Fifty-two patients with chronic thrombeembolism (41 male, 11 female) aged 33-67 yr underwent pulmonary endarterectomy between 1997-2008. Anesthesia was induced with etomidate, fentanyl/ sufentanil and rocuronium/vecuronium and maintained with large doses of narcotics supplemented with low concentrations of isoflurane/sevoflurane if necessary. Swan-Ganz catheter was placed after induction of anesthesia. Trausesophageal echocardiography was monitored. Bilateral pulmonary thromboembolism was performed using profound hypothermia with circulatory arrest. After operation, 35 patients still had sustained pulmonary hypertension (67%). Nervous system complications occurred in 7 patients ( 14% ). Six patients developed lung bleeding (12%) during and after operation and 4 patients infection (8%). The mortality was 15%.

Objective To evaluate the effect of different sevoflurane postconditioning on myocardial injury in patients undergoing coronary artery bypass grafting (CABG ) with cardiopulmonary bypass (CPB ) .Methods Seventy-five NYHA class Ⅰ or Ⅱ patients ,aged 46-72 yr ,weighing 57-90 kg ,scheduled for elective CABG with CPB ,were randomly divided into 5 groups ( n=15 each) using a random number table :control group (groupⅠ) , postconditioning with continuous administration of 1.7% sevoflurane group (groupⅡ a ) , postconditioning with continuous administration of 3.4% sevoflurane group (group Ⅲa) ,postconditioning with interrupted administration of 1.7% sevoflurane group (Ⅱb) and postconditioning with interrupted administration of 3.4% sevoflurane group (group Ⅲb) .Sevoflurane was not given in group Ⅰ .In Ⅱa group ,after the anastomotic stomas of the internal mammary artery to anterior descending artery were released ,the patients continuously inhaled 1.7% sevoflurane for 15 min .In Ⅱb group ,after the anastomotic stomas were released .In Ⅲa group ,after the anastomotic stomas were released , the patients continuously inhaled 3.4% sevoflurane for 15 min , the patients inhaled 1.7%sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting for 5 min ,and it was 15 min in total .In Ⅲb group ,after the anastomotic stomas were released ,the patients inhaled 3.4% sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting for 5 min ,and it was 15 min in total .Venous blood samples were taken for determination of the plasma creatine kinase ,creatine kinase isoenzyme-MB , lactic dehydrogenase , and cardiac troponin I concentrations before CPB and at 6 and 24 h after operation .Myocardial specimens were obtained from the right auricle before CPB and after termination of CPB for microscopic examination of the ultrastructure .Results Compared with group Ⅰ , the concentration of cardiac troponin Ⅰ was significantly decreased at 6 and 24 h after operation ( P<0.05) ,and no significant changes were found in the other parameters in Ⅱb group ( P>0.05 ) .The pathological changes were significantly attenuated in sevoflurane postconditioning groups as compared with group Ⅰ ,especially in Ⅱb group . Conclusion Postconditioning with continuous administration of 3.4% sevoflurane for 15 min can attenuate myocardial damage in patients undergoing CABG with CPB .

Objective To identify the risk factors for early postoperative elevation in body temperature in patients undergoing coronary artery bypass grafting (CABG).Methods Nine hundred and forty-one patients of both sexes,aged 14-70 yr,were assigned into hyperthermia (≥ 38 ℃) group or non-hyperthermia (＜ 38 ℃) group according to the bladder temperature at 8h after operation.Factors including age,sex,height,weight,complications (hypertension,hyperlipemia,diabetes),history of smoking and drinking,preoperative blood pressure,heart rate,ejection fraction,routine blood examination,routine urine examination,and respiratory function examination,intraoperative cardiopulmonary bypass (CPB) and hormone,operation time,extubation time,duration of stay in the intensive care unit,and blood pressure,heart rate,ejection fraction,routine blood examination,and routine urine examination at the end of operation,and postoperative analgesia were recorded.The risk factors of which P values were less than 0.05 would enter the multi-factor logistic regression analysis to stratify the risk factors for early postoperative elevation in body temperature after CABG.Results Six hundred and ninety patients developed early postoperative elevation in body temperature (73.3％).Logistic regression analysis showed that preoperative respiratory dysfunction,preoperative ejection fraction ≤ 50％ and CPB were independent risk factors for early postoperative hyperthermia after CABG (P ＜ 0.05).Conclusion Preoperative respiratory dysfunction,preoperative ejection fraction≤ 50％ and CPB are independent risk factors for early postoperative elevation in body temperature in patients undergoing CABG.

