| Objective: Post-operative pulmonary function disturbance caused by acute lung injury (ALI) correlated with cardiopulmonary bypass (CPB) has been a common clinical issue in cardiovascular surgery ever since. As CPB is a nonphysiological circulation pattern, it can evoke system inflammotary response syndrome (SIRS), and the SIRS is an important reason for ALI correlated with CPB. Recent studies have revealed that the proinflammatory cytokines may play important role in ALI correlated with CPB. Propofol has been shown that it not only has the actions of anesthesia and antioxidation, but also can clear oxygen free radicals, inhibit the function of neutrophil and the release of proinflammatory cytokines etc. In this experiment, propofol was used to the patients undergone the valvular replacement under the CPB. By means of observing the effects of propofol on the proinflammatory cytokines and respiratory function in order to inquire into the significance of proinflammatory cytokines in ALI correlated with CPB and the mechanism of propofol's protective action, provide theoretical basis for cardiac surgery anesthesia and improve post-operative pulmonary function.Methods: Twenty patients with rheumatic heart valvular disease whose ASA scale was II-HI, aortic clamping time and bypass time were more than 40, 60 minutes (min) respectively were selected and divided randomly into two groups (n=10 each): control group and propofol group. There were no differences between two groups about medication during operation except that the propofol was used for anesthesia induction and maintenance in propofol group. Under the monitoring of hemodynamics at surgery, heparinized anticoagulant blood samples from radial artery and superior vena cava were taken after anesthesia induction and before CPB (Ti) , 30 min after aortic clamping (T2) and 10min(T3),30 min(T4),2h(T5),4h(T6),6h(T7)after aortic declamping for determining the following data: respiratory index (RI) derived from arterial blood gas analysis,(2)median cell difference(MCD) of neutrophil count derived from left and right atrium blood, arterial plasma levels of malondialdilyde (MDA) ,tumour necrosis factor-a (TNF-a) and interleukin-8 (IL-8) .No adjustment was made for hemodilution. The data were expressed as mean + SD. Statistical package (SPSS 10.0) was used for processing data. P<0.05 was considered statistically significant. Results:1. General patient dataThere were no significant differences between two groups in age, weight, ascending aorta clamping time, CPB time, operation time and ASA scale (P > 0.05).2. Changes in hemodynamicsThere were no significant differences between two groups in HR, MAP and CVP during the operation (P > 0.05).3. Change in respiratory indexThere were no significant differences between two groups in RI at the points of Ti and T2 (0.67+0.11 vs 0.64+0.16, 0.70+0.10 vs 0.67+0.09, P>0.05), but there were significant differences at the points of TS to T7 (P< 0.01 ), RI of control group was higher than that of propofol group. Compared in two groups, RI at the points of T3 to T? was higher than that at the points of T1 and T2 (TO.05), but there was no significant difference between the time points TI and T2 (0.67+0.11 vs 0.70+0.10, 0.64+0.16 vs 0.67+0.09, P>0.05).4. Change in median cell difference (MCD) of pulmonary circulationThere was significant difference in MCD at the point of TS in control group (11.30+3.21X109/L vs 7.33+2.66X109/L, PO.01), neutrophil count of right atrium blood was higher than that of left one, but there was no significant difference in MCD at any time points in propofol group (P >0.05). Neutrophil counts at the points of TS to TI were higher than that at the points of TI and T2 and the difference was statistically significant (P O.01).5. Change in the plasma levels of MDAThere were no significant differences between two groups in MDA levels at the points of TI and T2 (3.42+1.24 nmol/ml vs 3.39+1.23 nmol/ml, 4.39+0.86 nmol/ml vs 4.31+0.87 nmol/ml, P >0.05), but there were significan...
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