The Lung Protection Of Sevoflurane On Patients With Cardiac Double Valve Replacements

Objective:Inflammatory cells, inflammatory factors and pulmonary function index before and after CPB were observed on patients with double valve replacements in order to study the effect of induction and maintenance anesthesia with sevoflurane on pulmonary and systemic inflammatory responses, and to discuss the possible mechanism.Method:Thirty patients undergoing mitral and aortic valve replacement surgery under cardiopulmonary bypass were randomly divided into the experimental group (group sevoflurane, group S) and the control group (group propofol, group P). Arterial blood was obtained to measure the arterial carbon dioxide tension (PaCO2), arterial oxygen tension (PaO2) and inspired oxygen concentration (FiO2) to assess the oxygenation index (OI) and respiratory index (RI) before anesthesia(TO), before CPB(T1),10minutes after the restoration of heart beats(T2),2hours after CPB(T3) and24hours after CPB(T4) respectively. Arterial blood was obtained at TO, pulmonary artery (PA) and right upper pulmonary vein (PV) blood was collected at T1and T2. The leukocyte counts (WBC), neutrophil counts (N), lymphocyte counts (L) and interleukin-6(IL-6) levels in plasma were measured. The PV/PA ratios of these inflammatory indexes were observed for the assessment of inflammatory situation in the lung. The mechanical ventilation time, the ICU stay time and the incidence of postoperative severe complications was recorded.Results:1. Compared with T1, the amount of WBC, N, L and IL-6in PA and PV increased significantly at T2(P<0.05), the PV/PA ratio of WBC and N in two groups and L in P group decreased (P<0.05), but the PV/PA ratio of IL-6in two groups and L in S group changed unclearly (P>0.05); compared with T0, RI went up and OI descended gradually in two groups at T1-T3, and they were back to normal a little at T4.2. Compared with P group, inflammatory index counts in PA and PV at T1and T2were lower in S group (P<0.05), in which the PV/PA ratio of WBC and N in S group at T2was higher (P<0.05), while the PV/PA ratio of N was unchanged (P>0.05), the PV/PA ratio of IL-6was lower at T1and T2(P<0.05); The RI and OI in S group at T1-T4were lower and higher respectively(P<0.05); the mechanical ventilation time and the ICU stay time was shorter than P group (P<0.05).3. The incidence of postoperative severe complications was no clear difference between the two groups (P>0.05).Conclusion:1. Lung injury happened during cardiopulmonary bypass, the performance is:inflammatory cells increased and were reserved in lungs and IL-6level in plasma went up. 2. Sevoflurane can attenuate the pulmonary and systemic inflammatory response during cardiopulmonary bypass through suppressing the pulmonary sequestration of inflammatory cells and restraining the production of inflammatory cytokines in human body, it also can improve oxygenation of lungs; sevoflurane can alleviate lung injury but can’t avoid it completely.