Effect Of Creatine Phosphate On Perioperative Myocardial Injury In Patients Undergoing Renal Transplantation

Objective: To investigate perioperative myocardial injury caused by renal transplantation in renal transplantation patients,and the intervention effect of creatine phosphate.Methods: Eighty ASA physical status III~IV patients of both sexes,aged 18 to 56 years,weight 45~76kg,undergoing renal transplantation were randomly divided into two groups(n = 40 each): control group(group C)and creatine phosphate group(group CP).The patients were received a restricted diet before surgery,before the anesthesia,the heart rate,blood pressure,electrocardiogram,pulse oxygen saturation,Narcotrend index were continuously monitored.The radial artery puncture and standardized central venous were performed to monitor arterial blood pressure and CVP.The CO?CI and SV were measured by the CNAP system.When the operation started,patients were given either CP 30 mg /kg intravenously(group CP)in 30 minutes,or normal saline(group C).HR,MAP,CVP,CO,SV and CI were recorded Before medication(T1),before reperfusion of the transplanted kidney(T2),30 minutes after reperfusion(T3)and the end of operation(T4).At the 4 time points and 12 hours(T5)?24hours after the operation(T6),blood samples were taken from central vein for determination of serum concentrations of c Tn I ? CK ? CK-MB and BNP.Postoperative cardiovascular adverse events and the length of hospital were recorded.Results: There was no significant difference in age,gender,BMI,operation time,blood loss and other general data between the two groups(P > 0.05).Compared with T1,MAP in group C decreased and HR increased 30 min after the vascular opening of them transplanted kidney,and the MAP and HR in the two groups were significantly different at T3(P<0.05).CVP in both groups was significantly higher at T3(P<0.05).Compared with T1,the indicators of CO,CI and SV in group C decreased to different degrees in T3 and T4.In the CP group,this index was significantly increased at T2 and decreased to the pre-cutoff level at T3 and T4.Compared with group C,CO,CI and SV in CP group were significantly increased at T2,T3 and T4(P<0.05),while the remaining indicators showed no significant difference(P > 0.05).Compared with T1,CK,CK-MB,c Tn I and BNP concentrations in group C gradually increased from T2 to T6,while those in CP group gradually increased from T3 to T6.Compared with group C,the concentrations of CK,CK-MB,c Tn I and BNP in CP group at T2-T6 is lower(P<0.05).Compared with group C,patients in the CP group had lower incidence of postoperative cardiovascular adverse events(P < 0.05)and shorter hospitalization stay(P < 0.05).Conclusion: Renal ischemia reperfusion can aggravate perioperative myocardial injury in renal transplant patients.Sodium creatine phosphate pretreatment can reduce the injury,improve cardiac function,stabilize circulation,reduce the incidence of cardiovascular adverse events in patients,and accelerate the recovery process of patients.