| Objective:To investigate the myocardioprotective effects of propofol and sevoflurane on the myocardial expression of heme oxygenase-1 (HO-1) and production of lactic dehydrogenase(LDH), creatine phosphokinase(CK), creatine phosphokinase isoenyme (CK-MB), cardiac troponin I(cTnI),superoxide dismutase (SOD),and tumor necrosis factor-a(TNF-a) in severe valvular disease during open-heart surgery with cardiopulmonary bypass (CPB).Methods:Thirty two patients with severe valvular disease were subjected to surgical treatment of valvular replacement with cardiopulmonary bypass were randomized into three groups:control group(M, n=8), propofol group(P, n=12) and sevoflurane group(S, n=12). Hemadynamic changes, pulse oxygen saturation (SpO2), and body temperature were monitored, and duration of extubation and ICU stay after surgery were recorded. For LDH, CK, CK-MB, cTnI, SOD and TNF-αanalysis, venous blood samples were collected at the opening venous pass (Ti),20min after aortic cross-clamping (T2),20min after aortic declamping(T3),2hr after aortic declamping (T4),24hr after surgery(T5). Myocardial tissues were taken at T2 and T3 for the observation of HO-1 protein expression.Results:①The plasma LDH,CK level in group M increased from T1 to T5, and the plasma LDH.. CK level at T2-5 were significantly higher than that of T1 (T2 vs T1 P <0.05, T3.5 vs T1 P<0.01); the plasma LDH level at T2-5 in group P was significantly higher than that of T1(P<0.05), and the plasma CK level at T2-5 in group P was significantly higher than that of T1 (T2-3 vs T, P<0.05, T4-5 vs T1 P<0.01); the plasma LDH level at T2-5 in group S was significantly higher than that of T1 (P<0.05), and the plasma CK level at T3-5 in group S was significantly higher than that of T1 (P <0.05), but no significant difference was found between T2 and T1(P>0.05)②The plasma LDH level at T2-5 in group P were lower than that of group M at same time point (T2-4 P<0.05, T5 P<0.01); the plasma LDH level at T2-5 in group S were also lower than that of group M at same time point (T2-3 P<0.05, T4-5P<0.01); The plasma CK level at T3-5 in group P were lower than that of group M at same time point (T3 P<0.05, T4-5 P<0.01); The plasma CK level at T3-5 in group S were lower than that of group M at same time point (T3 P<0.05, T4-5 P<0.01)③The plasma CK-MB level at T2-5 in group M were significantly higher than that of T1(T2,T5 P<0.05, T3-4 P<0.01); the plasma CK-MB level at T2-5 in group P were significantly higher than that of T1(P<0.05); the plasma CK-MB level at T3-5 in group S were significantly higher than that of Ti(P<0.05), but no significant difference was found between T2 and T1 (P>0.05)④The plasma CK-MB level at T2-5 in group P were significantly lower than that of group M at same time point (T2,T5 P<0.05, T3,T4 P<0.01); and the plasma CK-MB level at T2-5 in group S were significantly lower than that of group M at same time point (T2,T5 P<0.05, T3,T4 P<0.01)⑤within the same group, the plasma cTnI level of all subjects at T2-5 were significantly higher than T1 (P<0.01); the plasma cTnl level in group P at T2-4 were significantly lower than that of group M at same time point (T2 P<0.05, T3,T4 P <0.01); the plasma cTnl level in group S at T2-4 were significantly lower than that of group M at same time point (T2 P<0.05, T3,T4 P<0.01); but no significant difference was found among the three groups at T5 (P>0.05)⑥The plasma SOD activity at T2-4 in group M were significantly lower than that of T1 (T2 P<0.05, T3,T4 P<0.01); the plasma SOD activity at T3-4 in group P were significantly lower than that of T1 (P<0.05); the plasma SOD activity at T2-4 in group S were significantly lower than that of T1 (P<0.05)⑦The plasma SOD activity at T2-4 in group P and S were significantly higher than that of group M at same time point (P<0.05), and no significant difference was observed among the three groups at T5 (P>0.05)⑧The plasma TNF-αactivity at T2-5 in group M were significantly higher than that of T1 (T5 P<0.05, T2-4 P<0.01); the plasma TNF-a activity at T2-4 in group P were significantly higher than that of T1 (T2 P<0.05, T3-4 P<0.01), there was no significant difference between T5 and T1 (P>0.05); the plasma TNF-a activity at T3-5 in group S were significantly higher than that of T1 (T5 P<0.05, T3-4 P<0.01),and no significant difference was found between T2 and T1 (P>0.05)⑨The plasma TNF-a activity at T3-5 in group P were significantly lower than that of group M at same time point (T5 P<0.05, T3-4 P<0.01),but no significant difference was found at T2 (P>0.05); the plasma TNF-a activity at T2-4 in group S were significantly lower than that of group M at same time point (T2 P<0.05, T3-4 P <0.01),but no significant difference was found at T5 (P>0.05)⑩Within the same group, myocardial HO-1 expression at T2 were significantly lower than that at T3 (S:P< 0.05, M/P:P< 0.01). The myocardial HO-1 expression at T2 and T3 in group M were significantly lower than those at the same time point in group P and S (P<0.05)There were no significant differences between group S and P in plasma LDH,CK,CK-MB,cTnI,SOD,TNF-αlevel and mycardical HO-1 expression, except the plasma CK level at T4-5 in group S were significantly lower than that of group P(P< 0.05).The duration of extubation and ICU days of all patients were short, no significant difference was observed among the three groups (P>0.05)Conclusion:Propofol and sevoflurane both exerted myocardial protective effects in patients with severe valvular disease who underwent open-heart surgery and CPB, as evidenced by attenuating plasma LDH,CK-MB,cTnl and TNF-αlevel, enhancing plasma SOD activity and myocardial HO-1 expression. |
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