Study On Myocardial Protection Of Phosphate Creatine In Cardiopulmonary Bypass

Objective:To investigate the protective effect of phosphocreatine on myocardium during cardiopulmonary bypass(CPB)and different ways of administration.Methods:Ninety patients undergoing valve replacement under extracorporeal circulation were randomly divided into three groups: A,B and C.Group A and group C were given 100 m L of normal saline at 2 days before surgery and on the day of surgery.In group B,creatine phosphate(CP)(33 mg/kg)was added to normal saline for 100 m L of peripheral-intravenous drip.Intraoperative systemic blood flow cooling below 30 ℃,blocking the ascending aorta,A,B,C three groups of patients are immediately through the aortic root anterograde perfusion cardiac arrest liquid,perfusion amount to 20 ml/kg,every 30 minutes infusion time,infusion volume for 10 ml/kg.Group A and group B were perfusion with conventional blood-containing cold stopping fluid(4:1),while group C was perfusion with blood-containing cold stopping fluid(4:1)containing 10 mmol/L of creatine phosphate(CP).The patient’s age,gender,height,weight,body mass index,cardiac ejection fraction and other preoperative indicators were recorded in detail.During the operation,heart rate,pulse,electrocardiogram,blood oxygen saturation,invasive arterial blood pressure,central venous pressure,urine volume,Hct,nasopharyngeal temperature were continuously monitored.The operation time,extracorporeal circulation time,aortic occlusion time,and the heart auto-repeat after aorta opening were recorded.Dopamine use within 24 hours after surgery.Results statistical analysis wasperformed to draw a conclusion.Results:In this study,plasma cTnI,CK and CK-MB indexes were used to detect the degree of myocardial injury.cTnI is a marker of myocardial injury that has been widely used in clinical practice at present,which is characterized by high specificity,strong sensitivity and long duration of serum.Results: the plasma cTnI,CK,and CK-MB levels before aortic occlusion were all within the normal range in the three groups,and all of them were increased after aortic occlusion,indicating intraoperative myocardial injury.The plasma levels of cTnI,CK,CK-MB and the amount of dopamine used after surgery in group B and C were all lower than those in group A,and the rate of cardiac palpitation in group B and C was higher than that in group A,indicating that intravenous infusion of phosphocreatine(CP)or addition in the stoppage solution could protect cardiac myocytes.In addition,the plasma levels of cTnI,CK,CK-MB and the amount of dopamine used after the operation in group C were lower than those in group B,and the rate of rebeating in group C was higher than that in group B,indicating that the effect of phosphate creatine(CP)in the stoppage solution on the protection of cardiac myocytes was better than that of intravenous drip.Conclusion:1.Creatine phosphate(CP)during valve replacement under cardiopulmonary bypass can effectively protect cardiac myocytes and improve cardiac function through a variety of mechanisms;2.The cardioprotective effect of phosphate creatine(CP)in cardiac arrest fluid is better than that of peripheral intravenous drip.