ObjectiveTo investigate the effect of tranexamic acid on inflammatory response in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Sixty ASA Ⅰ -Ⅲ and NYHA Ⅰ -Ⅲ patients of both sexes,aged 45-64 yr,with body mass index 16-22 kg/m2,undergoing elective OPCABG,were randomly divided into 2 groups ( n =30 each):control group (group C) and tranexamic acid group (group T).Anesthesia was induced with iv injection of midazolam,fentanyl and pipecuronium.The patients were tracheal intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.Tranexamic acid 1 g was infused intravenously over 30 min after induction followed by continuous infusion at 400 mg/h until the end of operation in group T.While equal volume of normal saline was given in gtoup C.Anesthesia was maintained with inhalation of isoflurane and intermittent (i)v boluses of fentanyl and pipecuroninm.Venous blood samples were taken before induction,at the end of operation and 24 h after operation for determination of Hb,platelet count,prothrombin time,international normalized ratio and plasma D-dimer and IL-6 concentrations.The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation.The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was recorded.The complications during hospital stay were also recorded.ResultsCompared with group C,the plasma concentrations of D-dimer and IL-6 were significantly decreased at the end of operation and 24 h after operation,and the volume of chest tube drainage and the requirement for transfusion of allogeneic red blood cells and fresh frozen plasma were significantly decreased after operation in group T ( P ＜ 0.05 or 0.01).There was no significant difference in Hb,platelet count,prothrombin time and international normalized ratio between the two groups (P ＞ 0.05).No complications occurred during hospital stay in the two groups.ConclusionTranexamic acid can reduce inflammatory response in patients undergoing OPCABG.

Objective To evaluate premature clopidogrel cessation,intraoperative tranexamic acid and their interaction on bleeding and transfusion outcomes in on-pump CABG patients.Methods The current study is a prospective and randomized trial with 2 × 2 factorial design.The first factor is preoperative clopidogrel with 2 levels,clopidogrel ingestion within 7 days preoperatively (group E) and nave to clopidogrel (group B).The second level is antifibrinolytic therapy with 2 level,tranexamic acid (group T) and placebo (group P).A total of 333 patients receiving selective on-pump CABG were recruited.The tranexamic acid regimen was a bolus of 10 mg · kg-1 followed by a maintenance of 10 mg · kg 1 · h-1 throughout the surgery.Results Baseline characteristics were fairly balanced among the groups.Tranexamic acid significantly reduced postoperative blood loss.major bleeding,the volume of erythrocyte and plasma transfused,the exposure of erythrocyte,plasma and any allogeneic products (ET vs EP,P ＜ 0.01 ; BT vs BP,P ＜ 0.01).Clopidogrel within 7 days preoperatively significantly increased blood loss (EP vs BP,P＜0.05),major bleeding,the volume of erythrocyte (EP vs BP,P＜0.01) and the exposure of erythrocyte and plasma (EP vs BP,P ＜ 0.05) and any allogeneic products (EP vs BP,P ＜ 0.01).Under the protection of tranexamic acid,the bleeding and transfusion outcomes were comparable between the patients with premature clopidogrel cessation and those nave to clopidogrel (ET vs BP,P ＞0.05).Perioperative mortality,morbidity and the incidence of adverse events were comparable among the groups except for IABP.Conclusion Comparing with nave to clopidogrel,premature cessation within 7 days preoperatively deteriorated bleeding and transfusion outcomes in on-pump CABG patients.Intraoperative tianexamie acid could reduce the risk.

