The Effect Of Sevoflurane Early Ischemia And Early Reperfusion Treatment On Valve Replacement Patients Serum TNF-?,IL-8and SP-A

Objective:The lung injury sensitive SP-A and inflammatory cytokines IL-8,TNF-?,combination of hemodynamics and blood gas parameters during and after operation were observed during ischemia and early reperfusion period,to investigate the influence and significance of inhaled sevoflurane on serum TNF-?,IL-8 and SP-A in patients undergoing valve replacement,to study the protective mechanism of sevoflurane inhalation on lung injury after CPB.Methods:Forty mitral or aortic valve replacement patients were randomly divided into sevoflurane group(n=20)and control group(n=20).Sevoflurane group patients were inhalation 2% sevoflurane early ischemia and early reperfusion.Control group without inhalation sevoflurane.In befor cutting skin(T0),before CPB(T1),30 min after aortic opening(T2),aortic opening 2h(T3),6h(T4),24h(T5)arterial blood gas measurement and calculation of alveolar arterial oxygen pressure difference P(A-a)O2,oxygenation index OI and levels of inflammatory cytokines IL-8 and TNF-in arterial serum.At time of T1,T2 separately from the right atrium(pulmonary vein)and left atrium(pulmonary artery)blood measured neutrophils(NEV,NEA)and pulmonary surfactant A(SP-AV,SP-AA)calculates the difference(NEV-A,SP-AV-A).Results:1?There was no significant difference between the two groups in weight,age,CPB time,aortic block time,mechanical ventilation time and ICU retention time(P > 0.05).There were no significant differences in MAP and HR at each time between the two groups(P > 0.05)2?There was no significant difference in P(A-a)O2,OI,IL-8 and TNF-? between the two groups in T0(P > 0.05).Compared with T0,P(A-a)O2,TNF-?,IL-8,began to increase at T1 and T3 reached a peak.TNF-?,IL-8,OI in T1 began to reduce and T3 to reach the lowest point(P < 0.05),there was no significant difference between the two groups in T1,T5(P > 0.05);compared with group C,group S in T2,T3,T4 P(A-a)O2,IL-8 and TNF-? were significantly lower than that in group C,OI was significantly higher than that of group C(P < 0.05).3?At T1,there are no significantly different between two groups of NEV,NEA,SP-AV,SP-AA,at T2 significantly different between two group,And also NEV,NEA,SP-AV,SP-AA was significantly higher than T1.Conclusion:1?Compared with non inhaled sevoflurane,inhalation of sevoflurane during pre ischemic and early reperfusion can reduce the levels of inflammatory factors TNF-?,IL-8,and reduce the release of SP-A into the bloodstream.2?Compared with non inhaled sevoflurane,the sevoflurane group maintained a lower P(A-a)O2 and higher OI,which may reduce lung injury after CPB and is beneficial for lung protection...