Study The Effects Of Cardiac Surgery With Cardiopulmonary Bypass On Serum Level Of C-Reactive Protein And Cytokines And The Modulation Effects Of Milrinone And High-dose Fentanyl

Objective To compare effects of cardiac surgery with cardiopulmonary bypass (CPB) or an arresting heart on serum level of C-reactive protein (CRP) and cytokines in patients and observe the modulation effects of milrinone and high-doses Fentanyl. Methods Prospective, randomized, double-blind study. 88 patients scheduled for cardiac surgery with CPB divided into 5 groups and 10 subgroup: CPB adult group(group A) and children group(B), CPB with a beating heart group (C) and CPB with a non-beating heart group (as controlled group, D), milrinone F4 children group with milrinone (M) and. F4 children group with milrinone free(as controlled group, N), cardiac valve replacement group with milrinone (R) and cardiac valve replacement group with milrinone free(as controlled group, S) and high-dose fentanyl group (0.025 mg'kg-1h-1 of fentanyl, group R) and 0.010 mg'kg-1h-1 of fentanyl group (as controlled group, S). The standardized anaesthetic included fentanyl, vecuronium and midazolam. Blood samples for cytokines and CRP measurements were collected into EDTA-Vacutainers from central vein at the following time: just prior to induction of anesthesia (baseline, T0), 5 min after aortic cross-clamp release (T1), 5 min after weaning from CPB (end-CPB, T2), on completion of surgery (T3), 24 hours (T4) and 48 hours(T5) after the operation. Concentrations of TNF- a , IL-8, and IL-10 were measured using a quantitative sandwich enzyme linked-immunosorbent assay (ELISA). The concentration of CRP on blood serum was measured by radioimmunoassay (RIA). Results No significant rise of TNF- a was found almost in all groups. The peak of CRP emerged on T4 and T5 and increased nearly ten times as much as the value of baseline. Patients in the group A had significant rises in T5 CRP and significant reduces in T3, T4IL-8 compared with group B (P < 0.05). In group C vs group D a significant increase of CRPwas detected on T5. On T2 in group D, IL-8 levels were higher than the one in group C and the opposite result was got on T3. Compared with baseline value TNF- a was lower at T,. IL-10 level was seen in the group M at T2, T3, T4 and T5 (P<0.05). On the contrary, IL-8 was higher in group N at T1, T3, T4 than in group M (P<0.05). IL-10 was increased significantly in group M at T2, T3, T4 and T5 (P<0.05). TNF- a increased significantly at T2 compared with T0 in group O. Compared with baseline a significant increase of CRP in the group O and P at T4 and T5 each was emerged and the value in group O at the same time points was much higher than the one in P (P<0.05).A more increased IL-10 level was detected in the group O than group P at T4 and T5 (P<0.05}. Patients in the group R had significant rises in T4, T5 CRP, T2-5 IL-8 and T1-5 IL-10 (P < 0.05) and patients in the group S had significantly higher in T4, T5 CRP, T1-5 IL-8 and T5 IL-10 compared with the baseline of each (P < 0.05). Conclusions Systemic inflammatory response in children underwent cardiac surgery with CPB was more severe than the one in adults. In patients who underwent CPB without cardiocirculatory arrest CRP and cytokine production seems be an adaptive response for attenuating the CPB-induced inflammatory response. Milrinone and high-dose fentanyl inhibited systemic inflammation induced by CPB and the cardiac surgery.