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Objective To observe the effect of sevoflurane preconditioning on serum GDF-15,TNF-α, cTnI expression during perioperative period in patients in congenital heart diseases(CHD)with pulmonary artery hypertension(PAH),and to investigate the mechanism of myocardial protection. Methods Forty adult patients of CHD with PAH who received open-heart surgery under extracorporeal circulation were randomly divided into two groups(n=20):sevoflurane preconditioning group(Group S)and the control group(Group C). In the group S, 1MAC sevoflurane was inhaled for 20 min from beginning of operation ,and followed with oxygen elution for 10 min,in twice;only inhaling pure oxygen in the Group C. The artery blood samples were collected for measurements of serum GDF-15,TNF-α,cTnI immediately before anesthesia induction(T0),at 2 h(T1),12 h(T2),24 h (T3)after aorta declamping and 7 d(T4)after operation. The restoration of spontaneous heart beat ,reperfusion arrhythmia scores,preoperative and postoperative pulmonary artery systolic pressure were recorded. Results Com-pared with preoperative pumonary artery systolic pressure(PASP),it became low in the two groups at 7 days after operation(P<0.05);compared with the group C,the rate of restoration of spontaneous heart beat was promoted, and reperfusion arrhythmia scores were decreased in the group S(P<0.05);compared with the group C,GDF-15 were increased,TNF-α,cTnI were decreased in the group S at T1～3(P < 0.05);Compared with T0,GDF-15, TNF-α,cTnI were increased in the two groups at T1～3,GDF-15 in the two groups were decreased at T4(P <0.05). Conclusion Sevoflurane preconditioning may reduce inflammatory reaction during perioperative period in patients of CHD with PAH by promoting the expression of GDF-15,inhibiting the expression of TNF-α and then improve myocardial ischemia-reperfusion injury.
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Objective To observe the effect of sevoflurane preconditioning on serum GDF-15,TNF-α, cTnI expression during perioperative period in patients in congenital heart diseases(CHD)with pulmonary artery hypertension(PAH),and to investigate the mechanism of myocardial protection. Methods Forty adult patients of CHD with PAH who received open-heart surgery under extracorporeal circulation were randomly divided into two groups(n=20):sevoflurane preconditioning group(Group S)and the control group(Group C). In the group S, 1MAC sevoflurane was inhaled for 20 min from beginning of operation ,and followed with oxygen elution for 10 min,in twice;only inhaling pure oxygen in the Group C. The artery blood samples were collected for measurements of serum GDF-15,TNF-α,cTnI immediately before anesthesia induction(T0),at 2 h(T1),12 h(T2),24 h (T3)after aorta declamping and 7 d(T4)after operation. The restoration of spontaneous heart beat ,reperfusion arrhythmia scores,preoperative and postoperative pulmonary artery systolic pressure were recorded. Results Com-pared with preoperative pumonary artery systolic pressure(PASP),it became low in the two groups at 7 days after operation(P<0.05);compared with the group C,the rate of restoration of spontaneous heart beat was promoted, and reperfusion arrhythmia scores were decreased in the group S(P<0.05);compared with the group C,GDF-15 were increased,TNF-α,cTnI were decreased in the group S at T1～3(P < 0.05);Compared with T0,GDF-15, TNF-α,cTnI were increased in the two groups at T1～3,GDF-15 in the two groups were decreased at T4(P <0.05). Conclusion Sevoflurane preconditioning may reduce inflammatory reaction during perioperative period in patients of CHD with PAH by promoting the expression of GDF-15,inhibiting the expression of TNF-α and then improve myocardial ischemia-reperfusion injury.
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Objective To investigate the efficiency and safety of agkistrodon hemocoagulase on coagulation function in pa?tients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods In this prospective,randomized controlled trial,80 eligible patients accepted valve replacement were assigned to control group (n=20) and agkistrodon hemoco?agulase groups (H1, H2, H3) according to the different timing of administration. Twenty patients were given treatment 20 minutes before anesthesia induction (H1 group), 20 patients were given treatment 20 minutes after CBP (H2 group) and 20 patients were given treatment after CBP (H3 group). Coagulation parameters including prothrombin time (PT), activated partial thromboplas?tin time (APTT), thrombin time (TT), fibrinogen (Fib) and platelet (PLT) were detected 20 minutes before surgery (T0), immedi?ately after surgery (T1) and 24 hours after surgery(T2). Data of 24-h postoperative drainage of mediastinal and pericardial, dura?tion of mechanical ventilation, stay time of intensive care unit (ICU), the actual days of hospitalization and hospital costs were recorded. The clinical parameters were also recorded including blood transfusion after surgery, secondary thoracotomy, aller?gies, liver and kidney dysfunction, deep vein thrombosis and neuropsychiatric symptoms. Results Compared with control group, values of PT, APTT and TT at T1 and T2 were significantly lower in H1, H2 and H3 groups (P<0.05). Compared with T0, values of PT, APTT and TT at T1 and T2 were significantly higher in all groups of patients (P<0.05). Values of PT and TT at T1 and T2 were significantly decreased in H3 group than those of H1 group (P<0.05). The pericardial and mediastinal drainage, the duration of ventilation support within 24-h after surgery were significantly lower in H1, H2 and H3 groups than those of control group (P<0.05). There was no significant difference in the incidence of adverse events between groups. Conclusion Agkis?trodon hemocoagulase is safe and effective in patients undergoing cardiac valve replacement with cardiopulmonary bypass.
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Objective To investigate the effects of sevoflurane postconditioning on lung function in patients undergo-ing heart valve prosthesis implantation with cardiopulmonary bypass (CPB). Methods Thirty patients, scheduled for heart valve prosthesis implantation, were randomly divided into control group (C, n=15) and sevoflurane postconditioning group (S, n=15). Anesthesia was maintained by intermittent intravenous injection of midazolam, fentanyl and pipecuronium. In group S, 2%sevoflurane was inhaled continuously for 15 min , 2 min before aortic unclamping. Blood samples were taken at 30 min before CPB (T2), 30 min after CPB (T3), 6 h (T4), 12 h (T5) and 24 h (T6) after operation. The values of p(O2), SaO2, airway peak pressure (Ppeak) and airway plateau (Pplat) pressure during the time of mechanical ventilation were recorded. Oxygen index (OI), alveolar arterial oxygen tension difference (AaDO2), dynamic pulmonary compliance (Cdyn) and static pulmonary compli-ance (Cstat) were calculated. Results Compared with group C, the values of SaO2 and Cdyn were significantly higher in group S after 30 min of CPB. The values of OI, p(O2), Cdyn and Cstat were significantly higher in group S than those of group C after 6 h of operation. The value of AaDO2 was significantly lower 12 h and 24 h after operation than that of group C (P＜0.05). Conclusion CPB led to the lung injury. The sevoflurane postconditioning has a protective effect on lung function in pa-tients undergoing cardiac valve replacement with CPB.