| Objective:Sevoflurane is the new one of volatile anesthetics in the decades.It has already been widely used on the clinic.It has reported that sevoflurane has the protective effect on acute pulmonary injury due to pulmonary ischemia reperfusion in animal research.We have never found the research about the protective effect of sevoflurane in the clinical experiment.The aim of this study was to investigate the effect of sevoflurane preconditioning on acute pulmonary injury in patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).Methods:Forty patients were randomly allocated to four groups of ten patients each: control group(group C) and sevoflurane preconditioning group(group S1,group S2, group S3).Morphine 0.2mg/kg and penehyclidine 0.02mg/kg were injected intramuscularly in all patients at 30min before operation.All patients were monitored with ECG,SpO2,BP,BIS in the operating room.Anesthesia are induced with intravenous anesthetics including midazolam,etomidate,fentanyl,rocuronium.1%, 2%,3%sevoflurane were inhaled for 30min in group S1,S2,S3 after induction while the patients in group C don't use any inhaled anesthetics.Intravenous anesthesia was maintained in the period of and after CPB in all groups.Patients in all groups were ventilated mechanically after anesthesia induction(VT:8～14 ml/kg,RR:10～14 B/min). Pipcuronium was injected intermittent for neuromuscular block.Heart-lung machine, membrane oxygenate and microembolus filter were used for CPB.The patients in all groups entered into ICU after operation.Dopamine,Dobutamine and deoxyepinephrine were injected to maintain BP and HR.PaO2,PaCO2,SO2,AaDO2, OI,Cdyn,Cstat were measured before(T0) and after(T1) induction of anesthesia,at the discontinuation of CPB(T2),1h(T3),2h(T4),4h(T5),8h(T6),12h(T7) and 24h(T8) after CPB.Blood samples were obtained in T0 T2 T5 T8for determination of plasma levels of TNF-α,IL-6,MMP-9.The time of mechanic ventilation,extubation,staying in ICU and hospitalization was recorded.Results:There is no difference in pulmonary function and the concentration of inflammatory factor before CPB in all groups.Function and compliance of pulmonary are deteriorated and the inflammatory factor in plasma are increased after CPB in all groups.Compared with group C,the pulmonary oxygenation function of patients in group S1,S2,S3 is better at T3～4,T2～5,T2～7 respectively after CPB(P＜0.05);compliance of pulmonary of patients in group S2,S3 is raise at T3,T2～4 respectively(P＜0.05);plasma levels of TNF-αin group S2 is lower at T2,T5,and group S3 is lower at T2,T5,T8(P＜0.05),plasma levels of IL-6 in group S2,S3 is lower at T2,T5,T8 respectively(P＜0.05),plasma levels of MMP-9 in group S1 is lower at T5 and group S2,S3 are both lower at T2,T5(P＜0.05).The time of mechanic ventilation,extubation and staying in hospital of patients in group S2-3 is shorter than those in group C(P＜0.05).Conclusion:Sevofluane preconditioning can improve oxygenating function and compliance of pulmonary and protect CPB related pulmonary injury,which is related to inflammatory response.
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