The Clinical Research On The Cardioprotection Of Sodium Ferulate And Trimetazidine On Myocardical Injury During Cardiopulmonary Bypass In Patients Undergoing Cardiac Valve Replacement

Objective:To explore the protective effect of Sodium Ferulate(SF) and Trimetazidine(TMZ) on myocardical injury during cardiopulmonary bypass(CPB) in patients underwent replacement.Methods:40patients undergoing cardiac valve replacement under cardiopulmonary bypass were randomized into control group(A group), SF group(B group),TMZ group(C group),SF plus TMZ group(Dgroup),10in each group.B group received SF injection8mg/kg in cardioplegia solution during CPB. C group received TMZ oral20mg three times a day, and two hours before the day of surgery patients given60mg loading dose.Both SF and TMZ were administered in D group.Blood samples were taken to measure the activity of superioxide dismulase(SOD)and the levels of malondialdelyde (MDA),creatine kinase-MB and Cardine tropo-nin I(cTnI).The level of TNF-a is measureed by ELISA before CPB(T0), aortic declamping(T1),6h(T2)、12h(T3)、24h (T4)after the operation.Results:1.Mechanical ventilation time and dopamine dosage were significantly lower in D group than in A、B、C groups at postoperative.There were no significant differences in the four groups in other ecumenical thing.2.CK-MB and cTnI:②Serum levels of CK-MB were significantly higher than the baseline at T1～T4in the four groups, the highest was at T4(P<0.01), serum levels of CK-MB were significantly higher in A group than in B、C、D groups at T1～T4(P<0.05).Increasing amplitude of CK-MB was lower in both B and C groups,D group was the lowest, there was no difference in the treatment groups at the same time(p>0.05).②Serum levels of cTnI were significantly higher than the baseline at T1～T4in the four groups,the highest was at T4(P<0.01). Serum levels of cTnI were significantly higher in A group than in the treatment groups at T2and were significantly higher in A group than in both B and C group at T3～T4. Serum levels of cTnI were significantly higher in C group than in D group at T3～T4(P<0.05).3.MDA and SOD:①Serum levels of MDA in four groups were significantly higher than the baseline at T1～T4,the highest was at T3(P<0.01). Serum levels of MDA were significantly higher in A group than in the treatment groups from T1to T3(P<0.05).there were no difference in the treatment groups at the same time(p>0.05).②The activity of SOD in A、B、C group were significantly lower than the baseline at T1～T3.the lowest was at T1(P<0.05).But activity of SOD were no diffirence at every point in D group(p>0.05).The downdrend of A group was much higher than B,C,D groups from T1to T3(P<0.05). The activity of SOD in D group were significantly higher than C group at T3(P<0.05).4. Serum levels of TNF-a:①TNF-a were significantly higher than the baseline at T1～T3,the highest was at T1(P<0.05).Serum levels of TNF-a were significantly higher in A group than in the treatment groups at T1and T2(P<0.05),there was no difference in the treatment groups at the same time (P>0.05).Conclusion:1.During peri-CPB stage myocardium ischemia reperfu-sion result in myocardium; Sodium Ferulate and Trimetazidine can inhibit the expression of TNF-a in the patients undergoing mitral valve replacement and can effectively protect myocardium from reperfusion injury during CPB.2.There were no difference on myocardical protection at two medicines separately;Moreover, using Sodium Ferulate and Trimetazidine group is better than using the two medicines separately on myocardial protection during CPB.