Effect Of Lidocaine Preconditioning On Protamine Induced Pulmonary Vascular Reaction In Correction Of Congenital Heart Disease

Objective:To explore the effect of lidocaine preconditioning on protamine induced pulmonary vascular reaction in correction of congenital heart disease,and to provide a reference for clinical rational selection of medicine use.Methods:Eighty patients with congenital heart disease patients who will undergo intracardiac surgery with cardiopulmonary bypass(CPB),falling into ASA physical status I or II,aged 1-12 yr,weighing >10kg,without sex limitation,were selected.According to the results who with or without pulmonary hypertension measured in pulmonary artery directly by cardiac surgeon and the group whether to have lidocaine(2 mg/kg)preconditioning before protamine neutralization,all patients were randomly divided into four group : A1(non-pulmonary hypertension,lidocaine preconditioning group),A2(non-pulmonary hypertension,normal saline group),B1(pulmonary hypertension,lidocaine preconditioning group),B2(pulmonary hypertension,normal saline group),20 cases in each group.Pulmonary arterial blood pressure(PAP)was continuously measured at 1 min(T1)before CPB(T0)and 1,3,and 5min(T2-4)after protamine administration by placing BD 22 G intravenous indwelling needle into the pulmonary artery;The parameters of Paw,HR,MBP and Cdyn were recorded at T0-T4,T5(10min after protamine)and T6(20min after protamine).Radial artery blood samples were collected for blood gas analysis at time points T0,T1 and T6,and Alveolar gas-arterial partial pressure difference(A-a Do2),respiratory index(RI)and oxygenation index(OI)were recorded.Collection and cryopreservation Radial artery blood samples and right ventricular blood samples at T1 and T6,Respectively.Using enzyme-linked immunosorbent assay(ELISA)to detect Thromboxane B2(TXB2)and 6-keto-prostatin F1a(6-keto-F1a)in plasma.Record adverse reactions of protamine.Results:1.Compared with the A1 group,the PAP and Paw of A2 group in the time point T3 were significantly higher(P<0.05),the MAP of B2 group in the time point T3 was significantly lower(P<0.05);Compared with the B1 group,the Paw of B2 group in the time point T3 was significantly higher(P<0.05),and the Cydn of B2 group in the time point T3 was significantly lower(P<0.05);Compared with the time point T1,the PAP and Paw of group A2 and B2 in the time T3 were significantly increased(P<0.05),and the Cdyn of the A2 and B2 group in the time T3,T4 were significantly decreased(P<0.05).2.Compared with the time point T1,the plasma levels of TXB2 and 6-keto-PGF1 a in the radial artery and right atrium of the four groups in the time point T6 were decreased(P<0.05);In the time point T6,the plasma TXB2 level in group A2 and in group B2 was higher than that in group A1 and that in group B1(P<0.05),respectively,and the level of 6-keto-PGF1 a in group A2 and in group B2 was lower(P<0.05),respectively.3.Compared with the time point T0,the OI of B2 group in the time point T1 and T6 were significantly decreased(P<0.05),and the levels of RI and A-a DO2 of group A2,group B1 and group B2 in the time point T1 were significantly higher(P<0.05),but the levels of RI and A-a DO2 of group B1 in the time point T6 was recovered to that in the time T0(P<0.05).4.Compared with the normal saline group(A2 group +B2 group),the overall incidence of pulmonary adverse reaction induced by protamine in the lidocaine group(B1 group +B2 group)was lower(P<0.05).Conclusion:After the correction of congenital heart disease,lidocaine preconditioning before the neutralization of protamine can reduce TXB2 release and increase 6-keto-PG-F1 a generation to inhibit the inflammatory response in the lung and the pulmonary vasoconstriction response and can enhance the resistance of the blood vessel wall to the harmful stimulation of protamine to reduce the stress response and the spasm reaction of the pulmonary vascular and tracheal smooth muscle caused by the direct stimulation of protamine.Through reducing the occurrence of pulmonary vascular adverse reactions induced by protamine,lidocaine can improve the respiratory function and play a certain role in lung protection.