Objective To evaluate the blood-saving effect of tranexamic acid in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods The study was a prospective,randomized and placebo-control trial.Two hundred ASA Ⅰ-Ⅳ patients,aged 18-64 yr,weighing 50-100 kg,were randomized to receive placebo (group C,n =100) or tranexamic acid (group T,n =100).Tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision followed by continuous infusion at 10 mg· kg-1 · h-1 until the end of operation in group T.While the equal volume of normal saline was given in group C.The total volume of postoperative chest tube drainage,postoperative massive bleeding and a second thoracotomy for stopping the bleeding were reordered.The requirement for transfusion of allogeneic blood and complications during the perioperative period were also recorded.Results Compared with group C,the total volume of postoperative chest tube drainage and incidences of postoperative massive bleeding and a second thoracotomy for stopping the bleeding were significantly decreased,and the requirement for transfusion of allogeneic red blood cells,platelet and fresh frozen plasma was reduced in group D (P ＜ 0.05).There was no significant difference in the incidence of complications between the two groups (P ＜ 0.05).Conclusion Tranexamic acid exerts the blood-saving effect in patients undergoing CABG with CPB and can significantly reduce postoperative bleeding and transfusion of allogeneic blood.

Objective To investigate the effects of sevoflurane postconditioning on myocardial ischemiareperfusion(I/R)injury in patients undergoing coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB).Methods Forty NYHA Ⅰ -Ⅲ patients of both sexes,aged 55-64 yr,with BMI ＜ 30 kg/m2,scheduled for CABG under CPB,were randomly divided into 2 groups(n = 20): control group(group C)and sevoflurane postconditioning group(group S).Anesthesia was induced with midazolam and/or etomidate,fentanyl and rocuronium.Patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propefol and intermittent iv injection of fentanyl and pipecuronium.In group S,2% sevoflurane was inhaled continuously for 15 min immediately after aortic unclamping.After anesthesia induction,before CPB,10 min after the end of CPB,at the end of operation,and 6 and 24 h after operation,MAP,HR,CVP,mean pulmonary arterial pressure,pulmonary arterial wedge pressure,CO and S(v)O2 were recorded,and CI,SVI,systemic vascular resistance index and pulmonary vascular resistance index were calculated.Blood samples were taken from central vein before aortic clamping,at 6 h of reperfusion and 24 h after operation for determination of plasma creatine kinase(CK),creatine kinase isoenzyme(CK- M B)and lactate dehydrogenase(LDH)activities and tropenin I(TnI)concentrations.Myocardial tissues were obtained from right auricle before aortic clamping and at the end of CPB for observation of the ultrastructure and the severity of myocardial injury was assessed.Results There was no significant difference in hemodynamics and parameters of cardiac function between the two groups(P ＞ 0.05).Compared with group C,plasma CK-MB and LDH activities at 6 h of reperfusion and plasma CK activity and TnI concentrations at 24 h after operation were significantly decreased and the myocardial injury was significantly reduced after the end of CPB in group S(P ＜ 0.05).Conclusion Sevoflurane postconditioning can protect myocardium against I/R injury induced by CPB in patients undergoing CABG.

Objective To detect the expression of chemokine receptors CXCR3 mRNA in the peripheral blood mononuclear cells (PBNCs) of patients with Rheumatoid Arthritis (RA) and to analyze the relationship between the expression and the disease activity. Methods mRNA was extracted from PBNCs and the expression of CXCR3 mRNA was detected by real-time fluorescence quantitative PCR (RFQ-PCR) in 51 RA patients and 32 controls. T-test, x2-test, ANOVA were used for statistial analysis. Results Comparison between the two groups had shown that the expression levels of CXCR3 mRNA in clinical active RA group were higher than those of the RA patients in remission and healthy controls (P<0.05). The expression levels of CXCR3 mRNA were positively correlated with serum levels of ESR and CRP in clinical active RA group (r=0.824, r=0.765, P<0.05). In addition, RF titer, APF, AKA, and anti-CCP had no significant correlation with the expression levels of CXCR3 mRNA in RA patients (P>0.05). Conclusion RFQ-PCR is a sensitive,reproducible and practical test. The mRNA expressions of CXCR3 are significantly elevated in RA patients,which suggest that CXCR3 may be involved in the pathogenesis of RA. The mRNA expressions of CXCR3 in active RA patients are higher than those of RA patients in remission. These results indicate that CXCR3 may play an important role in the pathogenesis and progression of RA, and CXCR3 may be considered as an indicator for disease activity, therapeutic efficacy and prognosis of RA.

