The Protective Effect Of Aprotinin On Brain After Cardiac Surgery Under CPB

Objective: cerebral dysfunction remains to be a major source of morbidity after cardiac surgery under CPB. The causes of it possibly include cerebral hypoperfusion, cerebral embolization and systemic inflammatotory response. It's found that Aprotinin has characteristics of anti-inflammatotory response during CPB. Animal experiments show that Aprotinin attenuated simulated cerebral Ischemia-reperfusion injury ,but its effect on neuropschologial dysfunction after cardiac procedure with CPB is nucertain. The goal of this study was to evaluate the role of complement activation on cerebral dysfunction and the effect of different dosages of Aprotinin on cerebral injury.Material and Methods: 45 patients to undergo heart valve replacement with rheumatic heart valve disease was randomly assigned into three groups: small dosage group( reduced to Al),large dosage group(reduced to A2), and control group(reduced to C). All patients was intubated and anaesthetized. The CPB was conducted with mild hypothermia and hemodilution. Oxygenators consist of bubble . α -stat Blood-gas management was used.A1 group was primed with only 2.0×10⁶ KIU Aprotinin, A2 group intraveinously received the first dose of 0.05× 10⁶ KIU Aprotinin,then another dose of 1.5×10⁶KIU. A dose of 2.0×10⁶ KIU Aprotinin was used in the prime, and then a dose of 0.05 ×10⁶ KIU Aprotinin was used per hour until the end of CPB. C group received equal volume of physiological saline solution. Blood sample was taken from the indwelling radial artery and jugular vein catheter and immediately centrifuged .The plasma was stored in sterile vacuum tubes at -20 ℃,and subsequently assayed the levels of sC5_sb-9 and S-100 β protein according to the manufacture's procedure.The blood sampling time of sC_5b-9 was at prebypass(T₁),the end of bypass(T2),and 24 hours postbypass(T3) respectively; for S-100 β protein at...