Different Concentrations Of Morphine After Coronary Perfusion For The Myocardial Protection And Mechanism

Objectives:(1) to investigate whether the different concentrations of morphine after coronary perfusion has myocardial protection.(2) to research the different concentrations of morphine after coronary perfusion for the influence of IL-10 and TNF-α.Methods:The experiment consisted of three parts:(1) 45 patients undergoing heart valves replacement were randomly divided into 3 groups, group A,group B,group C. group A(morphine 2 u mol/L in the cardioplegic solution),group B(morphine 4 u mol/L in the cardioplegic solution) and group C (no morphine in the cardioplegic solution). The three groups before induction (T1), before cardiopulmonary bypass(CPB) 5minutes (T2), after CPB5 minutes (T3), perioperative (T4) of hemodynamic parameters:heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), were monitored. The post operation incidence of severe ventricular arrhythmia and low cardiac output, duration of ventilation and ICU and hospital stay, were recorded.(2) The blood samples were taken for detecting creatine kinase isozyme(CK-MB),creatine kinase (CK) and lactate dehydrogenase (LDH), alpha hydroxyl butyrate dehydrogenase (α-HBDH)and cardiac troponinⅠ(cTnI)as well at T2,2 hours after CPB (T5) and 24 hours after CPB (T6); The morphological changes of apoptosis were observed by electronic microscope, to investigate whether the different concentrations of morphine after coronary perfusion has myocardial protection.(3) the serum concentrations of interleukin 10 (IL-10) and tumor necrosis factor alpha (TNF-α) were measured by enzyme immunosorbent ELISA at T2,T5 and T6. To see whether morphine through regulation inflammatory factor as IL-10,TNF-αin order to achieve the cardioprotection. Results:(1) The levels of cTnI at T5 and T6 in group A and group B were significantly lower than those in group C (P<0.05),and at T6 in group B were lower than those in group A(P<0.05). The levels of CK-MB at T6 in group B were lower than those in group C(P<0.05). compared with group C,group A and group B have lower the post operation incidence of severe ventricular arrhythmia and low cardiac output, but no significant differences(P> 0.05).(2) The level of apoptosis after CPB was aggravated in there groups compared with those before CPB, which was more in group C than that in another groups (P< 0.05).The morphological changes in group A and group B were less than those in group C.(3) The serum concentrations of IL-10 and TNF-αat T5 and T6 in three groups were rose more or less,and the serum concentrations of IL-10 at T6 in group B were higher than those in the other two groups (P< 0.05), or the serum concentrations of TNF-αat T6 in group B were lower than those in the other two groups (P< 0.05).Conclusions:(1) 4μmol/L morphine after coronary perfusion has more ideal myocardial protection.(2) 4μmol/L morphine after coronary perfusion influence the value IL-10 and TNF-α,and the value of IL-10 was increased while the value of TNF-αwas decreased.