOI: 10.1051/ject/2004362149
J. Ostrowsky, Jennifer Foes, M. Warchol, Gary Tsarovsky, J. Blay
Approximately 3.5 million units of platelets are transfused in the United States each year to patients undergoing open-heart surgery with cardiopulmonary bypass (CPB). CPB is a known contributor to platelet loss and platelet dysfunction leading to disruption of hemostasis. Impaired hemostasis results in excess bleeding in 5–25% of all patients undergoing CPB. For this reason, it may be beneficial to measure platelet number and function in these patients. The purpose of this study was to compare the Plateletworks™ platelet function analyzer to the thromboelastograph (TEG) in predicting postoperatiave hemostatic outcomes as measured by blood product use and chest tube (CT) drainage. This study consisted of 35 adult patients undergoing cardiac surgery with cardiopulmonary bypass at Rush-Presbyterian-Saint Luke’s Medical Center (RPSLMC). The Plateletworks™ and TEG tests were performed preoperatively, after protamine was given, and 24 hours postoperatively on all patients. Plateletworks™ demonstrated a statistically significant change in platelet function as shown by the adenosine diphosphate (ADP) reagent tube from the preoperative period to the removal of the aortic cross clamp (p = .011). The TEG did not demonstrate a significant change in the k-time and maximum amplitude (MA), but did show a significant change in the alpha-angle from the pre-operative to postoperatiave sample (p = .035). A correlation was found between Plateletworks™ collagen reagent tubes preoperatively and CT drainage (p = .048, r −0.324). No statistical correlation was established between TEG parameters and CT drainage at any time interval. TEG preoperative MA showed a correlation to receipt of blood products (p = .016). When comparing the Plateletworks™ to the TEG in this study, the Plateletworks™ system was a more useful predictor of blood product use and chest tube drainage.
在美国,每年大约有350万单位的血小板输注给接受体外循环(CPB)的心内直视手术的患者。CPB是一种已知的血小板损失和血小板功能障碍导致止血中断的因素。在所有接受CPB的患者中,有5-25%的患者止血受损导致出血过多。因此,在这些患者中测量血小板数量和功能可能是有益的。本研究的目的是比较Plateletworks™血小板功能分析仪与血栓弹性描画仪(TEG)在预测术后止血结果方面的差异,这些结果是通过血液制品使用和胸管(CT)引流来测量的。本研究包括在拉什-长老会-圣卢克医疗中心(RPSLMC)接受心脏手术和体外循环的35名成年患者。所有患者术前、给予鱼精蛋白后和术后24小时分别进行Plateletworks™和TEG检测。Plateletworks™显示,从术前到移除主动脉十字钳期间,二磷酸腺苷(ADP)试剂管显示血小板功能有统计学意义的变化(p = 0.011)。TEG在k-time和最大振幅(MA)上没有明显变化,但在α角上从术前到术后有明显变化(p = 0.035)。术前Plateletworks™胶原试剂管与CT引流有相关性(p = 0.048, r−0.324)。TEG参数与CT引流在任何时间间隔均无统计学相关性。TEG术前MA与接受血液制品相关(p = 0.016)。在本研究中将Plateletworks™与TEG进行比较时,Plateletworks™系统是血液制品使用和胸管引流的更有用的预测指标。
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引用次数: 30
TGF-β1 Overexpression: A Mechanism of Diastolic Filling Dysfunction in the Aged Population TGF-β1过表达:老年人舒张充盈功能障碍的一种机制
Pub Date : 2004-03-01 DOI: 10.1051/ject/200436169
D. Larson, R. Ingham, Cory M. Alwardt, Bo Yang
The prevalence of cardiovascular disease in the United States dramatically increases with age. A hallmark feature of the aged myocardium is increased fibrosis resulting in diastolic dysfunction. Moreover, the survival of patients subsequent to a myocardial infarction is inversely related to age because of a certain extent to maladaptive remodeling mediated by cardiac fibroblasts. Our hypothesis is that cardiac fibroblast (CF) dysfunction results in overexpressed TGF-β1 leading to increased cardiac collagen content in the aged population. TGF-β1 stimulates the synthesis of the extracellular matrix proteins, including collagen in the cardiac tissues. The RT–PCR analysis of mRNA expression of TGF-β1 of the CF was increased by 43% in the aged mice as compared to the younger. The stiffness of the left ventricle is expressed with the slope of the end-diastolic pressure-volume relationship parameter, (mmHg/L). In a mouse model, we demonstrated that was 0.30 ± 0.05 in the young as compared to 0.52 ± 0.10 in the aged (p < .05). The ventricular stiffness was associated with the myocardial collagen content; namely, young versus the aged was 9.5 ± 4.0 as compared to 16.4 ± 2.3% of total protein, respectively (p < .05). In conclusion, the gene structure–function relationships support our hypothesis that cardiac fibroblast disregulation contributes to diastolic filling dysfunction in elderly persons. These data provide a potential contributory mechanism for diastolic dysfunction that may be vital in caring for the aged open-heart surgical patient.
