Opioid Delta Receptor Agonist Medicated Myocardial Protection And Clinical Observion On Sepsis-induced Cardiomyopathy

Part one:PPENK-MIDGE-NLS gene vector reduced myocardial ischemia-reperfusion injury in rats.Objective To investigate the protective effects and expression of the PPENK-MIDGE-NLS gene vector on myocardial ischemia-reperfusion injury in rats.Method Forty eight SD rats were divided into four groups randomly(n=12): Sham group(group C),ischemia reperfusion group(group I/R),gene vector group(group P),and MIDGE-NLS group(group D).Group C was treated identically except left anterior descending was not tied.Group I/R was treated with 30 min of occlusion and 24 h reperfusion.Group P was given PPENK-MIDGE-NLS gene vector by tail vein injection24 h later and then established the rat model of myocardial I/R.Group D were injected MIDGE-NLS gene vector by tail vein 24 h later and then established the rat model of myocardial ischemia reperfusion.Hemodynamic indexes including MAP and HR were recorded at T1(before ischemia),T2(30 min after ischemia)and T3(30 min after reperfusion).According to the Lambeth conference standard arrhythmia within 30 min ischemia and 30 min reperfusion were recorded and scored.At the end of reperfusion,the level of carciac troponin I(c Tn I)in plasma was measured by ELISA Kit.Myocardial infarction size was measured by Triphenyltetrazolium Chloride.The pathomorphology was examined with lens microscope,and the expression of proenkephalin(PENK)protein in the myocardial tissue was measured by western blotting.Results PPENK-MIDGE-NLS gene vector could reduced the drop of MAP and HR that induced by myocardial I/R in rats.The level of c Tn I in group Preduced compared with gproup I/R and group D.The cardiac arrhythmia score in group P(2.0±0.9)reduced compared with group I/R(4.1±0.6)and group D(4.0±1.0).The myocardial infarction size in group P was decreased significantly compared with group I/R(P<0.05).The pathomorphology of myocardial injury was reduced obviously in group P and the expression of PENK protein was increased compared with other groups.Conclusion PPENK MIDGE-NLS gene vector enhanced the production of enkephalin and had a protective effect on myocardial ischemia-reperfusion injury in rats.Part two:Clinical observation of pentazocine on myocardial dysfunction in sepsisObjective To observe the clinical effect of pentazocine for myocardial dysfunction in sepsis and its possible mechanism.Methods A prospective,single blind,randomized controlled trials,selectting 60 patients who were diagnosed sepsis in our Hospital from June 2016 to February 2017,randomly divided into two group :experimental group(30 cases)and control group(30 cases).The control group was given routine treatment according to the recommendations of the rescue campaign(SSC)guidelines,the use of continuous intravenous infusion of midazolam midazolam,first dose of 0.04/kg,followed by of 0.1mg/kg/h.The experimental group were treated with intravenous injection of pentazocine 60 mg on the basis of the control group,then using micro pump continuous intravenous infusion with 40ug/kg/h.Compared the level of cardiac troponin I(c Tn I),B type natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB),tumor necrosis factor-a(TNF-a),interleukin-6(IL-6)between two groups,compared the level of detection of echocardiography: ejection fraction(EF)and early diastolic and late ventricular filling velocity ratio(E/A)to evaluate cardiac function and prognosis the mortality rate of 28 days between two groups,and the statistical analysis was performed with the use of SPSS19.0 software.Results There were no significant differences between the two groups of age and sex,Apache?score before treatment(P>0.05),3 days after treatment the level of c Tn I,CK-MB,BNP,EF,E/A and inflammatory factors were decreased than before treatment,but the diffirence wass no statistically significant between the two groups(P>0.05);7 days after treatment the level of c Tn I,CK-MB,BNP,EF,E/A and inflammatory factors were decreased than before treatment,the difference was statistically significant(P<0.05);the mortality rate of28 days was no significant difference between the two groups(P>0.05).Conclusion Sepsis myocardial depression is the diastolic function damage,pentazocine can improve myocardial dysfunction in sepsis patients,suggesting that it can improve cardiac function,reduce inflammation in sepsis.