| IntroductionTo explore the myocardioprotective effect and mechanism of adenosine preconditioning in patients undergoing open heart surgery.Effective myocardial protection is a prerequisite for the success of Open heart surgery.At present,there are two main methods of myocardial protection:exogenous and endogenous.By reducing heart stress,reduce myocardial energy and increased myocardial oxygen consumption and energy supply methods are exogenous,and the effect of myocardial protection is limited.And Ischemic Preconditioning(IPC)is included in the human in the mammalian strong endogenous myocardial protection mechanisms,a reliable long myocardial protective effects.Preconditioning of adenosine is studied more and there is preliminary clinical application.A study showed that c-fos gene involved in ischemia - reperfusion myocardial apoptosis gene regulation.The role of IPC in accordance with principles of adenosine pretreatment heart bypass on the protective effect of ischemic myocardium and its mechanisms,and aims at the level of its genes do an exploration,the results will advance to the theory of adenosine research and clinical application development help.Materials and Methods25 cases patients with congenital heart disease whom without severe pulmonary hypertension were divided into adenosine precondition group(n = 13) and control group(n=12).In the control group after clamping using conventional modified cold St.Thomas cardioplegia solution to the myocardial protection(20 ml / kg),repeated every 30 min;the adenosine precondition group were injected adenosine slowly with 2 mg / kg to precondition before cardiopulmonary bypass (CPB),within 30 min,and then implementation the same method of myocardial protection and CPB with the control group.Cardioplegia later,repair the cardiac malformation,before the heart beating take myocardial tissue from the former as specimens to detect of c-fos gene by RT-PCR;complete heart operation then resumed cardiac blood supply.Observation the automatic heart beating rate and rhythm,and changes with serum creatine kinase(CK)and its isoenzyme MB (CK-MB),lactate dehydrogenase(LDH),cardiac troponin I(cTnI)levels after the operation about 2h,12h,and 48 h.Results1:Intraoperative and postoperative generation there were no surgical deaths.The auto-jumped heart rate of adenosine preconditioning group was 84.6% (11/13),while the control group was 58.3%(7/12),Compared to the two groups, there were significant differences(P＜0.05).The beating both were sinus rhythms, with the exception of the control group,2 patients were sporadic early in premature ventricular contractions,the other has not pathologic arrhythmia.Three cases to the control group needs dopamine 2-3μg /(kg·min)Complementary 3～4 h,the adenosine preconditioning group do not require the application of supplementary drug. Suggest that adenosine preconditioning may be effective pretreatment maintain cell membrane stability,reduce the occurrence of arrhythmias,conducive to the restoration of heart function.2:2 groups of CK,CK-MB and LDH in the points after myocardial ischemia have increased,but adenosine preconditioning group was significantly lower than the control group(P＜0.05).Suggest that both groups have myocardial injury,adenosine preconditioning group than the control group lighter.3: RT-PCR results Adenosine preconditioning group of c-fos gene expression levels were significantly higher(P＜0.05).Suggest that adenosine preconditioning may pretreatment increased myocardial through the c-los gene expression and play a roleConclusion1.Before open heart surgery,the application of exogenous adenosine may improve intraoperative and postoperative generation,as well as reduce the use of dopamine and release of CK-MB,cTn-I.So we say it has the effect of myocardial protection.2.RT-PCR results show that the c-fos gene expression levels of adenosine precondition group were significantly higher(P＜.05).Suggested that adenosine precondition may protect the myocardium through increase the c-fos gene expression and play a role...
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