Clinical Study On Myocardial Protective In Different Consistence Of Creatine Phosphate

Object:The purpose of this study is to investigate the effect on myocardial protection by adding different consistence of exogenous creatine phosphate(CP) to cardioplegia solutions in correction of cardiac defects in children.Patients and method:From January to March 2009,forty patients who scheduled for cardiacl defects correction were randomly divided into four creatine phosphate consistence groups, ten patients each group.Group T using cardioplegia solutions,and group A using the same solution but added wire 5mmol/L exogenous creatine phosphate sodium., 10mmol/L in group B and 20mmol/L in group C.The radial artery blood samples were collected to measure the plasma concentration of cTnI,CK,CK-MB,AST,LDH when at the onset of aorta clamping(T0),at the onset of aorta unclamping(T1),30 min after aorta unclamping(T2),6 h after weaning from CPB(T3),24 h after weaning from CPB(T4) and 48 h after weaning from CPB(T5).Time of emergence from anesthesia and the duration of stay in ICU were recorded.Cardiac electrophysiological data,recovery of hemodynamics,inotropic medicine dosage were assessed.Results:There were no significant differences between the four groups of mean age,mean weight,ejection fraction,the duration of mechanical ventilation and ICU settling,mean aortic cross-clamp duration or mean bypass duration(P＞0.05).None of the patients died.There was no arrhythmia in each group.The spontaneous recovery rate of heart automatic beats in group B higher than in group T (P＜0.05).The positive inotropic drug administrated in group A,B,C were significantly less than in group T.The values of LDH,CK,CK-MB,AST,cTnI have no significant differences between the groups at the time of clamping aorta.The levels of LDH,CK,CK-MB,AST and cTnI at 30min,6H,24H,48H after aortic open clamp were significantly higher than at clamping aorta in each group.Peak serum cTnI values occurred 30min aortic unclamp.The values of cTnI is significantly lower in group B than in other group at 30min,6H,24H,48H after aortic open clamp.The levels of CK-MB is lower in group A,B,C than in group T at 30min,6H,24H,48H.The values of CK,LDH and AST have no significant differences between the groups at postoperation.Peak serum CK and AST occurred 6H aortic unclamp.Conclusion:1,Creatine phosphate has been shown to improve myocardial protection and to reduce the incidence of arrhythmias added to cardioplegic solution.2,Creatine phosphate added to cardioplegic solution can relieve the ischemia/reperfusion injury.3,CP 10mmol/L is suitable for adding to cardioplegic solution.Increaseing CP consistence don't improve myocardial protection and reduce the incidence of arrhythmias.