Cardiopulmonary Protection Of Ischemic Postconditioning In Patients Undergoing Cardiac Valve Replacement Surgery

Object:Reducing the myocardial ischemia-reperfusion injury and protecting the cardiac function are the key points for improving the success rate of cardiac valves surgeory. Exogenous method is widely used at present. The post-ischemic treatment,as an internal method, has been proved to be effective in both multispecies models and cardiac PCI. Comparetively ,little research has been done in cardiac surgical field. My research observes the cardiopulmonary protection in patients of severe cardiac valves disease, treated by post-ischemic; just offering a new method for the treatment of severe cardiac valve disease.Method:60 cases of severe cardiac valve disease were randomly divided into the control group and the treated group. The control group received routine surgery, the treated group received post-ischemic treatment that was after the valve replacement surgery,opened the cross-clamping pliers 30s firstly, and then clamped the ascendind aorta for 30s,these as a treating cycle. Totally treated for 3 cycles. We evaluated the clinical index such as cardial electroplysiology index ,hemodynamics and biochemical indicators after the surgery. Results:1 The treated group showed obvious decrease compared to the control group in the scoring positive inotropic drugs, mechanical ventilation time, blood transfusion volume and ICU time.there was no obvious difference between the two groups in mortality, urine amunt,and drainage volume.2 There was a more stable hemodynamics in the treated group.there was significant difference in the index of MRAP, MPAP, SVR, CI.3 The treated group showed higher rate of cardiac auto-resuscitation and lower rate of ventrical arrhythmia and defibrillation than those of the control group.4 The serium LDH levels in both groups increased gradually after CPB.After the opening of the aorta, the levels in 12h,24h were significantly higher than the control group comparatively. The Serum CKMB levels in the control group increased gradually after CPB, especially in 6h point after the surgery.While in the treated group,the serum CKMB gradually increased after the CPB, but no significant change were observed in the process.And the Serum CKMB levels in the treated group at 6h,12h,24h were significantly lower than those of the control group The Serum cTnl levels in the control group increased gradually after CPB, reached the highest value at 6 hours point after the surgery. The Serum cTnl in the treated group gradually increased after CPB, but the highest value was significantly lower than that of the control group. The Serum cTnl levels in the treated group at 2h,6h,12h after surgery were significantly lower than those of the control group.5 The serum MDA gradually increased after the opening of the aorta in the control group,and the values increased compared with pre-operation. There were no significant rise in the treated groups.The serum SOD levels of 6h,24h,after the operation were significantly higher than these of the control group.6 The values of lactic acid of the two groups reached the maximum in the end of CPB.The blood LDH levels of the treated group were lower than those of the control group in the 3,6,9,12,24h point after the operation .The LDH value of the treated group decreased significantly in 3h after the operation, the LDH values were significantly lower than those of the control group in 3,6,9h point.7The oxygenation index(PaO2/FiO2) of the treated groups were higher than those of the contral group in 1,3,6,9,12,24h point and significantly higher than the control group in 6h point after the operation.Conclusion:1 Bypass can lead to vital organs such as heart and lung ischemia-reperfusion injury.2 The post-ischemic treatment can protect the supermicro fracture of the myocardial,stabilize myocardial cell electrophysiological environment,improve the microcirculation ,ensure a more stabilized hemodynamics and protect the cardiac function.3 The post ischemic treatment can significantly reduce plasma MDA,increase SOD activity .It suggested that these may be the protecting mechanisms.4 The post-ischemic treatment can reduce the formation of lactic acid, and accelerate the removal.5 The post-ischemic treatment can reduce the acute lung injury after operation,and contribute to the respiratory functional recovery.