Effects Of Sevoflurane Preconditioning On Patiens’ Serum N-terminal Pro-brain Natriuretic Peptide Undergoing Cardiac Valve Replacement With CPB

Objective: To understand the heart function undergoing cardiac valvereplacement with cardiopulmonary bypass by serum N-terminal pro-brainnatriuretic peptide measurement, and investigate the effects of sevofluranepreconditioning on myocardial protection.Methods: Selected60proper patients who received cardiac valvereplacement with cardiopulmonary bypass from Sept2013to Dec2013inCardiovascular Disease Institute of the First Affiliated Hospital of GuangxiMedical University. Randomly divided there patients into two groups, eachgroup had30patients: controlled group (C group) and treatment group (S group). The patients were premedicated with intramuscular morphine0.1mg/kg andscopolamine0.3mg/kg．Two groups received midazolam0.1～0.2mg/kg,fentanyl10μg/kg and vecuronium0.1～0.15mg/kg by intravenous injectionduring the anesthetic induction period．All patients were tracheal intubated andmechanically ventilated．Anesthesia was maintained midazolam、vecuroniumand fentanyl by intravenous injection．Sevoflurane was inhaled after anesthetic induction and the inhalation concentration was rapidly adjusted to2%andmaintained at this level for20min in group S．Blood samples were taken fromvein at the four time points: one day before operation (T0), at20min after aorticunclamping (T1), at6(T2) and24h (T3) after operation to measure theconcentrations of plasma N-terminal pro-brain natriuretic peptide. Recordedaverage blood press(BP)、heart rate(HR) and central venous pressure(CVP) atthe T0、T1′（the point of postoperation）、T2、T3four time points, and recordedthe continuous intravenous infusion dose of dopamine. Observed thepostoperative complications, like ventricular arrhythmia、 low cardiac output、vasoactive drug use and the use of artificial pacemaker and Intra-aortic ballooncounterpulsation.Results: There were no significant differences in the two groups of patientson the sex ration, weight, NYHA classification, operation time, aortic clampingtime, Cardiac resuscitation after Aortic unclamping, CPB time, postoperativemechanical ventilation, CCU stays, and postoperative hospital stays.Within-groups comparison: in C group compared with time point T0,T2、T3points had significantly lower serum N-terminal pro-brain natriuretic peptide（P<0.05）; in S group compared time point T0,T3point had significantly lowerserum N-terminal pro-brain natriuretic peptide（P<0.05）. Between-groupscomparison: at the point T3, compared with the two groups, serum N-terminalpro-brain natriuretic peptide significantly higher in C group than S group. Therewere no significant differences on postoperative complications, all patients lefthospital rehabilitatively.Conclusion: Undergoing cardiac valve replacement under CPB, patients’plasma NT-proBNP concentrations were increased gradually after aorticunclamping, but in the sevoflurane group plasma NT-proBNP concentration was significantly lower than that sevoflurane untreatment group, suggesting that thesevoflurane preconditioning has a cardioprotective effect.