Influence Of Using 1.0 MAC Sevoflurane In Different Phase During Cardiac Valve Replacement Surgery On Cardiac And Pulmonary Function

Objective:To observe the effect of using 1.0 MAC sevofluraneon perioperative cardiac and pulmonary function at different stages of cardiac vavle replacement surgery, and to explore the optimal occation and method perform myocardial and pulmonary protection by sevoflurane applyed. Methods:100 patients scheduled for cardiac valve replacement surgery were randomly divided into four groups:control group (group CON), sevoflurane throughout the treatment group (SEV group), sevoflurane preconditioning group (group PRE) and sevoflurane postconditioning group (group POS). The serum concentration of cTnI and BNP was determined on the day before surgery (T1), the end of surgery (T2), and 4 h (T3),8 h (T4),24 h (T5) and 72 h (T6) after surgery; The arterial blood gas analysis was dynamic monitored on the day before surgery(ti), the end of surgery (t2), and 2 h (t3),6 h (t4) and removing the tracheal catheter before 30 min (t5), the differnt time(t2-t5) of ventilator associated parameters were recorded, and calculating M index (PaO2/PAO2), respiratory index (RI), oxygenation index (01), intrapulmonary shunt fraction (Qs/Qt) and pulmonary dynamic and static compliance (Cd/Cs); the time of postoperative ICU residence, mechanical ventilation, patients with trachea catheter and hospital day, postoperative adverse events and the patients’mortality of follow-up 18 months was writed down; the results of preoperative and postoperative 3 months echocardiography were compared. Results:The serum concentration of cTn1 among 4 groups showed statistically significant difference (P<0.01), but the serum concentration of BNP, postoperative adverse events and the results of echocardiography among 4 groups were no statistically significant difference (P>0.05); Compared to CON group after surgery, patients from SEV, PRE and POS groups the results of pulmonary function were better at t2,t3, t5 and t5 (P<0.05), as SEV were better than PRE and POS groups (P<0.05); the time of postoperative mechanical ventilation, with endotracheal tube and ICU stay were shorter in group SEV, PRE and POS than CON group (P<0.05), as SEV was shorter than PRE and POS (P<0.05). Respiratory complications were less in the other three groups than in control group (P<0.05); the long-term mortality in patients with CON group after surgery was significantly higher than the other three groups (P<0.05), but among PRE and POS and CON group was no statistically significant difference (P>0.05); the short-term mortality of postoperative among 4 groups showed no statistically significant difference (P>0.05). Conclusion:The patients in the different stages of application of 1.0 MAC sevoflurane has the action of cardiac and pulmonary protection for patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass, the best method is to be inhaled during the whole surgery; It could affect the patients’ prognosis but couldn’t change the structure of heart.