Clinical Observation Of Penehyclidine Hydrochloride's Protection To Lung Injury During Cardiopulmonary Bypass Procedure

Backgroud:Cardiopulmonary bypass procedure(CPB)nearly has a sixty-years history,which has been improved rapidly in equipments and techniques. As the CPB,myocardium protection and cardiac surgery techniques'unceasingly development, the morbidity and mortality of cardiopulmonary by pass open-heart surgery has been decreased gradually. However, lung injury (LI) is still to remain as one of the severe complications of the cardiopulmonary bypass procedure. The mechanism of lung injury with CPB is very complex, which has not been known clearly.Recently,how to prevent and lessen the lung injury with CPB has become a research focus. It has been extensively reported that anti-cholinerglc drug (anisodamine for example) has a protective effect on LI. However, the action of anisodamine on M cholinoceptor is unselective,which usually increase the heart rates obviously while the treatment-dose was administered. This adverse effect of the anisodamine would not benefit patients'recovery of heart function after operation.Penehyclidine hydrochloride(PHC) is a new anticholinerglc drug which is invented by the institute of pharmacology and toxicology,Academy of Military Medical Sciences in the People's republic of China.It has the selective antagonism on MI and M3 cholinoceptor, and no obvious antagonism on M2 cholinoceptor,which could obviate the tachycardia .Objective:The object of this research was to explore the protective effect of PHC on the lung injury during cardiopulmonary bypass procedure (CPB).Materials and Method:42 patients,scheduled for selective cardiac valve operation were randomly divided into two groups:⑴PHC group(B): 3 mg of penehyclidine hydrochloride was added to the priming solution;⑵control group(A):the same volum's Sodium Chloride was added to the priming solution. Observation indexes:①chest x-ray film at the time of 1h post-operation,②Oxygen Index(OI)(OI=PaO2/FiO2) at the time of operation beginning,ending and 1h,6h,24h post-operation.③acid content of arterial blood at the time of operation beginning,ending.④breathing machine utilizing time post-operation.Results:Comparing the chest x-ray film at the time of 1h post- operation, there was no obvious difference between the two groups,p﹥0.05; there was no obvious difference between the two groups in acid content of arterial blood at the time of operation beginning( p>0.05),while PHC group's acid content of arterial blood was obviously lower than control group at the ending time(p<0.05). there was no obvious difference between the two groups in Oxygen Index at the time of operation beginning( p>0.05),while PHC group's Oxygen Index was obviously higher than control group at the time of ending and 1h,6h,24h post-operation (p<0.05); the breathing machine utilizing time post-operation of PHC group was fewer than the control group(p<0.05).Conclusions:Penehyclidine hydrochloride had the functions of relieving postoperative pulmonary edema,depressing acid content of arterial blood and improving the ability of lung,shortening the machine utilizing time post-operation . In a word ,Penehyclidine hydrochloride has a protective effect on LI during cardiopulmonary bypass procedure.