Gene Expression Changes In Heart Valve Surgery Under Epidural Anesthesia Plus General Anesthesia During Cardiopulmonary Bypass

Objective To establish the model of heart valve surgery under general anesthesia and epidural anesthesia plus general anesthesia during cardiopulmonary bypass, record the whole clinical process and prepare for the next study.Methods 20 patients diagnosed rheumatic heart disease were randomly assigned to 2 groups: general anesthesia group (group GA , n=10), and epidural anesthesia plus general anesthesia groups(group GEA, n=10) .group GEA were punctura ed in the T2-3 or T3-4 the night before operation . SWAN-GANZ was inserted with local anesthesia . After induction of local anesthetic and the segment appearance from T1-T6, the two groups were induced with midazolam, fentanyl, propofol, vecuronium and maintenance with fentanyl ,propofol. record the data of HR, MAP, CVP, MPAP, PCWP, CI, SVR, PVR at the moment of Tl(into operation room),T2(general anesthesia induced),T3 ( separate sternum ) ,T4(begin cpb 30min),T5(30min after cpb),T6(2h after cpb),T7(4h after cpb),T8(24h after cpb).and collect the venous blood at T1,T2,T4,T6,T7,T8 for corticosteroid analysis ;at T1,T6,T7,T8 for cTn-I analysis. The two groups were treatment accordingly with PCIA or PCEA after opration, and record the VAS and adverse reaction. Results 1,The HR of group GA were significantly raise up at T3,T7 compared with T1, but the HR of group GEA were significantly decrease at T2, T3 compared with Tl,and significantly slower than group GA at T2,T3,T6,T7,T8 ;the MAP of group GA was all decreased than T1 except at T3, and group GEA significant lower than group GA atT3,T4,T7,T8;the MPAP and PCWP of two groups were lower compared with T1 at T6,T7,T8; the CVP of the two groups fluctuate during the opration and have no significant difference; the CI of group GA was improved than T1 at T5 and T6, group GEA was improved than T1 at T5- T8 than Tl,group GEA improved more than group GA at T7 and T8; the SVR were decreased at T5 compared with T1 in both groups ;the PVR of group GEA were lower at T5,T6,T8 than Tl,but no change in grouo GA;2,The Cor levels of the two groups have no differance at T1, but increased from T4 to T8,the Cor levels of group GA were significantly increased than group GEA at T4,T6,T7,T8;3,The cTn-I levels of the two groups have no differance at T1, but increase at T7,T8.the cTn-I levels of group GA were significantly increased than group GEA at the two points. 4,The patients of group GEA come around early than group GA and VAS lower than group GA.Conclusion Compared with general anesthesia, the epidural anesthesia plus general anesthesia during cardiopulmonary bypass decreased the stress reaction and improve hemodynamics, preserve cardiac function and provide more satisfactories analgesia. Objective To survey and analysis the gene expression changes in heart valve surgery under general anesthesia and epidural anesthesia plus general anesthesia during CPBMethods To collect three women's right auricle at pro-CPB and post-CPB from two groups (group D=group GA,group E=group GEA)respectively, then abstract RNA and hybridization with Agilent 44K gene arrays .The difference genes were analysised with cluster analysis and Gene Ontology analysis.Results 1,After CPB, there are 286 probes up-regulated and 313 probes down-regulated in group D; 2,After CPB, there are 280 probes up-regulated and 240 probes down -regulated in group E; 3,There are 122 probes up-regulated(24 genes >3 fold change ) and 215 probes down -regulated(42 genes>3 fold change) after cluster analysis in six arrays; 4,There are 11 genes (MND1, ADRA2A, MT1H, GLS, PDIA2, JUN, ANLN, MCF2, RASD1, CTSB, TPM1,)represent the difference anesthesia ; 5,There are significant deviation of gene numbers in the two groups about apoptosis regulator activity, cell adhesion molecule activity, motor activity, defense immunity protein activity. Conclusion There are a lot of genes changed during cardiopulmonary bypass , especially on the genes express and regulation, inflammatory reaction, immunological reaction, host defence and apoptosis; 2,Group D and group E have much difference on the apoptosis regulator activity, cell adhesion molecule activity, motor activity, defense immunity protein activity . 3,The changes of 11 genes represent the difference anesthesia. Objective To validate the microarray gene expression profiles and to discuss the potential mechanism of myocardial preservation of epidural anesthesia plus general anesthesia during cardiopulmonary bypass.Methods Use Real-time PCR to validate the expression of apoptosis related gene JUN ,myocardium related gene TPM1 ,and house-keeping gene GAPDH in six pairs RNA samples.Results The outcome of real-time PCR consistent with microarray gene expression profiles . The expression of TPM1 was up-regulation in group E and down-regulation in group D; The expression of JUN was up-regulation in both groups, but more in group D.Conclusion The results of hybridization was reliable. Apoptosis related gene was up-regulated after CPB, the mechanism of myocardial preservation of epidural anesthesia plus general anesthesia was probably owing to anti-apoptosis pathway .