The Effect Of Sodium Phosphocreatine On Perioperative Myocardial Injury In Patients Undergoing Peritoneal Dialysis Catheterization

Objective: To investigate the effect of sodium phosphocreatine on perioperative myocardial injury in patients undergoing peritoneal dialysis catheterization.Methods: Sixty patients with chronic renal failure in uremia stage,33 males and 27 females,aged 18 to 65,ASA III or IV,undergoing peritoneal dialysis catheterization.According to the random number table method,they were divided into two groups,the control group(group C)and the phosphocreatine group(group CP),with 30 cases in each group.After admission,dexmedetomidine 0.5g /kg(10min)was used for sedation in both groups.They were anesthetized by transversus abdominis plane block combined with rectus sheat block.In the group CP,patients were intravenously injected 30 mg/kg sodium creatine phosphate that dissolved in 100 ml normal saline within about 15 mins before skin resection,then patients were intravenous infusion sodium creatine phosphate at a rate of 4.0 mg/kg/h until the end of the surgery.Group C received intravenous infusion of normal saline with equal volume.The concentrations of CKMB,c Tn I and BNP were measured in before surgery,24 hours and 48 hours after surgery.After the patient entered the room,vital signs such as MAP,HR and Sp O2 were recorded before the block(T0),after the block(T1),at the beginning of the operation(T2),10 min after the skin resection(T3)and at the time point after the operation(T4),and RPP was calculated and recorded.The length of hospital stay and incidence of cardiovascular adverse events during perioperative period were recorded.Results: The serum concentrations of CK-MB and c Tn I in the two groups at 24 hours and 48 hours after surgery were significantly higher than those before surgery(p<0.05).The serum concentrations of BNP in the group C at 24 hours and 48 hours after surgery were significantly higher than that before surgery(p<0.05).The concentrations of CKMB,c Tn I and BNP in group CP at 24 hours and 48 hours after surgery were significantly lower than those in group C(p<0.05).The HR of T3 in group CP were significantly lower than that of T0(P<0.05).Compared with T2,the HR of T1,T3 and T4 in two groups was significantly reduced(P<0.05).The MAP of time point T1 in both groups was significantly higher than that of T0.The MAP of T1,T3 and T4 in two groups was significantly lower than that of T2(P<0.05).Compared with T2,RPP of T0,T1,T3 and T4 were significantly reduced in the two groups(P<0.05).Compared with group C,there was no significant difference in HR,MAP and RPP of group CP at each time point(P>0.05).And no adverse events such as cerebrovascular accident occurred in both groups,during one month following up.Conclusion: Peritoneal dialysis catheterization may increase cardiac injury in patients with CKD;The use of sodium creatine phosphate can make the hemodynamics of patients with CKD more stable,alleviate the myocardial damage caused by peritoneal dialysis catheterization in patients with CKD,protect the myocardium and improve cardiac function;And can prevent cardiovascular adverse events during perioperative period.