The Effect Of Coenzyme Complex For Cold Blood Cardioplegia Solution On Myocardial Protection

Objective: It has been demonstrated that the good myocardial protectiveeffect of coenzyme complex during congenital heart disease treatment andcoronary artery byass. But the mixture of coenzyme complex and cold bloodcardioplegia solution has not been reported. To investigate the myocardialprotection of coenzyme complex mixed with cold blood cardioplegia solutionin adult mitral valve replacement surgery. To discuss the myocardial protectiveeffect of coenzyme complex on cardiopulmonary bypass (CPB) and theprobable myocardial protection mechanism.Methods: Thirty grade ASAⅡorⅢ patients,age42to63years old,undergoing elective mitral valve replacement surgery were randomly dividedinto two groups (n=15each). No spirit of the history of preoperativeneuropathy, no infectious disease, without uncontrolled hypertension (BP≥160mmHg), without any cardiac surgery, without coronary heart disease,diabetes, renal system disease and other complications. Body mass index, liverand kidney function was normal. In experimental group: coenzyme complex(Xin Beko)10branch (coenzyme A100u, coenzymeⅠ0.1mg per branch) wasmixed with cold blood cardioplegia solution, while in control group: coldblood cardioplegia solution without coenzyme complex was perfused. Allpatients were injected30min before surgery scopolamine0.3mg.kg-1,morphine0.1~0.2mg.kg-1. After the patients into the operating room, thepatients' blood pressure, heart rate, electrocardiogram, and pulse oxygensaturation were monitored. To open right upper intravenous infusion ofsodium lactate Ringer's solution. The paralled left-invasive radial artery bloodpressure monitoring, a control blood sample was obtained. And to inhale pureoxygen using mask. At the same time intravenous midazolam0.05~0.1mg.kg-1,etomidate0.2~0.3mg.kg-1, vecuronium bromide0.1~0.2mg.kg-1, and then fentanyl10~20μg.kg-1was injected as a bolus into an left arm vein.5~10minafter the administration, endotracheal intubation and mechanical ventilation inparalled. Done to monitor the central venous pressure internal jugular veinpuncture. Technique using propofol, fentanyl and vecuronium bromide,anesthesia was maintained. To establish CPB routinely after heparinizing. Twogroups perfused different cardioplegia solution respectively after aorticcross-clamping at15~20ml.kg-1. Then perfused once every30min. Othertreatments were same between the two groups. The simultaneous monitoringof HR, BP, MAP, SPO2, Bis, nose temperature and rectal temperature, andfixed time monitors activated clotting time (ACT), hematocrit (HCT), arterialblood gas analysis and electrolytes. To obtain blood sample3ml respectivelyfrom left-invasive radial artery at T1(5min before CPB running), T2(30minafter aortic cross-clamping), T3(5min after the clamp remove), T4(60min afterthe clamp remove) and T5(postoperative24hours). All blood samples wereplaced at room temperature for10min, then centrifuged10min (3000r.min-1),taken upper plasma1ml exactly into the sterile silicide plastic tube and storedat-80℃until assayed. Plasma levels of MDA, CK-MB and cTnI weremeasured. The cardiac arrest effect, spontaneous resuscitation rate, therequirement for inotropic, intubation time and CCU stay time were alsoevaluated.Results:①MDA: a rapidly increasing were shown at T3between thetwo groups, and achieved peak value at T4. While at T5value was thendecreased, which still higher obviously than basic value (P＜0.05); Plasmalevels of MDA were significantly higher in control group than in experimentalgroup from T3to T5(P＜0.01).②CK-MB and cTnI: two indicators' tendencywas approximately same. A rapidly rising was demonstrated at T2, whichcontinually rising over time. CK-MB achieved peak value at T4, while of thatcTnI at T5; Plasma levels of CK-MB were significantly higher in control groupthan in experimental group from T4to T5, while of that cTnI from T3to T5(P＜0.05).③The number of patients'required inotropic support in experimentalgroup was lower than in control group (P＜0.05); There were no arrest after the resumption of rebound phenomenon. There were no statistical differencesin spontaneous resuscitation rate, intubation time and CCU stay time betweentwo groups.Conclusion: The mixture of coenzyme complex and cold bloodcardioplegia solution enhanced myocardial protective effect during cardiacsurgery, which can reduce the level of myocardial enzyme, decrease thegeneration of oxygen free radicals and anti-lipid peroxidation, lessen theischemia and reperfusion injury and decrease the dosage of vasoactive drug.