Myocardial Protection Effect Of Sevoflurance Post-treatment On Patients Undergoing Cardiac Valves Replacemet Surgery With Cardiopulmonary Bypass

ObjectiveStudy the myocardial protection effect of Sevoflurane post-treatment on patients undergoing cardiac valves replacemet surgery with cardiopulmo-nary bypass. And explore the mechanism of myocardial protection of Sevo-flurane.Methods30 adult patients with rheumatic heart disease underwent heart valve replacement.Patients were randomly divided into control group(C group)(n=15) and sevoflurane post-treatment group(S group).S group was drenched with 2% Sevoflurane continuously for 15 mins instantly after aortic opening by turning on the Membrane OxygenatorCardiopulmonary Bypass Device. C group only received intravenous anesthesia.Compare the differences between the two groups of cardiac auto-resuscitation, he-modynamics, blood gas analysis, staying ICU time and changes in my-ocardial ultrastructure. Plasma concentrations of interleukin-6 (IL-6) interleukin-10 (IL10), malondialdehyde (MDA), superoxide dismutase (SOD), lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase (CK-MB), cardiac troponinâ… (cTnâ… ) were measured immediately before skin incision (T1),0.5h after aortic opening(T2),3h after aortic opening (T3), and 24h after aortic opening (T4). Western blot protein determination GST-glutathiones-transferase) in left atrial append-age tissues was measured both before the surgery and after cardiopulmon-ary bypass of the two group.Bypass time, aortic blocking time, operation time and the consumption of dopamine after surgery was recorded.All of datas were statistically analyzed.Results(1) Compared with the control group, in the Sevoflurane post-treatment group,LDH was lower atT4 (P<0.05). cTnâ… at T3, T4 decreased significantly (P<0.05); IL-6, IL-10 at T2, T3,T4 values were less than the control group (P<0.05); MDA at T2, T3 was significantly lower than the control group (P <0.05);CK-MB at T2 was significantly lower than the control group (p<0.05); S group's myocardial GST after bypass was significantly higher than control group (P<0.05).The automatical heart beat resuscitation rate was significantly higher than the control group (P<0.05); the ultrastructure structure damage of myocardial tissue was milder compared with the control group after bypass (P<0.05).(2) Compared with the preoperative baseline value, two groups of pla-sma LDH, IL-6, IL-10, CK, CK-MB, CTnâ… , at T1-T3 increased significan-tly and reached a maximum at T3 (P<0.05).In S group MDA value has no difference between Tl and T2(P> 0.05),MDA value of C group is high -er at T2 compared with T1 (P<0.05).The SOD value of two groups was lower on T1-T3 (P<0.05). The S group in the T4 and T1 SOD had no significant differences (P>0.05), while in the the control group T4 was significantly lower than T1(P<0.05).Conclusions(1) This study demonstrate tha 2% Sevoflurane treatment for 15 min immediately after the opening of the aortic has obvious myocardial protection effect on patients undergoing cardiac valves replacement surgery with cardiopulmonary bypass.(2) This study shows that Sevoflurane resist effect on the ischemia-reperfusion injury by reducing the release of enzymes against CPB, reducing the release of oxygen free radicals, anti-inflammatory mediators releasing changing the myocardial ultrastructure,and enhancing cardiac function.