The Protective Effect Of Ligustrazine On Inflammatory Reaction And Myocardial Ischemia-reperfusion Injury During Cardiopulmonary Bypass

Objective: To evaluate the protective effect of Ligustrazim given different dosage on inflammatory reaction and myocardial ischemia-reperfusion injury(MIRI) induced by cardiopulmonary bypass(CPB).Methods: Sixty cases of congenital heart disease with atrial or(and) ventricular septum defect undergoing open heart surgery with CPB were performed atrial or(and) ventricular septal defect repairment through meso or right-armpit incision.They were ASA1-2,heart functionâ… -â…¡,age3-14,body weight 12-47kg before operation. They were divided into 4 groups at random: group A,as control; group B,receiving Ligustrazine Hydrochloride Injection 3 mg/kg; group C, receiving Ligustrazine Hydrochloride Injection 9mg/kg; group D, receiving Ligustrazine Hydrochloride Injection 12mg/kg.They were all received meperidine 1 mg/kg,scopomamine 0.006-0.01 mg/kg,droperidol 0.1 mg/kg by i.m. before operation. In group A,0.9% Sodium Chloride Injection,the volume dose is 2ml/kg , was dripped through peripheral vein,within 30minutes before induction.Ligustrazine Hydrochloride Injection (20mg/ml) were admoveatured into 0.9%Sodium Chloride Injection,the volume dose is 2ml/kg in group B,C and D.They were dripped through peripheral vein,within 30minutes before induction.Midazolam 0.08-0.12mg/kg,vecuronium 0.1-0.12mg/kg,fentanyl 5μg/kg and etomidate 0.3mg/kg were supplied through i.v. during induction.All patients were intubated ,and mechanically ventilated.Propofol,fentanyl and vecuronium were supplied during operation.Fentanyl 5μg/kg and vecuronium 0.1 mg/kg were supplied before skin incision and splitting the sternum through central vein seperately. Fentanyl 10μg/kg and vecuronium 0.1 mg/kg were supplied at the beginning of CPB through oxygenator. Propofol 2-5mg·kg^-1·h^-1 were supplied continuously by i.v.after opening ascending aorta according to circulation function. Dopamine and dobutamine were supplied by infusion pump when necesory,so that systolic blood pressure ( SBP) was controlled between 80-100mmHg,and mean arterial pressure (MAP) was controlled exceeding 60mmHg.We phlebotomized before induction(To),at 15th min during CPB(T₁), at 2nd hour (T₂)and 6th hour(T₃) after CPB,at 24th hour after opeartion(T₄),then obtained centrifugate.Tumor necrosis factor(TNF) in blood serum were measured at T₀,T₂ and T₃,and cardiac protonin-I(cTnI) in blood serum were measured at T₁,T₂,T₃ and T₄.We recorded all hemodynamics indices of these patients and beating-recovery or defibrillation or arrhythmia and application of vasoactive agent at post-opening ascending aorta accordingly. Results: All pre-anaesthesia indices of four groups were comparable,no obvious difference.The TNF concentration was higher at T₂ than T₀ in group A (P<0.05) ,there were no significant difference of TNF concentration between T₂ and T₀ in group B,C and D, there were no significant difference of TNF concentration between T₃ and T₀ in group A,B,C and D. There were no significant difference of TNF concentration at T₀ in group A,B,C and D,the TNF concentration was lower in group B,C,D than in group A at T₂,and significantly low in group C,D (P<0.001). The TNF concentration was lower in group C,D than in group A at T₃ (P<0.05). The TNF concentration was significantly lower in group C,D than in group A,B as a whole (P<0.01) .The cTnI concentration was higher at T₂, T₃ than T₁ (P<0.05) ,and significangly higher at T₄ than T₁ (P<0.001) in group A. There were no significant difference of cTnI concentration among T₂,T₃,T₄ and T₁ in group C , the cTnI concentration was significantly lower in group C than in group A at T4 (P<0.001) , there were no significant difference of cTnI concentration between group A and C at T₁,T₂,T₃. The cTnI concentration was lower in group C than in group A as a whole (P<0.05) . There were no difference of all hemodynamics indices among group A ,B,C and D,and no difference of beating-recovery or defibrillation or arrhythmia and application of vasoactive agent at post-opening ascending aorta among group four groups.Conclusion: Ligustrazine Hydrochloride Injection 3 mg/kg,9 mg/kg and 12 mg/kg can antagonize inflammatory reaction induced by CPB ,thus depress the concentration of TNF, and Ligustrazine Hydrochloride Injection 9 mg/kg and 12 mg/kg can provide more protection. Ligustrazine Hydrochloride Injection 9 mg/kg can antagonize MIRI induced by CPB,thus depress the concentration of cTnI, and provide protection on MIRI. But we need further investigate the application of Ligustrazine into CPB ,including mechanism, indication,contraindicationjuncture,medication and dosage.