The Effects Of Penehyclidine Hydrochloride On The Expression Of Toll Like Receptor4during Cardiopmlmonary Bypass In Patients Undergoing Open Heart Surgery

Ojective:Cardiopulmonary bypass(CPB)during cardiac surgery often induces inflammatory response,which has been attributed to the morbidity of postoperative complication.we try to reduce inflammation by using Penehycl-idine Hydrochloride(PHC) before CPB.To observe the releasing of Inflamma-tory factor and the expression of Toll-like receptor4(TLR4),and discuss the relationship between them.Offering a new idea on the study of inflammatory response interference.Methods:After ethical approval and written informed consent,40patients undergoing cardiac valves Surgery under CPB were included and randomly divided into two groups,20Patients for each group, PHC group(P)and control group(C).0.1mg/kg of PHC were given iv before CPB to the group P,equal volume saline to the group C.Blood samples were collected directly before induction of anesthesia (T0),5mins after aortic clamping(Tl),the end of CPB(T2)and24hours after returning to ICU (T3) for assessment of serum TNF-α、DL-6、IL-8、IL-10concentration by ELISA and toll-like receptors (TLR)4expression on monocytes by flow cytometry(FCM).Meanwhile we collect the informations about morbidity rate of postoperative lung complication,time with the endotracheal tube,dates in ICU and morbidity of postoperative delirium.Resmlts:We found the expression of TLR4and cytokine IL-6、IL-8、 TNF-α、IL-10were significantly enhanced after CPB.IL-6,IL-8concentration at5mins after aortic clamping(T1),the end of CPB(T2)and24hours after returning to ICU (T3) were significantly higher than the time point before induction of anesthesia (T0)(P<0.05),And at the same time point group P was lower than that of group C(P<0.05).TNF-a concentration increased from the beginning of surgery, reached the peak at T3. There was significantly difference in two groups (P<0.05)at T2,T3.The expression of IL-10was rised from5mins after aortic clamping(T1) both in group C and group P.reached the peak at T2and cut to preoperative level at T3in group C while it was still higher then preoperative level in group P.The expression of TLR4was rised from the time point Tl,reached the peak at T2,then fell down, group P was lower than that of group C at T1,T2(P<0.05).There were no statistically significant difference between two group on the index,like the morbidity of postoperative pneumonia,intubation time, the time of ICU stay,the morbidity of postoperative delirium, etc.Conclusions:There are positive correlation between inflammatory factor and the expression of TLR4.Penehyclidine Hydrochloride can lower the expression of TLR4,which then alleviate the inflammatory responses.