本文選題：MCPR + 心肺復(fù)蘇�。� 參考：《河南大學(xué)》2013年碩士論文

【摘要】：1.背景 隨著社會發(fā)展及經(jīng)濟(jì)進(jìn)步，人們生活水平在不斷改善，隨之而來的是各種肥胖相關(guān)性疾病的增加。其中高血壓、冠心病及器質(zhì)性心臟病的終端治療措施只有心臟移植。目前常用的供體心臟大多數(shù)來自于腦死亡的患者，并且此類患者常伴有人工心肺復(fù)蘇的應(yīng)用，但是在進(jìn)行人工心肺復(fù)蘇時由于人的易疲勞性等不確定因素可使心臟受損，加上缺血再灌注損傷等因素嚴(yán)重影響了供心的心功能，從而不能作為供體使用。供體心臟如果移植前保護(hù)效果好，其心功能能夠得到較為完整的保存，這是心臟移植能否成功的前提條件。能夠符合條件的供體心臟數(shù)量嚴(yán)重影響了心臟移植的進(jìn)展。如何提供充足的供心，最大限度地保存供心的心功能，一直是廣大醫(yī)療工作者及科研工作者努力的方向。 目前在歐美及我國部分地區(qū)開始使用的一種新型設(shè)備Lund University CardiacAssist System （LUCAS; Lund, Sweden,自動心臟按壓器)，，能自動對停跳后的心臟進(jìn)行體外不間斷按壓，實(shí)施機(jī)械胸外按壓心肺復(fù)蘇術(shù)（MCPR），從而能在長途運(yùn)輸中有效地保護(hù)腦死亡后供體心臟的功能。本研究通過建立人工心臟按壓和應(yīng)用LUCAS的機(jī)械心臟按壓模型，對比二者在供體心臟的心功能、內(nèi)皮細(xì)胞功能、心肌細(xì)胞凋亡等方面的差異，分析應(yīng)用LUCAS后對供體心臟的影響。 2.方法 將瑞典品種的家豬隨機(jī)分為人工心臟按壓組和機(jī)械心臟按壓組，每組15頭。建立人工心臟驟停后，各組分別進(jìn)行人工心臟按壓(CPR)和應(yīng)用LUCAS的連續(xù)機(jī)械心臟按壓(MCPR)，成功復(fù)蘇并離體保存后，檢測供體心臟的肺動脈血流、冠狀動脈內(nèi)皮細(xì)胞功能等指標(biāo)，探討那種方法對供體心臟的保護(hù)作用更佳。 3.結(jié)果 結(jié)果表明，使用LUCAS后再保存的供體心臟肺動脈血流量顯著優(yōu)于人工按壓后再保存的供體心臟；冠狀動脈內(nèi)皮細(xì)胞功能得以最大限度地保護(hù)；同時，心肌細(xì)胞凋亡水平檢測表明，經(jīng)LUCAS后再保存可以顯著減少心肌細(xì)胞凋亡，細(xì)胞內(nèi)超氧化物水平顯著低于常規(guī)保存組。進(jìn)一步的研究發(fā)現(xiàn)，應(yīng)用LUCAS后再保存的心臟心肌細(xì)胞內(nèi)c-Src活性明顯高于對照組。 4.結(jié)論 這些結(jié)果表明經(jīng)LUCAS處理后的供體心臟，其冠狀動脈內(nèi)皮功能、心功能保存較好，心肌細(xì)胞c-Src活性一直處于高水平，可對心肌細(xì)胞氧化還原水平進(jìn)行調(diào)控，降低了細(xì)胞內(nèi)超氧化物水平，抑制了心肌細(xì)胞的凋亡，最大限度地保護(hù)了心功能。提示應(yīng)用自動心臟按壓器能夠?yàn)樾呐K移植提供較好的供體條件，進(jìn)而提供更多的供體來源。
[Abstract]:1.BackgroundWith social development and economic progress, people's living standards are improving, followed by an increase in various obesity related diseases.Heart transplantation is the only terminal therapy for hypertension, coronary heart disease and organic heart disease.Most of the commonly used donor hearts come from patients with brain death, and these patients are often accompanied by artificial cardiopulmonary resuscitation (CPR).Combined with ischemia-reperfusion injury and other factors seriously affect the heart function of the donor, so it can not be used as a donor.If the donor heart has a good protective effect before transplantation, its heart function can be preserved completely, which is the precondition for the success of heart transplantation.The number of eligible donor hearts seriously affects the progress of heart transplantation.How to provide sufficient donor heart and preserve heart function to the maximum extent has been the direction of medical and scientific research workers.At present, a new type of equipment, Lund University CardiacAssist System, LUCAS, Lund, Sweden, automatic cardiac compressors, is used in Europe, America and parts of China.Mechanical cardiopulmonary resuscitation can effectively protect the function of donor heart after brain death.In this study, the effects of LUCAS on donor heart were analyzed by establishing mechanical cardiac compression models of artificial heart compression and LUCAS, and comparing the difference of cardiac function, endothelial cell function and cardiomyocyte apoptosis between the two groups.2.MethodSwedish domestic pigs were randomly divided into artificial cardiac compression group and mechanical cardiac compression group with 15 pigs in each group.After establishing artificial cardiac arrest, each group was subjected to artificial cardiac compression (CPR) and continuous mechanical cardiac compression (LUCAS) respectively. After successful resuscitation and preservation in vitro, the pulmonary artery blood flow and endothelial cell function of coronary artery were measured.It is better to explore the protective effect of that method on donor heart.3.ResultThe results showed that the pulmonary artery blood flow of donor heart after LUCAS was significantly better than that of donor heart after artificial compression, the function of coronary artery endothelial cells was protected to the maximum extent, and the level of cardiomyocyte apoptosis was detected.After LUCAS preservation, myocardial apoptosis was significantly reduced, and the intracellular superoxide level was significantly lower than that in the conventional preservation group.Further studies showed that the activity of c-Src in cardiac myocytes after LUCAS was significantly higher than that in control group.4.ConclusionThese results suggest that the coronary artery endothelial function and cardiac function of donor heart treated with LUCAS are well preserved, and the activity of c-Src in cardiac myocytes is always at a high level, which can regulate the redox level of cardiomyocytes.It can reduce the level of superoxide, inhibit the apoptosis of cardiomyocytes, and protect cardiac function to the maximum extent.It is suggested that the application of automatic cardiac compressors can provide better donor condition for heart transplantation and provide more donor sources.
【學(xué)位授予單位】：河南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R459.7

