The Study Of Protective Effects Of Liposomal Prostaglandin E₁ On Cerebral Injury During Cardiopulmonary Bypass

【Objective】To discuss the protective effects and probable mechanism of liposomal prostaglandin E1 (Lipo-PGE1) on brain injury of patients during cardiopulmonary bypass (CPB).【Methods】30 patients underwent rheumatic heart valve replacement were selected randomly, including 10 males and 20 females with ages from 32 to 60,and the average age was 41.7±7.7 years. None of them had endocarditis, diabetes, hypertension, hyperlipidemia, cerebrovascular diseases, immune system diseases or mental disorders before operation, and had no drinking hobby or obvious lung, liver, kidney dysfunction before operation. These patients'heart function were GradeⅡ～Ⅲon the basis of New York Heart Association (NYHA), and none of them used the drugs which have significant effects on the immune system.The study was composed of 5 cases of aortic valve replacement (AVR), 13 cases of mitral valve replacement (MVR) and 12 cases of double valve replacement (DVR). The 30 cases were divided into two groups randomly, including experimental group (Group P, n=15) and control group (Group C, n=15).In Group P, Lipo-PGE1 (dose of 3ng/kg?min) was continuously pumped intravenously into the patients after induction of anesthesia and before CPB, till to the end of operation. In Group C, the patients were given identical volume of normal saline instead of Lipo-PGE1 with the same methods. 4 ml of blood samples were taken from jugular bulb after induction of anesthesia and before operation (T1), 30 minutes after initiation of CPB (T2), 1 h after the ascending aortic off-clamping (T3), 6h (T4) and 24h (T5) after discontinuation of CPB to determine the concentrations of plasma S100βprotein, NSE and TNF-αwith ELISA, to determine the concentration of MDA with thio-barbitone, and to determine the activity of SOD with xanthinoxidase, respectively.【Result】The difference of the plasma concentrations of S100βprotein, NSE and TNF-αwas not statistically significant between both groups at T1 (P>0.05). In contrast with Group C, the plasma concentrations of S100βprotein, NSE and TNF-αin Group P rose at T2 (P<0.05), reached to the peak at T3 (P<0.05), began to descend at T4 (P<0.05), and were still higher than pre-operation at T5, but the difference was not statistically between them (P>0.05). When contrasted between groups, the concentrations of Group P were lower than Group C in T2-T4 (P<0.05). 2. The difference of the plasma concentrations of MDA and activity of SOD was not statistically significant between both groups at T1 (P>0.05); in contrast with Group C, the plasma concentrations of MDA were higher than and the activity of SOD descended in Group P (P<0.05 ). When contrasted between groups, the plasma concentration of MDA in Group P was lower than Group C and the activity of SOD was higher than Group C in T2-T4 (P<0.05).【Conclusion】The plasma concentrations of specific biochemical marker for brain injury, such as S100βprotein and NSE, all markedly rose transiently during CPB, Lipo-PGE1 can relieve the expression level of S100βprotein and NSE of peri-CPB. Its mechanism may principally be suppressing the release of inflammatory factor TNF-α, lessening the production of MDA and increasing the activity of SOD.