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

1)脑死亡模型的建立（大鼠）根据Pratschke et al. （Transplantation 67: 343- 8,1999）的方法并进行修改，建立了脑死亡动物模型。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)挥发性麻醉药对脑死亡大鼠心肌的致敏作用异氟醚和七氟醚对脑死亡大鼠心肌的致敏作用弱于氟烷。然而，异氟醚和七氟醚对脑死亡大鼠的心肌致敏作用比不使用任何挥发性麻醉剂的脑死亡大鼠更强。3)心肌对血流动力学不稳定性最小的心律失常的保护作用尼可地尔是ATP敏感的钾通道打开剂，对血流动力学变化小的卤烷-肾上腺素型心律失常具有有效的抗心律失常作用。4)血流动力学的中枢调节中枢神经系统刺激咪唑酮受体1型通过激活迷走神经对大鼠氟烷-肾上腺素性心律失常具有抗心律失常作用。5)心脏移植术后肾上腺髓质素（肾上腺髓质素是一种有效的血管舒张肽）心脏移植患者体外循环分离后血浆中肾上腺髓质素的水平明显高于普通心脏手术患者，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肺动脉导管可以测量右心室射血分数，在心脏移植患者的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.