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Objective: To observe the cardiopulmonary bypass (cardiopulmonary bypass, CPB) period, congenital heart disease in patients with myocardial ischemia / reperfusion (ischemia / reperfusion, I / R) of inducible nitric oxide synthase (induced nitric oxide synthase, iNOS) mRNA and thermal shock proteins (heat shock protein, HSP) 72mRNA expression changes, and the impact of different doses of ketamine pretreatment on their expression, to investigate mechanism for ketamine myocardial protection. The: Proposed intercourse interval and / or ventricular septal defect repair patients and 36, were randomly divided into three groups (12): control group (C group) and ketamine intervention group (K 1 group , K 2 group). Sternotomy, aortic cannulation and aortic opening up 5min, the intervention group were intravenous ketamine 0.5mg · kg -1 and 1.0mg · kg -1 The control group was injected with saline. Intubation of the superior vena cava (T 1 ), aortic occlusion 30min (T 2 ) and aortic open after 30min (T is 3 ) take appropriate cardiac tissue, application of the one-step real-time quantitative RT-PCR technique (using SYBR Green 1 the chimeric fluorescent law), the detection myocardial in iNOSmRNA in and HSP72mRNA expression amount. Were T 1 T 2 T 3 and aortic 2h (T 4 ) to take on the vena cava 4ml, serum creatine kinase (CK) and creatine kinase MB (CK-MB) content. Results: 1. General comparison: three groups of the patient's age, sex, weight, type of surgery, preoperative body temperature, cardiopulmonary bypass time and aortic cross-clamping time differences were not statistically significant (P> 0.05). 2. Change myocardial iNOSmRNA expression: of iNOS mRNA expression, within-group comparisons, three groups after myocardial ischemia (T 2 ) and reperfusion (T 3 ) than those before ischemia (T 1 ) was significantly higher (P <0.01) after reperfusion (T 3 ) than ischemic (T 2 ) was significantly higher (P <0.01); between the two groups after myocardial ischemia (T 2 ) and reperfusion (T 3 ), ketamine intervention group were significantly lower than those in the control group (P <0.05), and K 2 group than K 1 significantly reduce (P <0.05). Change myocardial HSP72mRNA expression: HSP72mRNA expression levels within the group compared three groups of patients after myocardial ischemia (T 2 ) and reperfusion (T 3 ) were significantly higher than before ischemia (T 1 ) (P <0.05), after reperfusion (T 3 ) was significantly higher than ischemic (T 2 ) (P <0.05); between the two groups after myocardial ischemia (T 2 ) and reperfusion (T 3 ), ketamine intervention group were significantly higher than those in the control group (P <0.05), K 1 K 2 group compared the difference was not significant (P> 0.05). 4. Serum enzyme changes: serum enzyme levels, within-group comparisons, T 2 , T 3 , T 4 T 1 comparison, P <0.01; T 3 , T 4 T 2 comparison, P <0.01; T and T 3 comparison, P <0.01. Between the two groups, the three groups of patients the difference in T 1 point in time no statistically significant (P> 0.05) in T 2 T 3 T 4 point in time K 1 , K 2 and C (P <0.05), K 1 and K < sub> 2 difference compared to no statistically significant (P> 0.05). Conclusion: Cardiopulmonary bypass triggers myocardial ischemia-reperfusion injury, iNOS and HSP72 in myocardial ischemia-reperfusion injury occurrence and development. Anesthetic and sub-anesthetic doses of ketamine by the expression of a lowered myocardial iNOS mRNA expression and upregulation of myocardial HSP72mRNA, to reduce the leakage of serum enzyme with myocardial protection to a certain extent.
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