| Objective:inflammation is the serious complications during cardiopulmonary bypass (CPB). Anesthesiologists always want to mitigate inflammation during cardiopulmonary bypass (CPB) by anesthetic intervention and means. In this study, in order to provide a reference of the choice of narcotic drugs during CPB, propofol was compared to sevoflurane about the effect on inflammation during CPB. In order to probe the effect of TLR4on inflammation during CPB, and to provide a theoretical basis of means of prevention and cure for inflammation during CPB, the change of the expression of Toll like receptor four (TLR4) in peripheral mononuclear cell was analyzed.Methods:Forty patients, eighteen to forty-five years old, and ASA Ⅱ-Ⅲ, with heart valve diseases underwent CPB, were divided into two groups:group P (propofol group, n=20) and group S (sevoflurane group, n=20). It was excluded patients with liver and kidney dysfunction, and who has used glucocorticoid or non-steroidal anti-inflammatory drugs in two weeks. In both two groups, anesthesia was induced with intravenous injection of midazolam(0.05～0.15mg/kg), fentanyl (5ug-30ug/kg), propofol(1～2.5mg/kg), and vecuronium(0.08～0.12mg/kg), and maintained with intermittent intravenous injection of midazolam, fentanyl and vecuronium. Propofol (2.5～5mg/kg-h)was pumped in group P and sevoflurane(1～2MAC) was inhaled in group S for maintenance of anesthesia. Bispectral Index (BIS) was fluctuated from forty to sixty.The changes of body temperature, respiratory frequency and heart rate were observed at five different time points--pre-anesthesia, pre-CPB,0hours,4hours and24hours post CPB. At each time peripheral venous blood was sampled. The white blood cell count, neutrophil count, the concentration of IL-6and TNF, the expression level of TLR4were detected at these five different time points. Both the concentration of IL-6and TNF were measured by radioimmunoassay; and the expression level of TLR4was measured by RT-PCR. Results:1. There was no significant difference in patients’gender, age, body weight, cardiac function, time for CPB, and time for aortic occlusion between two groups(P>0.05).2. There was no significant difference in temperature, respiratory rate and heart rate in these five time points between two groups(P>0.05).3. There was no significant difference in white blood cell count in point T1and T2between two groups(P>0.05). It was lower in group S than in group P in point T3-T5(P<0.05). Compared with pre-operation within group, the white blood cell count was continued to rise from T3in both group P and group S. There was significant difference between T3-T5to T1-T2. In group P, the white blood cell count from T1to T5were (4.93±1.62)×109/L,(5.42±1.90)×109/L,(7.53±2.76)×109/L,(15.33±3.86)×109/L,(16.89±4.13)×109/L; in group S, the white blood cell count from T1to T5were(4.58±1.19)×109/L,(4.56±1.10)×109/L,(6.01±1.59)×109/L,(12.90±2.87)×109/L,(14.09±3.38)×109/L.4. There was no significant difference in neutrophil count in point T1and T2between two groups(P>0.05). It was lower in group S than in group P in point T3-T5(P<0.05). Compared with pre-operation within group, the neutrophil count was continued to rise from T3in both group P and group S. There was significant difference between T3-T5to T1-T2. In group P, the neutrophil count from T1to T5were (3.21±1.27)×109/L,(3.86±1.53)×109/L,(5.78±2.34)×109/L,(13.69±3.76)×109/L,(15.17±3.85)×109/L; in group S, the neutrophil count from T1to T5were (3.07±1.27)×109/L,(3.39±1.02×109/L,(4.52±1.29)×109/L,(11.20±2.49)×109/L,(12.71±3.46)×109/L.5. There was no significant difference in the concentration of TNF in point T1between two groups(P>0.05). It was lower in group S than in group S in point T2-T5(P<0.05). Compared with pre-operation within group, the concentration of TNF was rise from T2, peaked at T3, and then began to recover. There was significant difference between T2-T5to T1. In group P, the concentrations of TNF from Tl to T5were0.24±0.04ng/ml,0.37±0.12ng/ml,0.77±0.12ng/ml,0.69±0.13ng/ml,0.61±0.11ng/ml. In group S, the concentrations of TNF from T1-T5 were0.22±0.07ng/ml,0.30±0.10ng/ml,0.67±0.11ng/ml,0.58±0.10ng/ml,0.49±0.12ng/ml.6. There was no significant difference in the concentration of IL-6in point T1between two groups(P>0.05). It was lower in group S than in group S in point T2-T5(P<0.05). Compared with pre-operation within group, the concentration of TNF was rise from T2, peaked at T4, and then began to recover. There was significant difference between T2-T5to T1. In group P, the concentrations of IL-6from T1to T5were65.05±12.56pg/ml,84.40±17.39pg/ml,134.32±29.43pg/ml,261.55±49.10pg/ml,207.45±54.20pg/ml. In group S, the concentrations of IL-6from T1-T5were58.10±10.09pg/ml,73.15±13.18pg/ml,116.85±19.48pg/ml,226.95±36.36pg/ml,172.85±42.82pg/ml.7. There was no significant difference in the expression level of TLR4in T1-T3between two groups(P>0.05). It was lower in group S than in group S in point T4-T5(P<0.05). Compared with pre-operation within group, the expression level of TLR4down-regulated at T2and T3, and then began up-regulate at T4, and continued to rise at T5. In group P, the expression level of TLR4from T1-T5were0.33±0.07,0.24±0.06,0.24±0.05,0.36±0.08and0.46±0.10. In group S, the expression of TLR4from T1-T5were0.305±0.071,0.220±0.056,0.244±0.055,0.312±0.05and0.403±0.065.Conclusion:The systemic inflammatory response will be happened post cardiopulmonary bypass. The high expression level of TLR4play an important role in the pathogenesis of the inflammatory response post CPB (P<0.05). The effect of sevoflurane is more pronounced than propofol on preventting the inflammation during CPB. |
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