Objective　To explore the injurious effect of the serum drawn from patient under cardiopulmonary bypass (CPB) on pulmonary surfacant-associated protein A(SP-A) and the preventive effect of pentoxifylline (PTX) on the protein. Methods　The cultured rat alveolar epithelial cell type Ⅱ(AT-Ⅱ) were incubated with CPB serum to observe the change of the cell morphology, and the expressions of SP-A and SP-A mRNA. Results　Traumatic changes and the decrease of SP-A and SP-A mRNA expressions were found in AT-Ⅱ cells cultured with CBP serum. PTX exerted protective effect on the cells. Conclusion　The serum after CPB can directly injure rat AT-Ⅱ cells in vitro, and inhibit the SP-A expression at transcription and translation levels, which probably is an important reason for the quantitative and qualitative abnormality of pulmonary surfactant after operation. PTX may alleviate the inhibitory effect of CPB serum on SP-A.

Objective To explore the appropriately operative chance , method, and perioperative management of coronary arterybypass grafting (CABG) in the patients with severe left main artery (LMA) stenosis with three-vessel-disease.Methods A total of296 patients with severe LMA stenosis with three-vessel-disease who underwent CABG surgery was analyzed retrospectively from 2003through 2013.Of them, 276 patients underwent conventional coronary artery bypass surgery on pump ( CCABG)and 20 patients underwentoff-pump CABG( OPCAB); 172 Patients was over 60 years old (58.1%)and 246 patients (83.10%) had concomitant diseasesincluding valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect , stroke, renal failure,and cancer.Left internal mammary artery use was in 281 patients (95.1%); and 32 patients were implanted intra-aortic ballonpump(IABP) perioperatively.Results There were 7 cases(2.36 %) death of postoperative low cardiac output , ventricular fibrillation,cerebral infarction, renal failure, and multiple organ failure, respectively.Postoperative complications were low cardiac output ,respiratory failure , ventricular fibrillation, cereboembolism, cardiac tampomade, renal failure, stroke, and multiple organ failure.Afterfollow-up 2 to 84 months, there was 3 death in which 2 death of cardiac factors.Conclusions CCABG was a safe and effectivemethod in patients with severe LMA stenosis with severe three -vessel-disease.Preoperative insertion of IABP can certainly avoid the po -tential operative risk factor and significantly decrease the mortality and morbidity .