Objective To evaluate the safety and efficacy of FW-Ⅱ axial blood pump short term assistance for treating acute heart failure.Methods We selected 5 patients who were difficult to remove cardiopulmonary bypass,and implanted FW-Ⅱ axial blood pump by left atrium-pump-femoral artery.Perioperative hemodynamics,circulating markers of myocardial injury,vW factor levels in plasma and white blood cell-platelet aggregates in different rotational speed were observed and analyzed.Results All patients were assisted for(24.0 ± 2.6) h by FW-Ⅱ axial blood pump with speed of 7 000-9 000 r/min,flow of 1.9-3.0 L/min,and no mechanical dysfunction.Compared with mean artery pressure(MAP),cardiac index(CI) and systemic vascular resistance index (SVRI) before implantation of FW-Ⅱ axial pump was (50.29 ± 6.98) mmHg (1 mmHg=0.133kPa),(1.70±0.23)L· min-1 · m-2 and (2 009.86 ±129.46) dyn· s · cm-5,MAP and CI significantly increased,while SVRI significantly reduced at 8 000 r/min after pump assistance [(65.43 ± 6.90) mmHg,(2.53 ± 0.27) L · min-1 · m-2,(1 578.14 ± 356.70) dyn · s · cm-5,P ＜ 0.01).CK-MB and cTnI levels reached significant decrease after 12 hours of pump assistance and maintained low level [(66 ± 11) IU/L and (8.4 ± 3.8) μg/L,P ＜ 0.01].Compared with 7 000 r/min,vW factor levels significantly increased at 8 500 r/min [(2.59 ± 0.57) U/L vs (1.26 ± 0.43) U/L,P ＜0.01].Platelet activation and white blood cell-platelet aggregation was the lowest at 8 000 r/min,and reached the most high level at 7 000 and 9 000 r/min [(15 ± 3) ％,(33 ± 3) ％ and (31 ± 5) ％)].Conclusion FW-Ⅱ axial flow pump can be effectively used for short-term treatment of acute ischemic left ventricular failure,8 000 r/min is optimum speed to balance hemodynamics and biocompatility.

Objective To investigate the blood-saving effect of tranexamic acid in off-pump coronary artery bypass (OPCAB). Methods Two hundred and sixty ASA Ⅰ- Ⅲ and NYHA Ⅰ- Ⅲ patients of both sexes,aged 18-64 yr, with body mass index 16-22 kg/m2 , undergoing OPCAB, were randomly divided into 2 groups (n = 130 each): control group (group C) and tranexamic acid group (group T) . Anesthesia was induced with iv injection of midazolam 0.1 mg/kg, fentanyl 5-10μg/kg and pipecuronium 0.1 mg/kg. The patients were tracheal intubated and mechanically ventilated. PEr CO2 was maintained at 35-45 mm Hg. A bolus of tranexamic acid 1 g was infused intravenously within 30 min after indution followed by continuous infusion at 400 mg/h until the end of operation in group T. While equal volume of normal saline was given in control group. Anesthesia was maintained with inhalation of isoflurane and intermittent iv injection of fentanyl and pipecuronium. Venous blood samples were taken before induction, at the end of operation and at 24 h after operation for determination of Hb, platelet count (P1t), prothrombin time (PT) and international normalized ratio (INR). The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation. The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was also recorded. Results There was no significant difference in Hb, Plt, PTand INR at each time point between the two groups ( P ＞ 0.05). The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was significantly reduced in group T as compared with group C ( P ＜ 0.05 or 0.01 ). No deaths and complications occurred during hospital stay in the two groups. Conclusion Tranexamic acid exerts the blood-saving effect in OPCAB.