Abstract： Objective To observe the significance of the changes of cell adhesion molecules (CAM) CD11b/CD18 and sPselectin during the perioperative period of open heart surgery under cardiopulmonary bypass (CPB), and investigate the roles of CD11b/CD18 and sPselectin in systemic inflammatory response triggered by CPB. Methods Thirty patients including 18 males and 12 females, age ranged from 29 to 55 years (45.3±8.1 years) having undergone valvular replacement for rheumatic heart disease in our hospital were selected as the subjects of this research. After anesthesia induction, radial arterial blood sample was collected at six different time points including the time prior to skin incision, and 30 min, 1 h, 6 h, 12 h and 24 h following the start of CPB. The expression levels of CD11b/CD18 were tested by flow cytometry, and concentration of sP-selectin in the plasma was measured with enzymelinked immunosorbent assay(ELISA). Results The expression of CD11b/CD18 was elevated at 30min after CPB, and it reached the peak (581.44±215.26) at 6 h after CPB with significant differences (Plt;0.05). Its expression started to drop at 12 h after CPB, but it was still higher than the expression level before CPB. The expression returned under the level before CPB at 24 h after CPB with insignificance differences (Pgt;0.05). The expression of sPselectin in the peripheral blood started to rise evidently at 30 min after CPB, reaching the peak (51.44±10.06 ng/ml) with significant differences (Plt;0.05). Its expression level decreased at 12 h after CPB and fell back below the level before CPB with insignificant differences (Pgt;0.05). Conclusion CPB can cause the expression of CD11b/CD18 and sPselectin to rise in the peripheral blood, which may play an important role in the systemic inflammatory response triggered by CPB.
ObjectiveTo summarize our experience of right axillary straight mini-thoracotomy for surgical treatment of common congenital heart diseases in infants. MethodsWe conducted a retrospective analysis of 369 infants undergoing open heart surgery through right axillary straight mini-thoracotomy in the 153th Central Hospital of People's Liberation Army from April 2009 to April 2013. There were 191 males and 178 females with their mean age of 8.2±3.1 months (range, 3-12 months)and body weight of 7.8±4.5 kg (rang, 4.5-11.2 kg). Surgical procedures included ventricular septal defect (VSD)repair in 290 patients, atrial septal defect (ASD)repair in 16 patients, VSD and ASD repair in 34 patients, VSD repair and mitral valvuloplasty in 4 patients, valvotomy for pulmonary valve stenosis (PVS)in 9 patients, ASD repair and valvotomy for PVS in 6 patients, correction of partial anomalous pulmonary venous connection in 4 patients, and correction of partial atrioventricular canal defect in 6 patients. ResultsSix patients (1.6%)died postoperatively. Postoperative complications included right atelectasis in 3 patients, right pneumothorax in 2 patients, pneumonia in 16 patients, incision fat liquefaction in 12 patients, third-degree atrioventricular block in 1 patient, cerebral air embolism in 1 patient, and reexploration for bleeding in 3 patients. A total of 295 patients were followed up for 6 to 12 months after discharge. Residual VSD shunt was found in 4 patients, and mild mitral regurgitation was found in 2 patients. ConclusionClinical outcomes of right axillary straight mini-thoracotomy during open heart surgery are satisfactory for infants with common congenital heart diseases, but strict indications and skillful surgical techniques are needed.
Relative/absolute adrenal insufficiency is not uncommmon in the patients undergoing cardiovascular surgery with cardiopulmonary bypass. However, this complication was rarely reported due to its unspecific clinical presentations and the unawareness of ICU physicians and cardiac surgeons. However, this puts them on a higher risk of hemodynamic instability and cardiovascular adverse events during hospitalization. Systematic reviews concentrated on it are rarely reported currently. We aim to review the etiology, risk factors, potential pathogenesis and related research progress for this complication.
Objective To investigate the protection effects of cimetidine for the immune function of patients underwent cardiac operation under cardiopulmonary bypass (CPB). Methods From Jan. 2004 to Jan. 2005, thirty patients suffered from rheumatic cardiac valvular disease received cardiac valve replacement in our hospital, and were divided into cimetidine group and control group.The effects of cimetidine on cellular immune, fluid immune and erythrocytic immune were observed 1d before operation, 1, 3, 5, 7 and 14d after operation. Results After operation,CD3,CD4,CD4/CD8, NK cell activity, Interleukin-2(IL-2), RBC-C3bRR and RBC-ICR in cimetidine group were significantly higher than those in the control group(Plt;0.01). In cimetidine group,those index began to recover on the postoperative 3 to 5 days, and return to normal level on the postoperative 7 days (Pgt;0.05). In control group, 7 and 14 days respectively. Conclusion The protective effects of cimetidine on immune function of openheart operative patients are significant.