The Myocardial Protective Effects Of Ulinastatin On Infants And Young Children In Open Heart Surgery With Cardiopulmonary Bypass

Objective To investigate the variation of cardiac troponin I (cTnI) on infants and young children in open heart surgery with cardiopulmonary bypass (CPB) and the myocardial protection of ulinastatin Methods Thirty patients with atrial septal defect or ventricular septal defect were divided into two groups randomly,ulinastatin (U) group and control (C) group.In group U (n=15) the patients received ulinastatin 12000 unit per kilogram,the quarter of tatal dose was given intravenously before CPB,the half of total dose was added into the pre-filling solution of extracorporeal machine, and the left quarter was given after openning aorta.In group C (n=15) the patients didn't receive ulinastatin.Blood samples were drawn fron radial artery at baseline (T1),and 5 minutes (T2),2h (T3),6h (T4) and 24h (T5) after loosening the clamped aorta.Plasma levels of cTnI were measured.The aortic cross-clamping time,CPB time,duration of operation,the condition of heart spontaneous recovery, the variation of electrocardiogram and the drainage volume during the 24 hours were recorded. The myocardial tissues were taken from right atrium for observing ultrastructural changes. Results The plasma cTnI level was nomal before CPB and there were no significant differences between two groups.In group C the plasma level of cTnI at T3, T4 and T5 was increased significantly(P<0.01),peaked at T4 and started decreasing at T5.In group U the plasma level of cTnI at T3 and T4 was significantly higher than the baseline (P<0.01), and returned to the baseline at T5. The plasma level of cTnI at T3, T4 and T5 in group U was significantly lower than group C(P<0.01).The rate of spontaneous recovery of heart beat without defibrillation was higher in group U than in group C(P<0.05). The myocardial ultrastructural changes were significant in C group than in U group. Conclusion Ulinastatin can decrease the release of cardiac troponin I on infants and young children in open heart surgery with cardiopulmonary bypass (CPB) and effectively protect myocardium.