The Protective Effect Of Blood Cardioplegia On Immature Myocardium

ObjectiveTo assess the protective effects of the STH solution,HTK solution and different proportion cold blood solution on infants myocardium.Method100 patients(2 months- 3 years) with open-heart surgery of congenital heart disease were randomized into four groups. In group A was perfused with 4:1 cold blood solution, group B with 1:4 cold blood solution, group C with STH solution, group C with HTK solution. Each group was given the corresponding cardioplegic solution. Plasma levels of b-type brain natriuretic peptide(BNP), creafine kinase(CK), creatine kinase MB(CK-MB), plasma cardiac troponin(c Tn T) were respectively measured before cardiopulmonary bypass(t1), at the end of cardiopulmonary bypass(t2), 24 hours after aorta declamped(t3) and 72 hours after aorta declamped(t4).Results1.The general situation A total of 100 patients were selected, 6 cases were rejected according to the standard. In 6 cases, 2 cases of secondary perfusion stopped, 5 cases of ventricular fibrillation after heart re-beat, 3 cases of combination of other complicated deformity. There is no statistical difference between the four groups in demographic date(P > 0.05). There is no statistical difference between the four groups of patients in illness, cardiopulmonary bypass time, aortic crossclamp time, the lost tempreture(P > 0.05). 2. Laboratory test results: 2.1The same group of patients in each time point(t1, t2, t3, t4): The index of myocardial injury in each time point are not identical and the difference had statistically significant(P < 0.05). 2.2 At the same time point of comparison between the four groups: Before cardiopulmonary bypass(t1), there is no statistically significant difference between each groups about the levels of BNP, CK, CK – MB, c Tn T in plasma(P > 0.05). After aorta declamped and myocardial reperfusion, myocardial injury index in each groups at different time points(t2, t3, t4) is different, group C were higher than other three groups, the difference had statistical significant(P < 0.05); there was no statistically significant difference in the myocardial injury index between group A, B and D(P > 0.05); There were no interaction between different cardioplegic solution and measuring time(P > 0.05).ConclusionChildren with congenital heart disease after open-heart surgery and extracorporeal circulation, immature myocardial injury in different degree. Through this study, we preliminary think that two cold blood solution and HTK solution on immature myocardial protection effect is superior to STH. For simple congenital heart disease, the extracorporeal circulation time is short, there is no significant difference between cold blood solution and HTK solution in protecting immature myocardial. HTK solution is more expensive than cold blood solution, and 1:4 cold blood solution is more convenient and easier accepted by clinical physicians. Through this research,we provides a new clinical thought for young child immature myocardial protection.