RESUMO
Objective:To investigate the safety and effect of the operation of the upper sternum small incision assisted by normothermic cardiopulmonary bypass in the treatment of aortic valve disease.Methods:From March 2014 to June 2016, the clinical data of 25 patients who underwent single incision minimally invasive aortic valve replacement assisted by normothermic cardiopulmonary bypass in The Second Hospital of Hebei Medical University and 25 patients who underwent aortic valve replacement under hypothermia cardiopulmonary bypass were analyzed retrospectively.The former was used as minimally invasive surgery group, and the sternum was sawn in " J" shape through a small incision on the upper sternum.In the latter group, aortic valve replacement was performed under cardiopulmonary bypass.The operation effect and complications of the two groups were compared.Results:There was no death in the two groups.There was no significant difference in operation time between minimally invasive surgery group and routine operation group ( P>0.05). The time of aortic occlusion and cardiopulmonary bypass in minimally invasive surgery group ((50.0±6.8), (69.5±9.7) min) was longer than those in routine operation group ((45.8±7.2), (65.0±8.8) min), the difference was statistically significant ( t=2.120, 2.052, all P<0.05). In the minimally invasive operation group, red cell volume, plasma volume, intraoperative bleeding volume, incision length, postoperative 24-h drainage volume, postoperative 24-h leukocyte count, postoperative 24-h C-reactive protein concentration, postoperative 24-h total blood transfusion volume, ventilator-assisted time, ICU stay time and drainage tube retention time(85.1(42.3, 181.3) ml, 108.5(79.4, 173.8) ml, 186.4(132.6, 307.6) ml, (4.2±0.8) cm, 130.0(88.1, 224.3) ml, 14.2(9.8, 17.1)×10 9/L, 14.0(9.9, 23.2) mg/L, 186.6(135.3, 302.1) ml, 3.7(2.3, 6.8) h, 25.2(20.6, 35.6) h, 31.2(26.4, 41.9) h) were lower than those in the routine operation group (354.2(150.2, 507.2) ml, 211.9(119.2, 281.5) ml, 378.4(220.9, 496.5) ml, (13.8±6.5) cm, 365.8(171.8, 511.3) ml, 20.4(13.6, 24.7)×10 9/L, 28.6(14.4, 39.3) mg/L, 405.1(185.3, 570.1) ml, 7.7(4.2, 10.2) h, 52.8(30.8, 69.3) h, 57.2(37.6, 71.9) h), the difference between the two groups was statistically significant ((the statistical values were Z=3.393, 2.696, 2.781, t=7.329, Z=3.151, 2.638, 2.493, 2.597, 2.472, 3.254, 3.338, respectively; all P<0.05). There was no significant difference between the minimally invasive operation group and the routine operation group( P>0.05). The total incidence of postoperative complications in the minimally invasive operation group and the routine operation group was (12% (3/25) and 44% (11/25)), the difference was statistically significant ( P=0.025). Conclusion:CPB with normal temperature has the advantages of less trauma, fewer complications and faster recovery in the operation of single incision in the upper part of sternum.
RESUMO
Objective To monitor the function of infection on myelination in white matter damage,neonatal Wistar rats of postnatal day 2 (P2) and postnatal day 7 (P7) were injected intraperitoneally with the same doses of lipopolysaccharides (LPS),and 2',3 '-cyclic nucleotide phosphodiesterase (CNPase) and myelin basic protein (MBP) were labeled in immature oligodendrocytes and mature oligodendrocytes.To investigate the function of tumor necrosis factor(TNF)-α according to test the change of TNF-α expression in the brain.Methods Ninty-six neonatal Wistar rats were randomly divided into four groups (each group 24 rats):group A:LPS (5.0 mg/kg) was injected intraperitoneally on P2 ; group B:LPS (5.0 mg/kg) was injected intraperitoneally on P7 ;group C1 and C2 were control groups in which equal amount of normal saline was injected intraperitoneally on P2 or P7.The expression of CNPase at 24 h after injection and MBP at P14 in brain tissue of each group were measured by immunohistochemistry and express of TNF-α mRNA at 4 h after the injection was measured by RT-PCR.Results Punctate hemorrhage in the corpus callosum,external capsule and intraventricular hemorrhage were seen in group A.Periventricular leukomalacia appeared in the corpus callosum and glial cells hyperplasia could be seen periventricular in P14 rat brains,but not found in the group B and any of the saline-injected rat brains.Compared with group C1 and C2 respectively,CNPase-positive cells showed obvious decrease in the area of white matter in periventricular in group A(106.93 ± 2.62 vs 113.67 ± 2.69,P ＜ 0.01) and group B (96.37 ± 1.82 vs 101.65 ± 2.01,P ＜ 0.01).Following LPS treatment in group A,the protein expression of MBP in neonatal brain decreased evidently compared with group C1 at P14 (128.21 ± 2.99 v s 134.81 ± 2.98,P ＜ 0.01),while no significant change was found between group B and group C2(134.77 ±3.68 vs 134.81 ±2.98,P ＞0.05).After 4h of the LPS treatment,the level of TNF-α mRNA was greatly increased in group A,it was significantly higher than that in group B (1.79 ± 0.04 vs 1.18 ± 0.04,P ＜ 0.01).Conclusion Intraperitoneal injection of LPS to the development neonatal rats can lead to dysmyelination and white matter damage.The expression of TNF-oα mRNA increased significantly in these immature neonatal rats,while only myelination delay occurred in those of mature neonatal rats without dysmyelination.