在美国,心血管疾病的患病率随着年龄的增长而急剧上升。衰老心肌的一个显著特征是纤维化增加导致舒张功能障碍。此外,心肌梗死后患者的生存与年龄呈负相关,这在一定程度上是由于心肌成纤维细胞介导的不适应重构所致。我们的假设是,心肌成纤维细胞(CF)功能障碍导致TGF-β1过表达,导致老年人群心脏胶原蛋白含量增加。TGF-β1刺激心肌组织中胶原蛋白等细胞外基质蛋白的合成。RT-PCR分析老年小鼠CF TGF-β1 mRNA表达量较年轻小鼠增加43%。左心室的刚度用舒张末期压力-容积关系参数(mmHg/L)的斜率表示。在小鼠模型中,我们证明了年轻小鼠为0.30±0.05,而老年小鼠为0.52±0.10 (p < 0.05)。心室僵硬度与心肌胶原含量相关;即,年轻人和老年人的总蛋白含量分别为9.5±4.0和16.4±2.3% (p < 0.05)。总之,基因结构-功能关系支持我们的假设,即心脏成纤维细胞失调有助于老年人舒张充盈功能障碍。这些数据提供了舒张功能障碍的潜在机制,这可能对老年心内直视手术患者的护理至关重要。
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引用次数: 2
American Society of Extra-Corporeal Technology 42nd International Conference 美国超物质技术学会第42届国际会议
Pub Date : 2004-03-01 DOI: 10.1051/ject/200436191
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引用次数: 8
The Rheological Effects of X-Coating™ with Albumin and Hetastarch on Blood during Cardiopulmonary Bypass X-Coating™与白蛋白和Hetastarch对体外循环血液流变学的影响
Pub Date : 2004-03-01 DOI: 10.1051/ject/200436136
Bernadette T Nutter, A. Stammers, Ryan G Schmer, R. Ahlgren, Tunisia A Ellis, Chen Gao, Hunter B Holcomb, L. Hock, Tab Burkeman
Cardiopulmonary bypass (CPB) exposes blood to artificial surfaces, resulting in mechanical damage to the formed elements of the blood. The purpose of this study was to examine the effect of poly(2-methoxyethylacrylate) coating (PMEA, X-Coating™) on coagulation and inflammation under various prime conditions. An in vitro analysis was conducted utilizing fresh whole human blood (2 units) and a CPB circuit (n 18) consisting of a venous reservoir, oxygenator, and arterial filter. Nine nontreated circuits were used in a control group (CTR) and an equal number of tip-to-tip PMEA circuits for treatment (TRT). Each group was divided into three subgroups based upon prime: crystalloid, hetastarch (6%), and albumin (5%). CPB was conducted with a hematocrit 30% ± 2, temperature 37°C ± 1, and a flow of 4L/min. Samples were collected at 0, 60, 120, and 240 minute intervals. Endpoint measurements included thromboelastograph index (TI), and markers of inflammation and coagulation. The TI was significantly depressed in both groups when hetastarch was used in the prime. The TRT had significantly higher TI levels in both the crystalloid (0.3 ± 0.1 vs. −3.3±[1.2, P < .05) and albumin (0.6 ± 0.2 vs−3.9± −1.1. P < .03) subgroups compared to CTR groups. Platelet count was significantly higher in TRT as compared to CTR groups, except for both hetastarch groups. SEM demonstrated significant fibrin deposition on nontreated circuitry but little to no detection in the TRT group. In conclusion, both surface coating and prime components significantly effect coagulation, with PMEA circuits resulting in more favorable preservation of function.
