Basic and clinical research for perioperative management of braid-death donor and heart transplanted recipient

1)按Pratschke等人的方法建立脑死亡模型(大鼠)。(移植67：343-8,1999)和一些修改，我们建立了脑死亡的动物模型。我们的模型可以在脑死亡诱导期间和之后提供更长的血流动力学稳定性。2)脑死亡大鼠挥发性麻醉剂的心肌敏化作用异氟醚和七氟醚对脑死亡大鼠的心肌敏化作用弱于氟烷。然而，与没有任何挥发性麻醉的脑死亡大鼠相比，异氟醚和七氟醚对脑死亡大鼠的心肌敏化作用更强。3)对心律失常的保护作用最小，血流动力学不稳定。三磷酸腺苷敏感钾通道开放剂尼可地尔对心脏移植患者的氟烷肾上腺素心律失常有很强的抗心律失常作用，血流动力学变化很小。4)血流动力学的中枢调节与常规心脏手术患者相比，在中枢神经系统刺激咪唑受体1型对大鼠的氟烷肾上腺素心律失常有抗心律失常的作用。5)心脏移植手术期间血浆肾上腺髓质素水平显著增加，肾上腺髓质素是一种有效的扩张性多肽，在心脏移植患者中，与普通心脏手术患者相比，肾上腺髓质素水平显著升高。提示肾上腺髓质素可能与心肌损伤有关。6)心脏移植麻醉管理中右心功能的监测一种可测量右室射血分数的肺动脉导管在心脏移植麻醉管理中是有效的。

1)Establishment of brain death model (rats)According to the method by Pratschke et al. (Transplantation 67 : 343-8, 1999) and some modifications, we have established the animal model of brain death. Our model can provide longer hemodynamic stability during and following induction of brain-death.2)Myocardial sensitization of volatile anesthetics in brain-dead ratsMyocardial sensitizing effects of isoflurane and sevoflurane are less potent than that of halothane in brain-dead rats. However, both isoflurane and sevoflurane exert more potent myocardial sensitization in brain-dead rats compared with brain-dead rats without any volatile anesthetic.3)Myocardial protection from arrhythmias with minimum hemodynamic instabilityNicorandil, an ATP sensitive potassium channel opener, exerts potent antiarrhythmic effect on halothane-epinephrine arrhythmias with small hemodynamic changes.4)Central regulation of hemodynamicsStimulation of Imidazohne receptor type 1 in the central nervous system provides antiarrhythmic effect on halothane-epinephrine arrhythmias in rats through activation of vagal nerve.5)Adrenomedullin during nerioperative period of heart transplantationPlasma level of adrenomedullin, a potent vasodilating peptide, dramatically increases following separation of cardiopulmonary bypass in patients undergoing heart transplantation compared with patients undergoing usual cardiac operations, suggesting that adrenomedullin maybe related with myocardial injury.6)Monitoring of function of right heart during anesthetic management of heart transplantationA pulmonary artery catheter, which can measure ejection fraction of right ventricle, is effective in anesthetic management of patients undergoing heart transplantation.