Stroke is a leading cause of disability and death,yet effective treatments for acute stroke has been very limited.Thus far,tissue plasminogen activator has been the only FDA-approved drug for thrombolytic treatment of...Stroke is a leading cause of disability and death,yet effective treatments for acute stroke has been very limited.Thus far,tissue plasminogen activator has been the only FDA-approved drug for thrombolytic treatment of ischemic stroke patients,yet its application is only applicable to less than 4–5% of stroke patients due to the narrow therapeutic window（〈 4.5 hours after the onset of stroke） and the high risk of hemorrhagic transformation.Emerging evidence from basic and clinical studies has shown that therapeutic hypothermia,also known as targeted temperature management,can be a promising therapy for patients with different types of stroke.Moreover,the success in animal models using pharmacologically induced hypothermia（PIH） has gained increasing momentum for clinical translation of hypothermic therapy.This review provides an updated overview of the mechanisms and protective effects of therapeutic hypothermia,as well as the recent development and findings behind PIH treatment.It is expected that a safe and effective hypothermic therapy has a high translational potential for clinical treatment of patients with stroke and other CNS injuries.展开更多
目的探讨中低温心肺转流诱导心室颤动下全胸腔镜再次二尖瓣手术的围手术期结果,以及影响术后早期频发室性期前收缩的因素。方法本研究为回顾性病例系列研究。回顾性分析2021年1月至2023年12月在解放军总医院第一医学中心心脏大血管外科...目的探讨中低温心肺转流诱导心室颤动下全胸腔镜再次二尖瓣手术的围手术期结果,以及影响术后早期频发室性期前收缩的因素。方法本研究为回顾性病例系列研究。回顾性分析2021年1月至2023年12月在解放军总医院第一医学中心心脏大血管外科由同一术者实施的63例再次二尖瓣手术的患者资料。男性28例,女性35例,年龄(58.3±15.9)岁(范围:13~84岁)。手术通过全胸腔镜入路完成,采用中低温心肺转流诱导心室颤动性停搏,二尖瓣成形32例,二尖瓣置换31例。收集患者术前基线资料及围手术期结果,采用Logistic回归分析术后早期频发室性期前收缩的独立影响因素。结果术中心肺转流时间(191.5±50.9)min(范围:95~286 min),术中低温心室颤动时间(99.0±39.8)min(范围:34~203 min)。转机前肛温(36.3±0.5)℃(范围:35.2~38.0℃),术中最低肛温(27.3±1.3)℃(范围:23.7~30.1℃),停机时肛温(36.3±0.4)℃(范围:35.2~37.0℃),超越复温33例。术后需要人工心脏辅助装置维持循环6例,术后早期频发室性期前收缩17例,神经系统并发症2例,呼吸系统并发症5例,泌尿系统并发症1例。机械通气时间>3 d 6例,ICU停留时间>3 d 16例,术后住院时间[M(IQR)]8.0(3.5)d(范围:3~26 d),死亡或自动出院2例。Logistic回归结果显示,术前持续性心房颤动(OR=11.424,95%CI:1.477~144.564,P=0.033)和超越复温(OR=15.249,95%CI:1.357~279.571,P=0.038)是术后早期频发室性期前收缩的独立影响因素。结论中低温心肺转流诱导心室颤动下全胸腔镜手术可用于再次二尖瓣手术。术前持续性心房颤动和超越复温是术后早期频发室性期前收缩的独立危险因素。展开更多
