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

辫子死亡供者与心脏移植受者围手术期处理的基础与临床研究

• 批准号: 13470320
• 负责人: HAYASHI Yukiko
• 金额: $ 7.87万
• 依托单位: Osaka University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 2001
• 资助国家: 日本
• 起止时间: 2001 至 2003
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-13470320/
• 关键词: Brain death; Heart transplantation; Arrhythmias; Central nervous system; Adrenomedullin; アドレメデュリン

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.

1)脑死亡模型（大鼠）的建立根据Pratschke等（Transplantation 67：343-8，1999）的方法和一些改进，我们建立了脑死亡的动物模型。2）挥发性麻醉药对脑死亡大鼠心肌的增敏作用异氟醚和七氟醚对脑死亡大鼠心肌的增敏作用弱于氟烷。然而，与无任何挥发性麻醉剂的脑死亡大鼠相比，异氟烷和七氟烷在脑死亡大鼠中均发挥更强的心肌增敏作用。3）心肌保护免受心律失常的影响，血流动力学不稳定性最小尼可地尔，一种ATP敏感性钾通道开放剂，对氟烷-肾上腺素心律失常具有有效的抗心律失常作用，血流动力学变化较小。4）血流动力学的中枢调节刺激中枢神经系统中咪唑啉1型受体可通过激活迷走神经对大鼠氟烷-肾上腺素心律失常提供抗心律失常作用。肾上腺髓质素在心脏移植围手术期的应用肾上腺髓质素是一种强有力的血管舒张肽，与接受常规心脏移植的患者相比，接受心脏移植的患者在心肺转流分离后的6）心脏移植术麻醉管理中右心功能的监测肺动脉导管可测定右心室射血分数，是心脏移植术麻醉管理的有效方法。

项目成果

高山あかね, 林行雄, ほか: "心臓移植手術周術期管理におけるスワンガンツCCD/CEDVサーモダイリューションカテーテル^<【○!R】>の使用経験"循環制御. 23. 445-448 (2002)

Akane Takayama、Yukio Hayashi 等：“在心脏移植手术围手术期管理中使用 Swan-Ganz CCD/CEDV 热稀释导管的经验” 循环控制 23. 445-448 (2002)。 ）

林 行雄: "専門医のための麻酔科学レビュー2001"総合医学社. 180-184 (2001)

Yukio Hayashi：“2001 年专家麻醉学评论”Sogo Igakusha 180-184 (2001)。

Takayama A, Hayashi Y, Yamano R, Iwasaki M, Kamibayashi T, Mashimo T.: "Utility of the Swan-Ganz CCO/CEDV thermodilution catherter <R○>^の during anesthetic management of heart transplantation.(In Japanese)"Circ Cont. 23. 445-448 (2002)

Takayama A、Hayashi Y、Yamano R、Iwasaki M、Kamibayashi T、Mashimo T.：“心脏移植麻醉管理期间 Swan-Ganz CCO/CEDV 热稀释导管 <R○>^ 的实用性。（日语）”Circ Cont . 23. 445-448 (2002)

Nakatani T, Sasako Y, Hanatani A, Kobayashi J, Bando K, Ono Y, Nowata K, Tag sari O, Komamura K, Kimono K, Yagihara T, Miyatake K, Kitamura S.: "Cardiopretection for heart failure therapy. Surgical therapy for end-stage heart failure (Left ventricular ass

Nakatani T、Sasako Y、Hanatani A、Kobayashi J、Bando K、Ono Y、Nowata K、Tag sari O、Komamura K、Kimono K、Yagihara T、Miyatake K、Kitamura S.：“心力衰竭治疗的心脏保护。手术治疗

Nakatani T, Sasako Y, Hanatani A, Kobayashi J, Bando K, Ono Y, Niwaya K, Tagusari O, Sato N, Komamura K, Kumon K, Yutani C, Yagihara T, Miyatake K, Kitamura S.: "Experience of cardiac transplantation at National Cardiovascular Center. (In Japanese)"Transp

Nakatani T、Sasako Y、Hanatani A、Kobayashi J、Bando K、Ono Y、Niwaya K、Tagusari O、Sato N、Komamura K、Kumon K、Yutani C、Yagihara T、Miyatake K、Kitamura S.：“心脏的经验