Myocardial Protection And Systemic Anti-inflammatory Response Effects Of Phosphocreatine Enriched Cardioplegia Solution On Patients Undergoing Cardiac Valve Replacement During Peri-cardiopulmonary Bypass

Objective:To investigate the myocardial protective and systemic anti-inflammatory response effect of penehyclidine on patients undergoing cardiac valve replacement during peri-cardiopulmonary bypass and explore the related mechanism.Methods:45patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB) were randomized into3groups (n=15):control group (group C), low dose PC group (group PCL) and high dose PC group (group PCH). All the patients were anesthetized with intravenous injection of midazolam (0.05-0.10mg·kg-1), etomidate (0.2～0.3mg·kg-1), fentanyl (5～10μg·kg-1), pipecuronium bromide (0.08～0.15mg·kg-1), and were endotrachaelly intubated. Control ventilation was conducted and PETCO2was maintained between35to40mmHg. Anesthesia was maintained with addition of propofol, midazolam, and fentanyl and pipecuronium bromide. BIS was maintained between40～60. Experimental groups are as follows:C group using St. Thomas solution as the cardioplegic solution; PCL group by adding small doses of PC into St. Thomas solution to the final concentration of2.5g/L (10mmol/L); PCH group by adding large doses of PC into St. Thomas solution to the final concentration of5g/L (20mmol/L), the other treatment and medication administration among these groups have no differences. Plasma levels of inflammatory factors (including tumor necrosis factor alpha (TNF-a), IL-6, IL-8), creatine phosphokinase (CK), cardiac troponin I (cTnI), and creatine phosphokinase isoenzyme (CK-MB) were measured before anesthesia (To), before aortic cross-clamp (T1), at the beginning of aortic opening (T2),30min after aortic opening (T3),2h (T4),6h (T5),12h (T6) and24h (T7) after CPB termination. The duration of CPB, aortic cross-clamping and operation, cardiovascular active drugs, cardiac resuscitation situation and wound drainage of24h post-operation were recorded.Results:There were no statistical differences in age, weight, preoperative cardiac function grading, cardiothoracic ration, anesthetic dosage, CPB time, aortic cross-clamp time and surgical procedure time among the three groups.cTnl concentration, CK,and CK-MB activity increased at the time points of T1-T7(P<0.01) in all the three groups, with the lower increasing extent in both groups PCL and PCH, but without difference between group PCL and group PCH (P>0.05)..The plasma levels of TNF-aand IL-8were increased at the time points of T2-T5(P<0.05); IL-6was increased at the time points of T2-T6(P<0.05) in all the three groups. The plasma levels of TNFa at T2-T5, IL-6at T2-T7and IL-8at T2-T6were lower in both groups PCL and PCH (P<0.05), but without difference between group PCL and group PCH (P>0.05).During clinical observation,8patients were automatically re-jumped,7patients were re-jumped after defibrillation resuscitation,3patients were performed defibrillation resuscitation after automatically re-jumped and1patient was installed the temporary pacemaker in group c.12patients were automatically re-jumped,3patients were performed defibrillation resuscitation after automatically re-jumped,2patients were performed defibrillation resuscitation after automatically re-jumped and1patient was installed the temporary pacemaker in group PCL.11patients were automatically re-jumped,4patients were performed defibrillation resuscitation after automatically re-jumped,2patients were performed defibrillation resuscitation after automatically re-jumped and1patient was installed the temporary pacemaker in group PCH. The automatically re-jumped cases of both PCL and PCH were higher than group c (p<0.05), but without difference between group PCL and group PCH (P>0.05).Conclusions:Administration of phosphocreatine (10mmol/L) in cardioplegia solution on patients undergoing cardiac valve replacement during peri-cardiopulmonary bypass is able to protect myocardial function from ischemia-reperfusion injury and CPB, alleviate systemic inflammatory response, and reduce the dosage of positive inotropic drugs. However, increasing its concentration (20mmol/L) can not further improve the cardiac function and reduce arrhythmias.