The effects of recombinant human brain natriuretic peptide on the plasma endotoxin and systemic inflammatory response in patients with cardiac valve replacement during cardiopulmonary bypass / 中华胸心血管外科杂志

ABSTRACT

Objective To observe the effects of recombinant human brain natriuretic peptide on the plasma endotoxin and systemic inflammatory response in patients undergoing cardiac valve replacement surgery during cardiopulmonary bypass (CPB) and to explore its mechanism.Methods 32 patients with elective heart valve replacement surgery during cardiopulmonary bypass were divided into a control group and a treatment group randomly.The patients of treatment group were recievel rhBN (1.5 μg · kg-1 · min-1 bolus intravenous injection before aortic cross-clamping followed by 0.0075 μg · kg-1 · min-1 for 24 hours),while the patients of control group received the same volume of 0.9％ sodium chloride.The plasma levels of endothelin -1 ( ET-1 ),diamine oxidase(DAO),lipopolysaccharide ( LPS),tumor necrosis factor-α (TNF-α) before skin incision ( T1 ),the end of CPB ( T2 ),4 h after the end of CPB ( T3 ),8 h after the end of CPB (T4),24h after the end of CPB (T5) respectively.Results Before skin incision ( T1 ),plasma ET-1,DAO,LPS,TNF-α of two group patients showed no significant difference ( P ＞ 0.05 ) ; At each time point after the end of CPB ( T2,T3,T4,T5 ) Plasma DAO,LPS,TNF-α levels of two groups patients were significantly higher than before skin incision ( T1 ) levels ( P ＜ 0.01 ).There was no significant difference of the plasma levels of ET-1 between T5 and T1 in treatment group patients ( P =0.24).At each time point after the end of CPB ( T2,T3,T4,T5 ),treatment group patients'plasma ET-1,DAO,LPS,TNF-α levels were significantly lower than the control group respectively (P ＜0.01 ).The increase in blood ET-1 was highly positive correlated with the increase in blood DAO (r=0.51,P ＜0.01 ).The increase in blood DAO was highly positive correlated with the increase in blood LPS (r =0.77,P ＜ 0.01 ).The increase in blood LPS was significantly positive correlated with the increase in blood TNF-α ( r =0.48,P ＜0.01 ).Conclusion Recombinant human brain natriuretic peptide can reduce gastrointestinal vasoconstriction,improve gastrointestinal mucosal perfusion and oxygenation,protect the gastrointestinal mucosal barrier function,preventing intestinal endotoxemia Shift,reduce plasma endotoxin levels and reduce systemic inflammatory response by inhibiting the release of ET-1 during CPB.