Clinical application of extracorporeal membrane oxygenation for treatment of adult refractory cardiogenic shock / 中华心血管病杂志

<p><b>OBJECTIVE</b>To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult refractory cardiogenic shock.</p><p><b>METHODS</b>From January 2003 to January 2011, patients with refractory cardiogenic shock required veno-arterial ECMO by failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy were retrospectively studied. Patients with severe traumatic brain injury, advanced malignancies and multiple organ failure were excluded. Patients were divided into weaned group (n = 31) and not weaned group (n = 23) according to the ECMO weaning.</p><p><b>RESULTS</b>The duration of ECMO was 24.16 (14.12, 56.75) hours. Twenty-two out of 31 patients in the weaned group survived and were discharged, 9 patients died after successfully weaned from ECMO (5 due to multisystem organ failure, 2 due to reoccurred cardiogenic shock, 1 due to infectious shock and 1 due to disseminated or diffuse intravascular coagulation). Pre-ECMO mean arterial pressure, ejection fraction, the duration of ECMO were significantly higher while pre-ECMO blood lactate [(8.64 ± 3.17) vs. (14.44 ± 2.52) , P < 0.01], the duration of ROSC [ (16.70 ± 5.29) vs. (35.64 ± 5.89), P < 0.01] and multisystem organ failure [0 vs. 17.4% (4/23) , P < 0.05] were lower in weaned group than in not wean group.</p><p><b>CONCLUSIONS</b>ECMO is an effective mechanical assistant therapy strategy for adult refractory cardiogenic shock patients. Timely applying this strategy on suitable patients is crucial for the success of ECMO. Cardiac function and reversibility of heart failure are key factors determine the fate of weaned or not weaned ECMO in adult refractory cardiogenic shock patients.</p>

Expression of Rock2 and TGF-β1 mRNA and glucocorticoid intervention in asthmatic rats / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the roles of rhoassociated coiled coil forming protein kinase 2 (Rock2) and transforming growth factor-β1 (TGF-β1) mRNA in acute asthma and the effect of glucocorticoid intervention on the Rock2 and TGF-β1 mRNA expression in rats.</p><p><b>METHODS</b>Forty-eight male rats were randomly divided into 4 groups (n=12 each): asthma, control, dexamethasone treated (DXM) and budesonide treated (BUD). Rat model of asthma was prepared by the ovalbumin (OVA) challenge. The animals were sacrificed 24 hrs after the last challenge. The total cell number and differentiation cell number were counted in bronchoalveolar lavage fluid (BALF). The protein expression of Rock2 was ascertained by immunohistochemistry and the mRNA expression of TGF-β1 was ascertained by hybridization in situ.</p><p><b>RESULTS</b>The pathological changes in the BUD and the DXM groups were alleviated when compared with the asthma group. The total cell number and the percentage of eosinophil (EOS), polymorphonuclear leukocytes (PMN) and lymphocytes (Lym) in BALF in the asthma group were significantly higher than those in the control group (P<0.01). The percentage of macrophage (Mф) in the asthma group was significantly lower than that in the control group (P<0.01). The total cell number and the percentage of EOS and Lym in BALF in the DXM and the BUD groups decreased, while the percentage of Mф increased significantly compared with those in the asthma group (P<0.01). The Rock2 and TGF-β1 mRNA expression in lung tissues in the asthma group increased significantly compared with those in the control, BUD and DXM groups, while there were no significant differences in the Rock2 expression and TGF-β1 mRNA expression between the DXM or BUD group and the control group.</p><p><b>CONCLUSIONS</b>The expression of Rock2 and TGF-β1 mRNA in lung tissues is increased in rats with acute asthma. Glucocorticoids can significantly decrease the expression of Rock2 and TGF-β1 in lung tissues, thus alleviates airway inflammation.</p>

Effect of plasmaslyte A on the liver function of patients undergoing cardiac surgery with extracorporeal circulation / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of plasmaslyte A on the liver function of patients receiving cardiac surgery with extracorporeal circulation.</p><p><b>METHODS</b>Sixty patients scheduled for cardiac surgery were randomized to receive plasmaslyte A (group P, n=30) and ringer lactate solution (group R, n=30). The two agents were used in priming heart-lung machine and intra- and postoperative crystal solution. All the patients were examined for the levels of AST, ALT and Lac the day before and at 2 h and 1, 3 and 7 days after the surgery. The time of extubation and length of stay at the ICU were record.</p><p><b>RESULTS</b>The levels of ALT, AST and Lac in group P were significantly lower than those in group R (P<0.05), and the duration of intubation and stay at the ICU was shorter in group P (P<0.05).</p><p><b>CONCLUSION</b>Plasmaslyte A can markedly reduce the level of AST, ALT and Lac and protect the liver function of patients undergoing cardiac surgery with extracorporeal circulation.</p>