| ObjectiverTo clinically evaluate the myocardial protective effects of leukocyte-depleted blood cardioplegia (LDBCP) in valve replacement patients.Blood cardioplegia (BCP), which was proposed by Follete and colleagues in 1978, is now widely used for myocardial protection.Current evidence strongly indicates that activated neutrophils contribute to myocardial reperfusion injury after ischemia.This research use Leukocyte depletion filter (LDF) on the bypass circuit,observe the level of Intercellular adhesion molecule-1 (1CAM-1),Troponinl(cTnI) and Malondialdilyde(MDA) in serum.Study the effects of neutrophils and cell adhesion molecule-1 in myocardial ischemia-reperfusion.Methods : Twenty patients with rheumatic heart valvular disease whose ASA scale was II-III,aortic clamping time and bypass time were more than40,60 minutes (min),were respectively selected and divided randomly into two groups (n=10 each):control group and experiment group.There were no differences between two groups except that experiment group received leukocyte-depleted warm blood cardioplegia.Under the monitoring of hemodynamics at surgery,heparinized anticoagulant blood samples from coronary sinus after anesthesia induction and before CPB (T|),30 min after aortic clamping (T2) and aortic declamping 30 min(T3),60 min(T4),120min(T5) determiningthe following data:(1)blood count before and after Leukocyte depletion filter,(2)coronary sinus plasma levels of malondialdilyde (MDA),(3)coronary sinus plasma levels of Troponin I(cTnl) (4)coronary sinus plasma levels of intercellular adhesion molecule-1 (ICAM-l).The data were expressed as mean±SD.Statistical package (SPSS 10.0) wasused for processing data.P<0.05 was considered statistically significant. Results:1. General patient dataThere were no significant differences between two groups in age,weight, ascending aorta clamping time,CPB time,operation time and ASA scale (P > 0.05).2. Change in the plasma levels of MDAThere were no significant differences between two groups in MDA levels at the points of TI and T2(5.76±0.56 nmol/ml vs 5.39±0.57nmol/ml,5.97±0.57 nmol/ml vs 5.94±0.57nmol/ml,P >0.05),but there were significant difference between two groups at the points of T} to TS (P <0.05),the MDA levels of control group were higher than that of experiment group.Compared in control group.the MDA levels at the points of T3to T5 were higher than that at the points of T±(P <0.01)with a maximum value at time point Tj.But inexperiment group,there were no significant differences among the MDA levels at the point of T5,Ti and T2(P >0.05).3. Changes in the plasma levels of cTnlThere were no significant differences between two groups in cTnl levels at the points of T!(0.188±0.028y g/1 vs 0.176±0.034n g/1, P >0.05),but there were significantdifferences between two groups at the points of Ti to T> (P <0.05),the cTnl levels of control group were higher than that of experiment group. Compared in groups, the cTnl levels at the points of T2 to 1$ were higher than that at the point of T|(P<0.01).4. Changes in the plasma levels of 1C AM-1There were no significant differences between two groups in ICAM-1 levels at the points of T, and T2(235.42±12.34 ng/ml vs 238.21±12.18 ng/ml, 141.03±16.68ng/ml vs 146.37±15.64ng/ml,P >0.05).But there were significant differences between two groups at the points of TS to TS (P <0.05),the ICAM-1 levels of control group were higher than that of experiment group. Within groups,the ICAM-1 levels at the points of T2 to T5 were higher than that at the points of T| The ICAM-1 levels at the points of T2 to T.s in control group were (238.21±12.18ng/ml, 333.35±31.1 Ing/ml, 365.653±22.96ng/ml, 272.92±28.62ng/ml) higher than that at the point of T,(141.03±16.68ng/ml,P<0.05).INexperiment group,there were no significant differences between the ICAM-1 levels at the point of T2 and that at the point of T5(235.42±12.34 ng/ml vs 245.29±24.12ng/ml,P >0.05).Conclusions:1. This clinical study confirmed that cTnl levels can reflect e...
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