The Effects Of Sevoflurane Postconditioning On Serum Concentration Of CTnT And Production Of ROS In Myocardial Cells During Valve Replacement Surgery For Adult Patients With RHD

Abstract:Objective:A large number of experiment or studies demonstrated that sevoflurane can, as a commonly used volatile anesthetic, protect heart from ischemia/reperfusion by means of preconditioning or post-conditioning. However, the myocardial protective effect and mechanism of sevoflurane postconditioning remains unclear in clinical background. It's well known that the over production of reactive oxygen species(ROS)is one of key impact factors in myocardial reperfusion injury in experiments.This clinical study is aimed to observe and investigate the protective effect and the effect on production of ROS in myocardial cells of sevoflurane postconditioning in patients with rheumatoid heart disease (RHD).Methods:24 patients with RHD, classified as-ASAâ…¡-â…¢, NYHAâ…¡-â…¢,and undergoing valve replacement were enrolled and divided randomly into study and control group.All patients were anesthetized and managed in the same way and EEG,BP, SpO2, MAP, CVP, PETCO2, PETsevoflurane, blood electrolyte, blood gas analysis were routinely monitored.sevoflurane was inhaled after aorta-declamping in the study group for 10 minutes and control PETsevoflurane to 1MAC for at least 5 minutes.Myocardial tissue in right auricle was collected for ROS fluorescence detection before CPB and at 1h after reperfusion.3ml arterial blood sampling was withdrawn through A-line for serum cTnT concentration detection before operation and at 1h, 2h,4h after aorta-declamping. Results:(1)There was no significant difference in general data between the two groups(p>0.05).(2)The serum cTnT concentrations were in normal range and without difference at baseline in both groups-(p>0.05).Comparing with baseline (Ti), serum cTnT increased dramatically in both groups(p<0.05).However, Serum cTnT was much lower in the study group than in the control at all time points after aorta declamping(p<0.05).(3)ROS level in myocardial cells showed no difference between the two groups before aorta-clamping and increased at 1h after aorta-declamping in both groups(p<0:05).However, ROS level was much lower in study group than that in control (p<0.05).Conclusion:Sevoflurane postconditioning could attenuate myocardial ischemia/reperfusion injury and the protection may be related with prohibited over-production of ROS in myocardial cells in adult patients with RHD during valve replacement surgery.