CHEN Feifei,MIAO Jianxia,LIN Lina. Effects of sevoflurane on pulmonary inflammatory responses after cardiopulmonary bypass in early stage#br#[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2014, 44(8): 570-.
Abstract：Objective: To observe the effects of sevoflurane inhalation on changing inflammatory mediators in the early stage after cardioversion in patients receiving coronary artery bypass grafting under cardiopulmonary bypass (CPB). And to provide a theoretical basis for the selection and application of general anesthesia drug. Methods: Thirty patients, ASA status II or III, 45 to 75-year- old, undergoing coronary artery bypass grafting under CPB for the first time were included and randomized into two groups: sevoflurane group (group S, n=15) and propofol group (group P, n=15). 0.05 mg/kg midazolam, 1.0μg/kg sufentanil, 0.3 mg/kg etomidate, and 0.15 mg/kg vecuronium were injected into two groups of patients and then the tracheal intubation were inserted. In group S, the sevoflurane was inhaled during the whole operation.including the CPB procedure. While in group P, propofol was administrated by Target Controlled Infusion system instead, and the other were same. Blood samples from both pulmonary artery and vein were collected immediately before CPB (T0), 5 min (T1), 15 min (T2), 30 min (T3) and 1 hour (T4) after cardioversion. The serum levels of human neutrophilelastase (HNE), IL-6 and IL-10 concentrations were measured, and the relative concentration of these mediators in pulmonary vein versus artery, which was expressed as PV/PA ratio, was calculated. Meanwhile, the duration of CPB, aorta blockage and tracheal intubation, the hospitalization in CCU, and use of the vasoactive agents were recorded. Results: No statistically significant differences were revealed in the terms of inflammatory mediators (HNE, IL-6 and IL-10) before CPB between two groups (P>0.05). After recovery of heart beating, two groups of HNE, IL-6 content in PV, PA ratio increased in varying degrees, but in S group at each time point rise extent was lower than that of P group (P<0.01 or P<0.05). IL-10 in the CPB ratio also increased significantly, and S was increased significantly than that in Pgroup, the differences were statistically significant (P<0.01 or P<0.05). As compared to group P, the frequency of using vasoactive agents were less, and the duration of tracheal intubation and hospitalization in CCU were shorter in group S (P<0.05 or P<0.01). Conclusion: The sevoflurane inhalation, possibly by attenuating inflammatory response, can effectively reduce lung injury in the early stage after coronary artery bypass grafting under CPB and shorten the hospitalization in CCU. In addition, more conducive to the stable hemodynamics during CPB
