Effects Of Sevoflurane Administration In Early Stage Of Ischemia And Reperfusion On Serum TNF-α And S100β In Patients Undergoing Cardiac Valve Replacement Under CPB

Objective:To observe the effects of sevoflurane administration in early ischemia and early reperfusion during cardiopulmonary bypass(CPB)on serum TNF-α and S100β protein concentrations in patients undergoing cardiac valve replacement,and to investigate the effect of this kind of administration on alleviation of brain injury after cardiac valve replacement under CPB.Methods:Forty patients with rheumatic heart disease undergoing mitral valve or aort ic valve replacement under cardiopulmonary bypass(ASA II or III)were randomly divided into the sevoflurane group(group S,n=20)and the control group(group C,n=20).The control group(group C)were treated with total intravenous anesthesia;the sevoflurane group(group S),after intravenous anesthesia,inhaled 2% sevoflurane for 15 min before and after the ascending aorta was blocked,and then inhaled 2% sevoflurane for 15 min before and after opening the ascending aorta by membrane oxygenator.Other treatments were the same as the control group.At the point of T0(after anesthesia,before opening the chest),T1(After blocking the ascending aorta),T2(immediately after CPB stopped),T3(2h after shutdown),T4(6h after shutdown)and T5(24h after shutdown),internal jugular vein blood was sampled.ELISA was used to detect the concentration of TNF-α and S100β protein in serum.The cognitive status of the patients was assessed by MMSE 1d before and 3d after the operation.Results:Both groups successfully completed the cardiac valve replacement under CPB and were discharged.(1)Two groups of patients with gender,age,weight,operation time,CPB time,aorta blocking time,heart chest ratio and ejection fraction,auto-rebeat rate of heart at the end of CPB,perioperative hemodynamic information were not statistically different,and there was no significant difference in the use of nitroglycerin,dopamine and norepinephrine during perioperative period(P>0.05).(2)Compared to the baseline values(T0),the concentrations of TNF-α and S100β protein in serum of both two groups increased to different extent(P<0.05),most obviously at T3,after 24 hours of downtime measured value has declined,but still higher than the T0,the change of TNF-α concentration was more sensitive than that of S100β protein,but the change trend was basically consistent with the trend of S100β protein,and the concentrations of the sevoflurane group(group S)were lower than that of the control group(group C)at different time points(except for T0)(P<0.05).(3)The MMSE scores of the two groups were within the normal range,the postoperative score was lower than the normal score,the MMSE score of the sevoflurane group(group S)was higher than that of control group after 3d of the operation(P<0.05).Conclusion:In the early stage of ischemia and reperfusion,administration of 2% sevoflurane was safe for 15 min,which could decrease the concentrations of TNF-α and S100β protein and reduce brain injury in patients undergoing CPB.The related mechanism may be associated with the inhibitory effects of sevoflurane on inflammatory factors in the process of CPB.