Effect Of Ketamine On The Expression Of Myocardial Heat Shock Protein 72mRNA In Congenital Heart Disease Patients Undergoing Cardio-pulmonary Bypass

Objective To study the change of the expression of myocardium induced nitric oxide synthase (iNOS) mRNA and heat shock protein (HSP) 72 mRNA in congenital heart disease (CHD) patients suffering from myocardial ischemia /reperfusion injury (MI/RI) during cardiopulmonary bypass (CPB), and the effects of ketamine on them, and to approach the mechanism of it.Methods 36 patients operated atrial septal defect (ASD) and/or ventricular septal defect (VSD) correction were randomly allocated in 3 groups (each 12 patients): control and ketamine interfered groups (K₁ and K₂ group). Ketamine, which dose were 0.5 rog·kg^-1 and 1.0 rog·kg^-1, were vein injected before sternum splitted, at the time of aorta intubated and before 5 minutes of aorta clamped off partly. Got the myocardium at the time of right atria intubated (T₁), 30 minutes after aorta clamped on (T₂) and 30 minutes after aorta clamped off (T3). Detected the value of iNOSmRNA and HSP72mRNA in myocardium by one step real time fluorescence quantitative RT-PCR (used SYBR Green 1 fluorescence inosculating method). Blood samples were drawn from superior vena at time intervals: T₁, T₂, T₃ and 2h after aorta clamped off (T₄). The content of creatinekinase (CK) and creatinekinase isozyme (CK-MB) were detected. Results 1. There were no significant differences among the three groups in sex, age, weight, time of aorta clamped on and cardiopulmonary bypass etc. (P >0.05).2. The change of myocardium iNOSmRNA: the expression of myocardium iNOSmRNA, compared within groups, the expression of iNOSmRNA was significantly higher at T₃ and T₂ than at T₁ (P <0.01), and it was higher at T₃ than at T₂ (P <0.05); Compared between groups, the interfered groups were both less than control group at T₂ and T₃ (P <0.01), and it was significantly less in K₂ than in K₁ (P <0.05).3. The change of myocardium HSP72 mRNA: the expression of myocardium HSP72 mRNA, compared within groups, it was significantly higher at T₃ and T₂ than at T₁ (P <0.05), and it was higher at T₃ than at T₂ (P <0.05); Compared between groups, the interfered groups were both higher than control group at T₂ and T₃ (P <0.05), and there were no significant difference between K₁ and K₂ group (P >0.05).4. The change of serum cardiac enzyme: the contents of serum cardiac enzyme , Compared within groups, T₂,T₃,T4 compared with T₁, P <0.01; T₃,T₄ compared with T₂, P <0.01; T₄ compared with T₃, P <0.01. Compared between groups, there were no significant differences among three groups at T₁ (P >0.05), K₁,K₂ compared with C at T₂,T₃,T₄,P <0.05, and there are no significant differences between K₁ and K₂ (P >0.05).Conclusion Myocardial ischemia-reperfusion injury is triggered during cardio-pulmonary bypass . iNOS and HSP72 gene take part in the progression of myocardial ischemia-reperfusion injury. Anes and deuto- anes dose of ketamine can decrease iNOSmRNA and increase HSP72 mRNA in myocardium significantly, and decrease the leak of serum markers of cardiac injury, thus acts myocardial protection in some degree.