The Effect Of Penehyclidine Hydrochloride On Gut Mucosal Barrier Function During Cardiopulmonary Bypass In Patients Undergoing Open Heart Surgery

Objective:To observe the dynamic change of the concentration of blood Intestinal fatty acid binding protein(I-FABP)and D-Lactate, and the influence of penehyclidine hydrochloride to its contents and cytokines releasing during cardiopulmonary bypass(CPB);To discuss the gut protective function of penehyclidine hydrochloride(PHC),and to approach relative mechanisms.Methods:Forty patients undergoing heart valve replacement with cardiopulmonary bypass were randomly divided into two groups with 20 cases each:penehyclidine group(group P),control group (group C) respectively. Patients in group P were injected PHC 0.05mg/kg before CPB 10 min from the internal jugular vein,patients in group C were injected the same volume saline as controll.Jugular vein blood was drawn at 6 time points:before CPB (T1),10min after aortic crossclamp release (T2), immediately at the end of CPB (T3),2h after operation(T4),6h after operation(T5), and 18h after operation(T6).The density of blood I-FABP was detected by enzyme-linked immunosorbent assay as well as cytokine levels (IL-6,IL-10).The concentration of D-Lactate was detected using spectrophotometer.Blood samples were taken for analysis of blood gas,serum glucose and lacatate concentration at every time point. SPSS 13.0 was used for statistical analyses. Data was expressed mean±S.D.Statistical significance of difference between and within groups was evaluated by repeated measures of variance, Significance of comparision between groups at the same time point was assessed by independent-sample t-test.and P<0.05 was considered as statistical significance.Results:1 There were no significantly difference in age,sex,the time of CPB,and aorta block in two group(P>0.05).2 Changes of serum glucose and lacatates concentration:Comparing with T1(beforeCPB),the concentration of serum glucose and lacatate were all increased significantly more at T2,T3,T4,T5,T6(P<0.05). The peak values were measured at T5 for serum glucose and lacatate.Comparing between groups,there were no significantly difference in the concentration of serum glucose and lacatate before CPB(P>0.05).In group P,the concentration of serum glucose was significantly lower at T2, T4,than those in groupC(P<0.05). In group P, the concentration of lacatate was significantly lower at T3 than those in group C(P<0.05)3 Changes of blood I-FABP and D-Lactate concentration:Comparing with T1(beforeCPB),the concentration of blood I-FABP and D-Lactate were all increased significantly more at T2,T3,T4,Ts,T6 (P<0.05). The peak values were measured at T5 for blood I-FABP and at T4 for D-Lactate.Comparing between groups, there were no significantly difference in the concentration of blood I-FABP and D-Lactate before CPB(P>0.05).In group P, the concentration of blood I-FABP was significantly lower atT2,T4;T5than those in group C(P<0.05).In group P, the concentration of D-Lactate was significantly lower atT3,T4 than those in group C (P<0.05).4 Changes of IL-6 and IL-10 level:Comparing with T1(beforeCPB),the IL-6 and IL-10 level were all increased significanly more at T2,T3,T4,T5,T6(P<0.05).The peak values were measured at T5 for IL-6 and IL-10.Comparing between groups,there were no significantly difference in the level of IL-6 and IL-10 before CPB(P＞0.05).In group P, the level of IL-6 was significantly lower at T4, T5 than those in group C (P<0.05). There were no significantly difference in the level of IL-10 between group P and group C (P>0.05).Conclusion:1.The increase of blood I-FABP and D-Lactate concentration indicates that the gut mucosal barrier was injuried during CPB.2.0.05mg/kg penehyclidine hydrochloride preconditioning before CPB could suppress CPB-induced stress response.3.0.05mg/kg penehyclidine hydrochloride preconditioning before CPB could descrease blood I-FABP and D-Lactate concentration and have gut mucosal barrier protection effect.4.The gut protective mechanisms of penehyclidine hydrochloride (PHC) during CPB might be relative to stress response suppressing by regulating nervous-endocrine system and immunity system.