Effect Of Penehyclidine Hydrochloride On Myocardium During Cardiopulmonary Bypass Heart Surgery

Effect of Penehyclidine Hydrochloride on Myocardium during Cardiopulmonary Bypass Heart Surgery【Objective】To observe the effect of penehyclidine hydrochloride on myocardium during cardiopulmonary bypass(CPB) heart surgery through cardioplegic solution.【Methods】20 patients,ASAⅡ～Ⅲ,cardiac functional gradingⅡ～Ⅲ,age 20～60y scheduled for mitral valve replacement(MVP or MVR) surgery under CPB were included in this study.They were randomized into two groups:penehyclidine hydrochloride group(P group) and control group(C group).During the operation,in P group,1mg(2ml) penehyclidine hydrochloride was added into the first bag of cardioplegic solution,and in C group,we added 2ml sodium chloride.After the operation,we send the patients to the cardiac intensive care unit with endotracheal catheter.8ml vein blood of every patient was collected before anesthesia induction (T1),after the incision of pericardium(T2),at the end of CPB instantly(T3),6 hours after CPB(T4),12 hours after CPB(T5),24 hours after CPB(T6),and 48 hours after CPB(T7),to measure the troponin(cTnT),myoglobin(Mb),myocardium zymogram (CK,CK-MM,CK-MB),respectively.At the same time,heart automatic beat recovery rate after aorta open-clamp and delirium after operation were observed.【Results】(1)There is no significant difference on the age,gender,BMI,EF and ASA between two groups(P＞0.05).As well as the operation time,CPB time and aorta close-clamp time.(2)Heart automatic beat recovery rate after aorta open-clamp of P group is 70%,and 50%of C group,P＞0.05.Delirium happened on none patient.(3)The basic value of cTnT,Mb,CK,CK-MM,CK-MB of both groups were in the normal range,and without difference.(4)Compared with the basic value,cTnT of P group and C group raised significantly after CPB(P＜0.05).But there was no significant difference between P group and C group at every time(P＞0.05),except T4. At that time,the value of P group was 0.47±0.15ng/ml,C group was 0.65±0.23ng/ml,P=0.05.Until T7,the two group were still both higher(P＜0.05).(5) Mb of P group and C group significantly raised after anesthesia induction immediately(P＜0.05).The peak values were T3,P group was 11 times as the basic value,as C group was 18.But P group and C group were without difference at every time,P＞0.05.T4,Mb of P group and C group were conspicuously lower than T3(P＜0.05).Then P group had a small ridge at T5,C group was at T6 as well.At T7, both were extremely lower than T3(P＜0.01),but still higher than T1.(6) Myocardium zymogram,CK,CK-MM,CK-MB of T3 were significantly higher than T1(P＜0.05),both P group and C group.There was no difference between the two groups(P＞0.05).The rise of CK lasted until T6,then decreased significantly. (7)CK-MM of C group at T7 was lower than T6(P＜0.05).(8)CK-MB,as the peak value of P group was 65.4±24 U/L(T4),4.36 times as T1;In C group,the max value was at T5(84.2±35.4U/L),6.63 times as the basic number;T7 of both group was lower conspicuously(P＜0.05).【Conclusion】During CPB operations,using penehyclidine hydrochloride through cardioplegic solution does not have conspicuous myocardium preservation.This administration method will not cause delirium.