Discuss The Limb Remote Ischemic Preconditioning In Myocardium Protection During VSD Repair Operation Under Thoracoscopic

Objective:Objective to investigate the effect of limb remote ischemic pr-econditio ning on myocardium protection in thoracoscopic cardiac surgery of ventricular septal defect repair with cardiopulmonary bypass（CPB）.Methods:Sixty adult patients with ventricular septal defect were divided into two group.one was remote ischemic preconditioning group（R group,n=30）,Patients in the observed group were given pressure remote ischemic preconditioning after 30 min of anesthesia induction),another was control group（D group,n=30）,the plasma level of H-FABP、CK-MB、cTnI and inflammatory factors were observed before surgery（T₀）,after anesthesia induction（T₁）,30min（T₂）、three hours（T₃）、six hours（T₄）、twelve hours（T₅）、twenty four hours（T₆）after aortic de-clamping.and record hemody-namics changes and CPB time,postoperative mechanical ventilation time,Automati-c recovery rate of heart,Postoperative vasoactive drugs and the intensive care unit s tay time.Results:1.There was no significant difference between the two groups in gender,a-ge,BMI,EF values preoperation,CPB and aorta clamping time,ICU stay time,24h dra-inage,postoperative mechanical ventilation time（P>0.05）.Postoperative vasoactive dr-ugs of group R was significantly lower than that of group D（P<0.05）.Automatic reco-very rate of heart of group R was significantly higher than that of group D（P<0.05）.2.Hemodynamics change:the level of HR and MAP in group R and D was signifi-cantly lower at T₁（P<0.05）,there was no significant difference between the two groups in HR and MAP at 30min、3h、6h、12h、24h after aortic de-clamping（P>0.05）.3.H-FABP:Compared to T₀,The level of H-FABP of groups R and D showed a significant increase at 30min、3h、6h、12h after aortic de-clamping（P<0.05）,and reached the peak at 6h after aortic de-clamping,had a downtrend at 12h after aortic de-clamping,returned to the preoperative level at 24h after aortic de-clamping.The level of H-FABP of group R was significantly lower than that of the control group at 30min、3h、6h after aortic de-clamping（P<0.05）.4.CK-MB and cTnI:The level of CK-MB and cTnI of groups R and D showed a significant increase at 3h、6h、12h、24h after aortic de-clamping（P<0.05）,and reached the peak at 24h after aortic de-clamping.Moreover,compared with the contr-ol group,the level of CK-MB and c TnI in the observed group were significantly lower than that of the control group at 3h、6h、12h、24h after aortic de-clamping（P<0.05）.5.Inflammatory factors:the level of IL-6,IL-8,TNF-αat 30min、3h、6h、12h、24h after aortic de-claming were significantly higher than that of T₀.（P<0.05）.and the-re were no significant difference between the two groups in the lever of IL-6、IL-8、TNF-αat 30min、3h、6h、12h after aortic de-claming（P>0.05）,but there was signi-ficant difference at 24h after aortic de-claming（P<0.05）.Conclusions:1.Limb remote ischemic preconditioning can reduce the release of biochemical marker:CK-MB、cTnI、H-FABP and reduce Postoperative vasoactive drugs,increase the Automatic recovery rate of heart,reduce myocardial injury for pa-tient with ventricular septal defect repair operation.2.Limb remote ischemic preconditioning can reduce the forward level of inflamm atory factors.3.H-FABP can be a earlier diagnosis in preoperative myocardial injury than cTnI and CK-MB.