Effect Of Flurbiprofen Axetil On Inflammatory Cytokines And Myocardiac Injury In Patients Undergoing Cardiac Valve Replacement Surgery With Cardiopulmonary Bypass

Objective To investigate the effects of flurbiprofen axetil﹙FA﹚on inflammatory cytokines and myocardiac injury in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass﹙CPB﹚.Methods Fifty patients NYHA classⅠ-Ⅲwith rheumatic heart disease scheduled for elective cardiac valve replacement under CPB were randomly divided into 5 groups,each group has 10 patients.Patients with preoperative hepatic and renal dysfunction,coagulation defect,diabetes,primary hypertension , hyperlipidemia, infective nendocarditis, peptic ulcer, bronchial asthma, second heart surgery,et al were excluded.The patients were premedicated intramuscular morphine 0.2mg/kg and Scopolamine 0.3mg.Anesthesia was induced with midazolam 0.05mg/kg,fentanyl 5μg/kg,etomidate 0.3mg/kg and rocuronium 0.9mg/kg and maintained with intermittent iv fentanyl﹙total dosage 15～20μg/kg﹚and pipecuro- nium and target-controlled infusion propofol at 1.0～2.5μg/ml. GroupⅠreceived 0.2ml/kg intralipid 15min before skin incision,groupⅡ,Ⅲreceived flurbiprofen 1mg/kg,2mg/kg respectively 15min before skin incision,GroupⅣ,Ⅴreceived FA the same dosage as groupⅡ,Ⅲ15min before the termination of CPB. Fifty patients scheduled for cardiac valve replacement surgery were randomly devided into five groups, each group has 10 patients. Blood samples were taken at pre-anesthesia﹙T0﹚, 15 min after aorta declamped﹙T1﹚,30min﹙T2﹚,4h﹙T3﹚,24h﹙T4﹚,48h﹙T5﹚after termination of CPB for plasma TNF-α,IL-6 ,IL-10 concentration.The plasma level of cTnI and CK-MB were detected at T0,T3,T4,T5. Results The plasma TNF-α,IL-6 levels were higher in groupⅠ,Ⅳat T1,T2 and in other groups at T1 than T0 respectively; TNF-α,IL-6 levels at T1,T2 was lower in groupⅡ,Ⅲthan groupⅠ. The plasma IL-10 level was higher in groupⅠat T1~4 and in other groups at T1~3 than T0 respectively; IL-10 level at T1~4 was lower in groupⅡ,Ⅲthan groupⅠ.The plasma cTnI,CK-MB levels were higher in groupⅠduring T3~5,and in other groups during T3~4 than T0. Compared to groupⅠ, the plasma cTnI,CK-MB levels of groupⅡ,groupⅢwas lower during T3~5; the plasma cTnI levels at T4 ,T5 in groupⅣwas lower than groupⅡ.The dopamine dosage of groupⅡ,Ⅲwas lower than groupⅠ.The duration of ICU stay in groupⅡ,Ⅲw as longer than groupⅣ,Ⅴr espectively. Conclusion Flurbiprofen can effectively inhibit pro-inflammatory cytokines,maintain the balance of cytokines and reduce myocardiac injury, and be beneficial to patients with early rehabilitation after operation.