The Correlations Of Perioperative Serum Catecholamines And Cytokines Level In Patients Undergoing Valve Replacement

Objectives:The purpose of this study was to investigate the correlations of perioperative serum catecholamines and cytokines TNF-α,IL-6 level in patients undergoing valve replacement,and it may imply that catecholamines play a critical role in controlling inflammations.Methods:Twenty patients suffered from heart disease were scheduled for elective cardiac valve replacement under CPB,who had no systemic diseases(ASA gradeⅡ～Ⅲ,NYHA gradeⅠ～Ⅲ,EF≥40%). Exclusion criteria were as follows:patients with acute infections, rheumatoid activity and blood,endocrine,immune system diseases,signs of significant liver or renal function failure,or carrying human immunodeficiency virus were not enrolled into the study.Patients treated with immune modulators(cytostatic drugs,corticosteroids) within 1 month before surgery or received epinephrine and norepinephrine after declamping of the aorta during the operation were also excluded.Blood samples were taken from radial artery at the time-points of before anesthesia(T0),before CPB(T1),1 h(T2),4 h(T3), and 24 h(T4)after the end of CPB,then the concentrations of E,NE,TNF-α,IL-6 were measured separately.Results::The serum concentrations of E,NE,TNF-α,IL-6 changed similarly during CPB,increased significantly at 1 h,4 h after the end of CPBcompared with the value before anesthesia(P＜0.01),and peaked at 1h after the end of CPB.After 24h of the end of CPB,the levels were similar to those before anesthesia(P＞0.05).Spearman correlation analysis demonstrated that there was a positive relationship between catecholamines E,NE and pro-inflammatory cytokines TNF-α,IL-6(P＜0.01).Conclusion:The cardiac valve replacement in CPB leads to a significant pro-inflammatory response and peaked at 1h after the end of CPB.Catecholamines E,NE was positively correlated with pro-inflammatory cytokines TNF-α,IL-6.It can imply that catecholamines may exert pro-inflammatory effects though regulating the release of cytokines.This might be one of possible mechanisms of systemic inflammatory response(SIR).