文摘目的：比较心肺复苏（ CPR）同时即刻降温与常规复苏和复苏后降温治疗对复苏成功率、存活率、神经系统功能等的影响。方法24只健康雄性新西兰家兔采用4 min室颤模型，随机分为三组，每组8只。常温复苏（ normothermia theat， NT）组：常规致颤复苏，不行降温干预。复苏中降温（ intra－arrest therapeutic hypothermia， IATH）组：于CPR同时启动颈部快速降温，目标脑温为34℃，以后维持目标脑温至自主循环恢复（ ROSC ）后4 h。复苏后1 h降温（ post －arrest therapeutic hypothermia， PATH ）组：于CPR后1 h 启动颈部快速降温，目标脑温为34℃，余同IATH组。观察复苏成功率，4 h内脑温、肛温、血流动力学及呼吸功能的变化，24 h神经功能缺损评分（ NDS）评分。结果 IATH组有7只、NT组和PATH组分别有4只和5只复苏成功；在诱发室颤4 min后，各组肛温、脑温比较差异无统计学意义；经过4 min CPR，IATH组、NT组、PATH组脑温分别为（37．4±0．7）℃、（38．2±0．3）℃、（38．1±0．5）℃，IATH组与另外两组比较差异有统计学意义（P＜0．05）；各组肛温比较差异无统计学意义。在CPR 4 min内，IATH 组舒张压从5．2 mm Hg升至32．0 mm Hg，而NT组从5．7 mm Hg增高至22．0 mm Hg，PATH组从5．4 mm Hg增高至21．0 mm Hg（P＜0．05）；复苏期间各组收缩压比较差异无统计学意义。 IATH组48 h存活率明显高于NT组（P＜0．05）。复苏后24 h NDS评分各组均较差，各组比较差异无统计学意义，但颈部降温组的评分还是好于NT组。结论在CPR同时早期选择颈部降温不仅能降低脑温还能提高复苏时舒张压，进而提升复苏时的冠状动脉灌注压，提高CPR成功率和48 h生存率。
基金supported by an American Heart Association(AHA)Postdoctoral Fellowship 15POST25680013(JHL)NIH grants NS085568(SPY)a VA Merit grant RX000666(SPY)
文摘Stroke is a leading cause of disability and death,yet effective treatments for acute stroke has been very limited.Thus far,tissue plasminogen activator has been the only FDA-approved drug for thrombolytic treatment of ischemic stroke patients,yet its application is only applicable to less than 4–5% of stroke patients due to the narrow therapeutic window（〈 4.5 hours after the onset of stroke） and the high risk of hemorrhagic transformation.Emerging evidence from basic and clinical studies has shown that therapeutic hypothermia,also known as targeted temperature management,can be a promising therapy for patients with different types of stroke.Moreover,the success in animal models using pharmacologically induced hypothermia（PIH） has gained increasing momentum for clinical translation of hypothermic therapy.This review provides an updated overview of the mechanisms and protective effects of therapeutic hypothermia,as well as the recent development and findings behind PIH treatment.It is expected that a safe and effective hypothermic therapy has a high translational potential for clinical treatment of patients with stroke and other CNS injuries.
文摘目的探讨中低温心肺转流诱导心室颤动下全胸腔镜再次二尖瓣手术的围手术期结果,以及影响术后早期频发室性期前收缩的因素。方法本研究为回顾性病例系列研究。回顾性分析2021年1月至2023年12月在解放军总医院第一医学中心心脏大血管外科由同一术者实施的63例再次二尖瓣手术的患者资料。男性28例,女性35例,年龄(58.3±15.9)岁(范围:13~84岁)。手术通过全胸腔镜入路完成,采用中低温心肺转流诱导心室颤动性停搏,二尖瓣成形32例,二尖瓣置换31例。收集患者术前基线资料及围手术期结果,采用Logistic回归分析术后早期频发室性期前收缩的独立影响因素。结果术中心肺转流时间(191.5±50.9)min(范围:95~286 min),术中低温心室颤动时间(99.0±39.8)min(范围:34~203 min)。转机前肛温(36.3±0.5)℃(范围:35.2~38.0℃),术中最低肛温(27.3±1.3)℃(范围:23.7~30.1℃),停机时肛温(36.3±0.4)℃(范围:35.2~37.0℃),超越复温33例。术后需要人工心脏辅助装置维持循环6例,术后早期频发室性期前收缩17例,神经系统并发症2例,呼吸系统并发症5例,泌尿系统并发症1例。机械通气时间>3 d 6例,ICU停留时间>3 d 16例,术后住院时间[M(IQR)]8.0(3.5)d(范围:3~26 d),死亡或自动出院2例。Logistic回归结果显示,术前持续性心房颤动(OR=11.424,95%CI:1.477~144.564,P=0.033)和超越复温(OR=15.249,95%CI:1.357~279.571,P=0.038)是术后早期频发室性期前收缩的独立影响因素。结论中低温心肺转流诱导心室颤动下全胸腔镜手术可用于再次二尖瓣手术。术前持续性心房颤动和超越复温是术后早期频发室性期前收缩的独立危险因素。
