| A major factor of myocardial injury in cardiopulmonary bypass ( CPB) stud-y is myocardial ischemia reperfusion injury (MIRI) , which is an acute inflammatory response, and often causes multiple complications after operation. The activation of lymphocytes and endothelial cells performs decisive functions. En-dothelial cells activation plays a key role in MIRI. There are two phases in endo-thelial cells activation: the first phase is the fast phase of seduction of comple-ment active portions. The increase of complement C5a in CPB is close correlated to endothelial cells activation fast phase. C5a is the activator of endothelial cells expression adhesion molecule P-selector, which can be expressed on the surface of those cells, triggered adhesive response of PMN and endothelial cell surface. PMN express CD11/CD18, which combines to Intercellular Adhesion Molecules (ICAM-1) . C5a can activates platelets and mononuclear cells, promotes the re-lease of cytokines and adhesion of PMN and endothelial cell, raises the sensitiveness of endothelial cell to TNF. The second phase is the combination of cytokines, inflammatory mediators and the receptors on endothelial cell surfaces, which increase the express of E-selector, ICAM-1, VCAM-1, etc, NF-kB is the main translation adaptation factor. This also is called delayed phase. After the activation of endothelial cells; multiple mechanisms cause vessel dysfunctions and tissue injuries, i.e. MIRI.Liposomal Prostaglandin El ( Lipo-PGEl) is a stable type of PGE1, which is target-oriented, continuous, high efficient and safe. Animal trials present its anti-MIRI effects.OBJECTIVETo test indexes sensitive and specific to myocardial injury such as cTnl and CK-MB, and to different classes in inflammatory response such as EL-6, TNF-aand sICAM-1 in CPB heart surgeries before and after the myocardial reperfu-sion at different times. Observe the changes in these indexes and the influence of Lipo-PGE1. Infer systemic inflammatory response and myocardial injury extent. Explore further Lipo-PGEl 's protective effect on myocardial ischemia reperfusion injury and its mechanism and seek a highly effective, safe, reliable anti-MIRI method in CPB heart operations.METHODS32 cases of valve replacement, VSD, ASD amendment from July 2003 to March 2004 were selected. Whose ages are from 13 to 65 years old, heart func-tions are from I to III, liver, kidney, coagulation, WBC were within normal range. They were divided into 2 groups with strap randomization method, and underwent routine anesthesia, medication, moderate hypothermia ( 26-28 ). Mean blood pressure was maintained at 60-80 mmHg. Hemoglobin in CPB was 70-80g/L. HCT was 25-30%. Perfusion index was 2.4-2.6L/min/m2. 4 K + paralyze fluid was used to protect the myocardial cell by irrigating the aortic root. Lipo-PGEl was continuously pumped into the experimental group at 2ng/ kg/min until 2 hours after the aorta was open. Control group use the same conditions except Lipo-PGEl.11ml arterial blood was collected at each time from before CPB and 1h, 6h, 24h after the aorta was open. Heparin was added for anticoagulation. 8ml was sent for assay of cTnl, CK-MB and blood routine immediately. The rest was centrifuged for 20 minutes. The supemate was kept in -70 in refrigerator.After all the sample were collected, IL-6, TNF were assayed by radio-immune method. sICAM-1 was assayed by ELISA method. All the data were expressed in x s. SPSS 11.5 was used for statistical analysis. One-way ANOVAwas used for difference within group. T-test was used for difference between groups. Chi-square test was used for quantitative data. Significance level was P <0.05.RESULTSAge, weight, operation, CPB time, aorta clamped time and lowest nostril temperature were of no significant difference ( P > 0.05 ). cTnI, CK-MB, TNF-, IL-6 and sICAM-1 level rise after CPB, and keep rising tendency until peak level at the 24th hour. The difference between them was significant ( P < 0.01). There is no difference in experimental and control group...
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