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ObjectiveThe blood supply of heart muscles went through low perfusion and re-perfusion when the aortic clamped and opened during CPB. The body underwent metabolic alkalosis because of excessive artificial ventilation. Hemodilution during CPB led to changes in blood supply of vital organs and micro-environment, and then led to high anaerobic metabolism in body. Metabolic waste and the disorganized internal environment gave rise to dysfunction of mitochondria, acidosis and necrosis of heart muscles. Ischemia reperfusion injury brought about irreversible necrosis in heart muscles. So how to protect heart muscles from injury became research priority and hot off the press in department of cardiac surgery and department of anesthesiology.To observe the effect of penehyclidine hydrochloride on Ischemia reperfusion injury myoeardium during the operation on myocardial impact in infants heart surgery.Methods20 patients, heart functionⅠ-Ⅱ, ASAⅡ, aged 1 month-1 year old, scheduled for congenital atrial septal defect (2 patients) or ventricular septal defect(18 patients) repair in this study were randomized into two groups:Penehyclidine Hydrochloride group (P group) and control group (C group). Infants in P group were given 0.02mg-kg-1 Penehyclidine Hydrochloride intravenously during induction of anesthesia. Infants in group C were given the same volume of Sodium Chloride intravenously. After the operation, we sent the infants into the cardiac intensive care unit without extubation. Haemodynamics index were continuous monitored during the operation. Blood pressure and heart rate were recorded immediately at the following times:after tracheal intubation 1 min, extracorporeal circulation start, aortic occlusion, aortic patefaction, cardopulmonary bypass termination. Operation time, CPB time, aortic clamped time and the hours of stay in intensive care unit with endotracheal catheter were also recorded simultaneous. The serum concentration of troponin (cTnT) and myocardium zymogram (AST、CK、CK-MB、HBDH、LDH) in venous blood were detected at the preoperative time, one hour after operation and 24 hours after operation. At the time 20 minutes after aortic occlusion and 20 minutes after aortic patefaction, we cut a small amount of myocardium of right atrium which had not been clampped during the surgery. In order to fix, the tissues were submerged in 10% Formalin immedialtely. Then HE stain followed. Observed them through 20×10 times high power microscope and took photos.ResultThe serum concentration of cTnT and myocardium zymogram (AST,CK,CK-MB,HBDH,LDH) in both groups were at normal level.And there were no significant difference between the two groups before anesthesia induction(T1)(P>0.05). Compared with that at T1, the serum concentration of cTnT and myocardium zymogram (AST,CK,CK-MB,HBDH,LDH) at T2 and T3 were significantly higher(P<0.05) in the two groups. And the serum concentration of cTnT and myocardium zymogram (AST,CK,CK-MB,HBDH,LDH) in group P were significantly lower than that in group C at the three corresponding times(P<0.05). And at T2 and T3 times the serum concentration of cTnT and myocardium zymogram (AST,CK,CK-MB,HBDH,LDH) in group P were significantly lower than that in group C (P< 0.05). The microstructure of heart tissues in P group were significantly better than those in C group.ConclusionPenehyclidine Hydrochloride injection intravenously 0.05mg/Kg plays an important role in protection myocardium from Ischemia reperfusion injury during CPB operations in infants.
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