体外循环(CPB)将血液暴露在人造表面,导致血液中已形成元素的机械损伤。本研究的目的是研究聚(2-甲氧基乙基丙烯酸酯)涂层(PMEA, X-Coating™)在不同条件下对凝血和炎症的影响。体外分析利用新鲜全血(2单位)和CPB回路(n 18)进行,CPB回路由静脉储血器、氧合器和动脉过滤器组成。9个未处理的电路作为对照组(CTR),等量的尖端对尖端PMEA电路用于治疗(TRT)。每组根据质数分为三个亚组:晶体蛋白、淀粉蛋白(6%)和白蛋白(5%)。CPB在血细胞比容30%±2,温度37℃±1,流量4L/min的条件下进行。每隔0、60、120和240分钟采集样品。终点测量包括血栓弹性指数(TI)、炎症和凝血标志物。两组在启动期使用hetastarch时,TI明显下降。TRT在晶体(0.3±0.1 vs. - 3.3±[1.2,P < 0.05)和白蛋白(0.6±0.2 vs. - 3.9±- 1.1)中的TI水平均显著升高。P < .03)。与CTR组相比,TRT组血小板计数显著高于CTR组,但两组除外。扫描电镜显示,在未处理的电路中有明显的纤维蛋白沉积,但在TRT组中几乎没有检测到。综上所述,表面涂层和主要成分都对凝血有显著影响,PMEA电路更有利于功能的保存。
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引用次数: 8
From the Editor Extracorporeal Circulation: A Half-Century of Accomplishment 体外循环:半个世纪的成就
Pub Date : 2003-03-01 DOI: 10.1051/ject/20033512
A. Stammers
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引用次数: 0
Trillium™-Coated Oxygenators in Adult Open-Heart Surgery: A Prospective Randomized Trial Trillium™涂层氧合器用于成人心内直视手术:一项前瞻性随机试验
Pub Date : 2002-12-01 DOI: 10.1051/ject/2002344248
MS Timothy Dickinson, PhD C. B. Mahoney, MS Ccp Mark Simmons, MS Ccp Angela Marison, BS Ccp Paul Polanski, 60154-5701. E-mail
This randomized, prospective clinical trial examines the impact of the use of Trillium™ biopassive surface coating on clinical outcomes after cardiopulmonary bypass (CPB) that may be induced by contact of blood elements with foreign surfaces. The study consisted of 98 consecutive patients randomly assigned to either a CPB circuit that consisted of a Trillium-coated Affinity open reservoir oxygenator or a CPB circuit with an uncoated Affinity open reservoir oxygenator. The operative procedure performed on all 98 patients consisted of either coronary artery bypass graft (CABG), valve, or a combination of the two. Exclusion criteria consisted of patients who presented to the operating room in circulatory arrest. Trillium biopassive surface coating resulted in improved clinical outcomes and fewer adverse events when compared to the control group. Significantly, fewer patients required no blood products (18.3% in the control group vs. 32.7% in the treatment group), even though the control group had a significantly higher pre-bypass hematocrit. Postoperative atrial fibrillation (24.5% vs. 16.3%) and reoperation for bleeding (10.2% vs. 4.1%) showed a much lower incidence in the Trillium group. Significance was not reached because of the small sample size resulting in low power. Trillium circuits result in improved patient outcomes in the treatment group when compared to the control circuit group.
这项随机、前瞻性临床试验研究了使用Trillium™生物活性表面涂层对体外循环(CPB)后临床结果的影响,CPB可能是由血液元素与异物表面接触引起的。该研究包括98名连续的患者,随机分配到CPB回路中,CPB回路由一个涂覆的亲和开放储氧器组成,或CPB回路与一个未涂覆的亲和开放储氧器组成。所有98例患者的手术包括冠状动脉旁路移植术(CABG)、瓣膜或两者的结合。排除标准包括在手术室出现循环停止的患者。与对照组相比,Trillium生物钝化表面涂层改善了临床结果,减少了不良事件。值得注意的是,不需要血液制品的患者较少(对照组为18.3%,治疗组为32.7%),尽管对照组的旁路术前血细胞比容明显较高。Trillium组术后房颤发生率(24.5%比16.3%)和再手术出血发生率(10.2%比4.1%)明显降低。由于样本量小导致功耗低,因此没有达到显著性。与对照组相比,治疗组的Trillium电路改善了患者的预后。
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引用次数: 1
A Man to be Remembered Bennett A. Mitchell (1923–2002) 贝内特·A·米切尔(1923-2002)
Pub Date : 2002-09-01 DOI: 10.1051/ject/2002343168
P. R. Cappola
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引用次数: 0
Abstracts for Oral and Poster Presentations for the American Society of Extra-Corporeal Technology 40th International Conference 美国超物质技术学会第40届国际会议口头和海报报告摘要
Pub Date : 2002-03-01 DOI: 10.1051/ject/200234141
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引用次数: 0
期刊
The Journal of ExtraCorporeal Technology
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