Effects of penehyclidine hydrochloride combined with ulinastatin on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To evaluate the effects of penehyclidine hydrochloride combined with ulinastatin on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB). Methods Forty-eight patients of both sexes, aged 20-64 yr, weighing 40-66 kg, of ASA physical status Ⅱ(NYHA Ⅱ), scheduled for elective cardiac valve replacement with CPB, were randomly divided into 4 groups(n=12 each)using a random number table: control group(group C), penehyclidine hydrochloride group(group P), ulinastatin group(group U), and penehyclidine hydrochloride and ulinastatin group(group PU). Penehyclidine hydrochloride 0.02 mg/kg was injected via the right internal jugular vein at 15 min before induction of anesthesia in group P. In group U, the total amount of ulinastatin was 2×104 U/kg, 30% of the total amount was given via the right internal jugular vein after induction and before surgery, 40% was added to the priming solution, and the remaining 30% was injected via the right internal jugular vein while the aorta was opened.In group PU, penehyclidine hydrochloride or ulinastatin was given according to the method previously described in group P or U. The equal volume of normal saline was given instead in group C. After induction and before surgery(T1), at 30 min of CPB(T2), and at 30 min and 6 h after termination of CPB(T3, 4), blood samples were taken from the left internal jugular bulb and radial artery for blood gas analysis and determination of jugular venous oxygen saturation, jugular venous O2 content, arterial O2 content, and plasma concentrations of S-100β protein and neuron-specific enolase(NSE)(by ELISA). Arteriovenous oxygen content difference(Ca-jvO2)and cerebral O2 extraction rate(CERO2)were calculated. Results Compared with group C, SjvO2 was significantly increased, and CERO2 was decreased at T2, 3 in P and U groups and at T2-4 in group PU, and Ca-jvO2 and plasma concentrations of S-100β protein and NSE were decreased at T2, 3 in P, U and PU groups.The plasma concentrations of S-100β protein and NSE were significantly lower at T2, 3 in group PU than in P and U groups. Conclusion The combination of penehyclidine hydrochloride and ulinastatin produces better efficacy than either alone in attenuating brain injury in patients undergoing cardiac valve replacement with CPB. Key words: Trypsin inhibitors; Cholinergic antagonists; Cardiopulmonary bypass; Brain injuries