Effect Of Sevoflurane On Proinflammatory Cytokines And Heat Shock Protein 70 In Pregnant Women

Part 1Effects of sevoflurane on maternal pro-inflammatory cytokines and heat shock protein 70 in general anesthesia in caesarean sectionObjective Using sevoflurane compound remifentanil and propofol compound remifentanil in general anesthesia in cesarean section,to compare the change of hemodynamic index,pro-inflammatory cytokines,heat shock protein(HSP)70 concentration in maternal plasma and the expression of HSP70 in the placenta tissue,and to evaluate postpartum hemorrhage,intraoperative awareness,and baby health condition.To clarify the advantages of sevoflurane inhalation anesthesia over intravenous general anesthesia in maternal anesthesia,and provide thinking method and evidence for reasonable,effective,safe and comfortable obstetric general anesthesia.Methods Sixty caesarean section mature puerperas undergoing general anesthesia were enrolled and randomly divided into the propofol group(P group)and the sevoflurane group(S group)using random number table,with 30 cases in each group.Maternal plasma concentrations of pro-inflammatory cytokines and HSP 70 and the expression of HSP70 in placenta tissue were monitored at different time points.The mean arterial pressure(MAP)and heart rate(HR)of puerperas,Apgar score and the pH value of umbilical artery blood were recorded at different time points.Also,the time between cesarean section and fetal childbirth,uterine contraction,intraoperative hemorrhage and awareness were recorded.Results MAP and HR in Group P after intubation and at childbirth were recorded,and the mean values were significantly lower than To(P<0.05),but HR in Group P were significantly higher than T0.At each time point,the mean values of MAP in Group S were significantly higher than Group P,while the mean values of HR in Group S were significantly lower than Group P(P<0.05).The variation trends of MAP and HR were different in both Group S and Group P(P<0.05).Of those,the MAP and HR varied slightly in Group S when compared with Group P(P<0.05).In Group P,the concentrations of IL-6,TNF-? and HSP70 were significantly elevated after caesarean operation than those recorded before the operation(P<0.05).At each time point,the concentrations of IL-6,TNF-? and HSP70 were significantly higher in Group P than Group S(P<0.05).In Group P,the concentration of sTNFR ? was significantly elevated 24h after caesarean operation than those recorded before the operation(P<0.05).At each time point,the concentration of sTNFR ? was significantly higher in Group P than Group S(P<0.05).After delivery of the placenta,the expression level of HSP70 in placenta tissue was apparently up-regulated in Group P than Group S(P<0.05).No obvious difference was seen regarding puerpera age,gestational age,BMI,caesarean operation,time of childbirth,intraoperative blood loss,cases of uterine atony,cases of explicit memory of intraoperative events 24h after surgery,Ramesay scores at T4,Apgar scores after delivery,pH value in umbilical artery blood(P>0.05).Conclusion Compared with propofol,sevoflurane used in general anesthesia for cesarean section has no obvious effects on maternal blood circulation,uterus contraction and fetus,while it can reduce the concentrations of pro-inflammatory cytokines,HSP70 in maternal blood and expression of HSP70 in placental tissue.Part 2Effects of sevoflurane on protein expression and apoptosis of placental trophoblastObjective To investigate the effects of sevoflurane on the protein expression of IL-6,TNF-?,HSP70 and cellular apoptosis in placental trophoblasts obtained from ordinary parturients,and provide evidence for safe application of sevoflurane on obstetric general anesthesia.Methods Trophoblasts were isolated from ordinary placentae and treated with 3%sevoflurane for 0 min(Group SO),15min(Group S15),30min(Group S30),60min(Group S60),respectively.Then cells were cultured in a 37? constant temperature incubator for 24h.Protein expression of IL-6,TNF a and HSP70 were detected by western blot.Cellular apoptosis of placentae was detected by Tunel and FCM assay.Results Compared with Group S0,the expression level of IL-6 and TNF-a in the placentae tissue were significantly decreased in Group S15(P<0.001),while that were significantly increased in Group S30 and Group S60(P<0.001).Compared with Group SO,the expression level of HSP70 in the placentae tissue was significantly down-regulated in Group S60(P<0.001),while it was significantly up-regulated in Group S15 and Group S30(P<0.001).No obvious morphological change of placental trophoblasts was observed placental trophoblasts in Group S15,while those in Group 30 had a tendency to form apoptotic bodies,with apoptotic bodies already formed in some of the placental trophoblasts.Moreover,placental trophoblasts in Group 60 had apparent tendency to form apoptotic bodies.Compared with Group S0,the apoptotic cells per 10000?m2 trophoblastic villi were not altered in Group S15(P>0.05)while apoptotic cell number was significantly higher in Group S30 and Group S60(P<0.001).Through flow cytometry analysis,no significant difference was observed between Group SO and Group S15(P>0.05),but apoptotic rates were significantly higher in Group S30 and Group S60 compared with Group SO(P<0.001).Conclusions In placental trophoblasts obtained from ordinary parturients,cell vitality was normal and no obvious apoptosis was seen after treated with 3%sevoflurane for 15min,while cell vitality decreased significantly and apoptosis was induced greatly after treated with 3%sevoflurane for more than 30min.Hence we concludedthat application of 3%sevoflurane was safe in short-term cesarean section.