Discuss The Limb Remote Ischemic Preconditioning In Myocardium Protection During VSD Repair Operation Under Thoracoscopic

Objective:Objective to investigate the effect of limb remote ischemic pr-econditio ning on myocardium protection in thoracoscopic cardiac surgery of ventricular septal defect repair with cardiopulmonary bypass?CPB?.Methods:Sixty adult patients with ventricular septal defect were divided into two group.one was remote ischemic preconditioning group?R group,n=30?,Patients in the observed group were given pressure remote ischemic preconditioning after 30 min of anesthesia induction),another was control group?D group,n=30?,the plasma level of H-FABP?CK-MB?cTnI and inflammatory factors were observed before surgery?T₀?,after anesthesia induction?T₁?,30min?T₂??three hours?T₃??six hours?T₄??twelve hours?T₅??twenty four hours?T₆?after aortic de-clamping.and record hemody-namics changes and CPB time,postoperative mechanical ventilation time,Automati-c recovery rate of heart,Postoperative vasoactive drugs and the intensive care unit s tay time.Results:1.There was no significant difference between the two groups in gender,a-ge,BMI,EF values preoperation,CPB and aorta clamping time,ICU stay time,24h dra-inage,postoperative mechanical ventilation time?P>0.05?.Postoperative vasoactive dr-ugs of group R was significantly lower than that of group D?P<0.05?.Automatic reco-very rate of heart of group R was significantly higher than that of group D?P<0.05?.2.Hemodynamics change:the level of HR and MAP in group R and D was signifi-cantly lower at T₁?P<0.05?,there was no significant difference between the two groups in HR and MAP at 30min?3h?6h?12h?24h after aortic de-clamping?P>0.05?.3.H-FABP:Compared to T₀,The level of H-FABP of groups R and D showed a significant increase at 30min?3h?6h?12h after aortic de-clamping?P<0.05?,and reached the peak at 6h after aortic de-clamping,had a downtrend at 12h after aortic de-clamping,returned to the preoperative level at 24h after aortic de-clamping.The level of H-FABP of group R was significantly lower than that of the control group at 30min?3h?6h after aortic de-clamping?P<0.05?.4.CK-MB and cTnI:The level of CK-MB and cTnI of groups R and D showed a significant increase at 3h?6h?12h?24h after aortic de-clamping?P<0.05?,and reached the peak at 24h after aortic de-clamping.Moreover,compared with the contr-ol group,the level of CK-MB and c TnI in the observed group were significantly lower than that of the control group at 3h?6h?12h?24h after aortic de-clamping?P<0.05?.5.Inflammatory factors:the level of IL-6,IL-8,TNF-?at 30min?3h?6h?12h?24h after aortic de-claming were significantly higher than that of T₀.?P<0.05?.and the-re were no significant difference between the two groups in the lever of IL-6?IL-8?TNF-?at 30min?3h?6h?12h after aortic de-claming?P>0.05?,but there was signi-ficant difference at 24h after aortic de-claming?P<0.05?.Conclusions:1.Limb remote ischemic preconditioning can reduce the release of biochemical marker:CK-MB?cTnI?H-FABP and reduce Postoperative vasoactive drugs,increase the Automatic recovery rate of heart,reduce myocardial injury for pa-tient with ventricular septal defect repair operation.2.Limb remote ischemic preconditioning can reduce the forward level of inflamm atory factors.3.H-FABP can be a earlier diagnosis in preoperative myocardial injury than cTnI and CK-MB.