【共引文獻(xiàn)】

相關(guān)期刊論文 前6條

1 尹宏宇;孫劍;劉廣鵬;崔磊;曹誼林;;玻璃化凍存骨髓基質(zhì)干細(xì)胞的實(shí)驗(yàn)研究[J];中國美容醫(yī)學(xué);2009年03期

2 栗華;;上消化道出血[J];臨床消化病雜志;2013年05期

3 李玫;楊藝;季學(xué)麗;李惠芬;郝衛(wèi)文;吳敏;李琳;林征;;急診護(hù)士團(tuán)隊(duì)式情境模擬培訓(xùn)的實(shí)踐[J];護(hù)理學(xué)雜志;2013年19期

4 王世強(qiáng);陳寄梅;莊建;朱平;;心臟保存的研究進(jìn)展[J];實(shí)用醫(yī)學(xué)雜志;2013年15期

5 李小健;成萍;王衛(wèi)華;;醫(yī)護(hù)人員心肺復(fù)蘇術(shù)理論知識和技能操作現(xiàn)狀調(diào)查分析[J];中國臨床研究;2013年11期

6 胡志斌;嚴(yán)志q;王海濤;潘曉華;;不同灌注保存方法對豬離體供心保護(hù)作用的比較[J];中華移植雜志(電子版);2013年03期

相關(guān)博士學(xué)位論文 前3條

1 宋康;二氮嗪預(yù)處理對大鼠小體積肝移植缺血再灌注損傷的保護(hù)作用及對肝再生的影響[D];復(fù)旦大學(xué);2008年

2 尹宏宇;組織工程化骨的構(gòu)建與玻璃化凍存的體外實(shí)驗(yàn)研究[D];中國協(xié)和醫(yī)科大學(xué);2009年

3 張和華;胸阻抗信號監(jiān)測心肺復(fù)蘇質(zhì)量的方法研究[D];第三軍醫(yī)大學(xué);2013年

相關(guān)碩士學(xué)位論文 前2條

1 梁培培;心搏驟停后綜合征患者預(yù)后相關(guān)因素分析[D];安徽醫(yī)科大學(xué);2013年

2 費(fèi)悅;影響患者圍手術(shù)期心肺復(fù)蘇成功率的因素分析[D];浙江大學(xué);2013年

本文編號：1770989