Background: Protamine is a polycationic, and a strong basic peptide isolated from Clupeidae or Salmonidae fishes’ sperm, which is rich in arginine and highly alkaline.
Objective: To explore the effect of lidocaine pre-treatment on protamine-induced pulmonary vascular reaction during the repair of congenital heart disease.
Methods: Eighty patients undergoing repair of congenital heart disease were randomly divided into four groups: A₁ (non-pulmonary hypertension + lidocaine pre-treatment) group, A₂ (non-pulmonary hypertension + normal saline) group, B₁ (pulmonary hypertension + lidocaine pre-treatment) group, and B₂ (pulmonary hypertension + normal saline) group. Hemodynamic parameters, pulmonary inflammation, and pulmonary function were assessed at six intraoperative time points, two intraoperative time points and three intraoperative time points, respectively. P -value < 0.05 was considered statistically significant.
Results: A₂ group exhibited increased PAP, Paw, RI and A-aDO₂. B₂ group exhibited increased Paw, RI and A-aDO₂ and decreased Cydn and OI after protamine administration. These changes were not observed in A₁ and B₁ group. Compared with A₁ and B₁ groups, plasma TXB₂ level in A₂ and B₂ group was higher, but 6-keto-PGF_1a in A₂ and B₂ groups was lower. Incidence of protamine adverse reactions in A₁ and B₁ group was lower than that in A₂ and B₂ group.
Conclusion: Precondition of lidocaine before neutralization of heparin may be effective for protamine-induced pulmonary vascular reaction during CHD repair.
Keywords: congenital heart disease, protamine, adverse reactions, extracorporeal circulation, pulmonary hypertension