目的探讨亚低温联合持续肾脏替代治疗（CRRT）对心脏外科术后重症心力衰竭的临床效果 方法回顾性分析我中心2009年2月至2013年12月行心脏外科术后重症心力衰竭38例患者的临床资料，其中男18例、女20例，年龄55～74岁，虽应用大剂量血管活性药物及主动脉内球囊反搏（IABP）辅助循环，心力衰竭无改善，采用CRRT及亚低温联合治疗。监测患者在联合治疗前后心脏指数（CI）值、混合静脉血氧饱和度（SvO2）、尿量、肌酐（Cr）及乳酸（Lac）的变化。 结果亚低温联合CRRT治疗后，患者CI较治疗前明显改善[（2.3± 0.7）L/（min· m2）vs.（1.8± 0.2）L/（min· m2）]，SvO2升高（62%± 5%vs.50%± 4%），乳酸明显降低[（8.6± 2.3）mmol/L vs.（3.0± 1.1）mmol/L]，尿量明显增加[（2.5± 0.9）ml/h vs.（1.0± 0.7）ml/h]，Cr明显下降[（140± 19）mmol/L vs.（292± 24）mmol/L]。 结论亚低温联合CRRT治疗心脏外科术后重症心力衰竭能有效改善循环功能，且操作简单易行。
ObjectiveTo explore the inhibition action of valproic acid to inflammatory cells and smooth muscle cells then to find out that valproic acid (VPA) can repress rat thoracic aortic aneurysm or not. MethodsThe model of rat thoracic aortic aneurysm was built through the method of soaking the adventitia of artery using porcine pancreatic elastase (PPE). The rats were divided into three groups:a normal saline blank control group (a C group), an adventitia soaked PPE group (a P group), and adventitia soaked PPE plus intraperitoneal injection by injecting intraperitioneal VPA 200 mg/kg for seven days (a PV group).The animals of the three groups were all using vascular ultrasound to detect blood vessel diameter. Animals were killed after operation to observe the general morphology of vascular aneuysm and do the immunohistochemial, morphological, protein analysis of interleukin 1 (IL-1), interleukin 6 (IL-6), smooth muscle 22 alpha (SM22α), matrix metallopeptidase 2 (MMP-2), MMP-9 and Western blot by drawing animals on the 14th day. ResultsThe vessels diameter in the PV group was narrower than that in the P group (P value<0.05). HE staining, immunohistochemistry and Western blot displayed that the cells in the P group were in disorder arrangement and interstitial disorder while the cells in the PV group maintained better albumin layer. The protein expressions of IL-1, IL-6, MMP-2, and MMP-9 in the PV group decreased except that SM22α increased. ConclusionVPA can inhibit phenothpic transforming of aneurysm inflammatory cells and smooth muscle cells, reduce the levels of cell proliferation, decrease the secretion of matrix metalloproteinases, and depress tumor growth of rat thoracic aorta.