| For many years,Multiple Organ Failure (MOF )has remained one of the leading cause of death in surgical intensive care units,and now it is considered that the pathogenesis of Multiply Organs or Systems Disfunction (MODS) caused by various factors is the same,which is tissue injury caused by the overwhelming inflammatory response. Various severe injuries and stimuli can generate the Systematic Inflammatory Response Syndrome(SIRS),which is a risk factor f which is a risk factor of MODS. After operations with the use of cardiopulmonary bypass(CPB),a systematic inflammatory response may develop,and it is proved that SIRS is concerned with MOSD after cardiac operations. IL-6,IL-8 and ET-l are the predominant mediators in inflammatory and play an important role in the process of SIRS. Interleukin-6 appears to be a marker of the presence of activity of proinflammatory mediators such as TNF and IL -I,and IL-6 is thought to be the cytokine whose levels best predict patient outcome. IL-8 is a potent chemoattractant for neutrophils. IL-8 may play a role in lung injuries associated with pulmonary leukocyte sequestration following CPB. ET-l is the most effective b100d vessel contractor and contributes to the ARDS.The purpose of this study is to observe the regular pattern of the concentrations of IL-6,IL-8 and ET-l in serum in patients with rheumatic heart disease (RHD) undergoing Heart Valve Replacement,and study the factors that affect the concentrations of these mediators via observing the relationship between the factors such as Cardiopulmonary Bypass Time (CPBT),Aortic Cross Clamping Time (ACCT),Pulmonary Artery Pressure(PAP) and the concentrations of these mediators in serum after CPB. In order to make out the correlation between inflammatory mediators and lung injury,we also study the lung functional indices. To evaluate the efficacy of modified ultrafiltration (MUF) in reducing those inflammatory mediators after CPB,we compare the modified ultrafiltration group with control group without using modified ultrafiltration.The research work and results were divided into three parts as follows:Part 1 Perioperative changes of plasma IL-6,IL-8,and ET-1 in patients undergoing heart valve replacementTo investigate the perioperative changes of plasma IL-6,IL-8,and ET-1 concentration in patients with rheumatic heart disease (RHD) undergoing Heart Valve Replacement,we randomly chose 38 patients who underwent Adult's Valves Replacement. These patients were divided into three groups according to different diseases which these patiens had suffering from. Group I (n=13),rheumatic heart disease MVR or AVR group without pulmonary hyperthnsion(PH);Group II (n=ll) rheumatic heart disease DVR group without PH;GroupIII(n=14),rheumatic heart disease DVR group with Pulmonary hypertension (PH),. CytokineS were measured before surgery,30th min before aortic cross clamping(ACC),30th min after ACC,30th min,2th,8th,24th hour after CPB. IL-6,IL-8 were measured respectively by enzyme-linked irnmunosorbent assay with matched antibody pairs. ET-1 were measured by radio-irnmunoassay. result:The mean ACCT of every group is 47.03min,72.78min,73.50min;The CPBT of every group is 84.90min,115.50mm,120.50min. Comparing with the concentrations before surgery,the concentrations of IL-6 and IL-8 in serum increase significantly after ACC(P<0.05),and the concentrations of IL-6 and IL-8 seem to reach the peak level at the 30th min after CPB(P<0.05);then decrease to the base level 24th hours after CPB(P>0.05);The mean plasma ET-I concentration in RHD patients was higher than that in normals (P<0. 01). After operation,the ET-I concentrations increased significantly,and was higher in group PH than in group NPH During Perioperation (P<0.05) .The peak level level of ET-1 in serum is observed at 30th mionutes after ACC(P<0.05) and then decrease to the base level 24th hours after CPB(.P>0.05);There is significantpositive relation between peak IL-6,IL-8,ET-1 level and CPBT(P<0.05).There is no difference among three groups at 24th hours after CPB(P>0.0...
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