Postoperative Hemodynamic Effects Of Different Ways Trace Pump Infusion Protamine On The Acyanotic CHD With PH In Intracardial Surgery With ECC

Objective To investigate the postoperative hemodynamic effects of different ways of trace pump infusion protamine on the acyanotic congenital heart disease patients with pulmonary hypertension in intracardial surgery with extracorporeal circulation, and provide a way for clinical to mitigate the adversereaction of protamine.Methods Select the80cases of the acyanotic congenital heart disease patients prepared for intracardial surgery with extracorporeal circulation, according to the different routes of administration and with or without pulmonary hypertension are divided into four groups: A1(non-pulmonary hypertension, aortic root administration), A2(non-pulmonary hypertension,central venous administration), B1(pulmonary hypertension, aortic root administration), B2(non-pulmonary hypertension,central venous administration). Record preoperative(T0), before infusion of protamine (T1),1minute after infusion of protamine (T2),3minute (T3),5minutes (T4),10minutes (T5),15minutes (T6) and25minutes (T7) all time points Ppeak, Pmean, HR, SBP, MAP, CVP and PAP. Collection and preservation the central venous blood specimen. Using radio-immunity assay detect TXB2in plasma using enzyme-linked immunosorbent assay (ELISA) detect histamine in plasma. The data was analyzed by SPSS17.0.Result1.After the trace pump infusion protamine(T2, T3, T4), the MAP and RPP(RH*SBP) of group B2are obviously lower compared to group B1(P<0.01), the MAP, RPP(RH*SBP) of group A2are lower compared to group A1(P<0.05); the CVP of group B2is higher compared to group B1in the time T2, T3and T4(P<0.05); compares with T1, each group’s HR ware change more in T2(P<0.05). 2.After the trace pump infusion protamine(T2), the PAP of group B2are higher compared to group B1(P<0.05). the Pmean and Ppeak of group A2are obviously higher compared to group A1in the time T2, T3and T4(P<0.01); also the Pmean and Ppeak of group B2is obviously higher compared to group B1in the time T2, T3and T4(P<0.01).3.After the trace pump infusion protamine (T2, T3, T4, T5, T6, T7), the TXB2and histamine in four groups all obviously increased compared to preoperation (To)(P<0.05); the TXB2and histamine of group B2are increased more significantly compared to group B1(P<0.01); also the TXB2and histamine of group A2are increased more significantly compared to group A1(P<0.01).Conclusion Patients with congenital heart disease after intracardial surgery with extracorporeal circulation use trace pump infusion protamine through the aortic root can significantly reduced TXB2and histamine release compared with central vein administration, have little effect on myocardial fibers and systemic blood pressure, which can avoid a high concentration of protamine directly into the pulmonary circulation which can strongly stimulate the pulmonary vascular and tracheal smooth muscle. It also have a slightly effects on hemodynamics in patients after intracardial surgery with extracorporeal circulation, especially in the congenital heart disease patients with pulmonary hypertension.