ecm技术iu王培栋.pptVIP

* * 供体（心、肺） 原发性肺高压 受体（心、肺） 供体（心） 复杂先心ECMO无效 受体（心） 天外有天 ECMO pECMO 经皮静脉插管房间隔打孔 AALA bridge to XP: Hoopes, 2009 清醒 ECMO Rudich SM, et al, Transplantation, 2002 ECS assisted DCD 成人双腔引流灌注管 ADP tPA heparin thrombomodulin NO ADP PGI2 tissue plasminogen activator Endothelial Cell Non-thrombogenic Endothelium thrombin Collagen Tissue Factor Fibronectin PAF cytokines Quiescent Platelet prostaglandin I2 nitric oxide thrombin platelet activating factor platelet activating inhibitor PAI-1 protein S PS TFPI Effect of Nitric Oxide on Platelets Direct Effects: directly binds to guanylate cyclase to increase cGMP: inhibits Ca 2+ influx into platelets inhibits phosphorylation of myosin light chains inhibits GpIIb/IIIa expression inhibits phosphorylation by protein kinase C modulates phospholipase A2 and C mediated responses decreases local plasma [Ca 2+] Indirect Effects: NO reacts with S-thiols in the blood to create nitrosothiols NO Releasing and Generating Materials as Thromboresistant Materials NO releasing/generating materials (hydrophobic) NO NO NO NO NO NO Platelet Red blood cell NO flux from the endothelial cell (EC) surface Vaughn, M. W.; et al. Am. J. Physiol. 274 (Heart Circ. Physiol. 43) 1998, H2163. 4.1 × 10-10 mole·cm-2·min-1 Estimated based on Radomski’s experimental data (Biochem. Biophy. Res. Comm. 1987, 148, 1482.) 1.6 × 10-10 mole·cm-2·min-1(Bradykinin stimulated EC) 0.5 × 10-10 mole·cm-2·min-1(unstimulated EC) Materials with equal or higher NO flux from their surfaces might be able to help prevent platelet adhesion/activation/aggregation on such materials. Neonatal Respiratory Cases Jan 2009 HFOV Surfactant iNO Cardiac Cases By YearUnder 16 years 1/09 ECMO 和 H1N1 EMERGENCY MEDICINE 0 中国何处去 ECMO 团结协作 争取成功 内外科 恢复室 体外 循环 护理 不断学习 加强宣传建立网络正规培训数据库医疗保险 几点建议 避免畸形发展 脚踏实地工作 心浮虚荣的学者 追求利润的商家 制造新闻的媒体 渴望政绩的官员 科学怪物 搞好中国ECMO建议 打有准备之仗 打有把握之仗 打有合作之仗 一 不要你爱我需要时能 想到我ECMO 耐心 爱心 信心 健康--本金 锻炼--微