Effect of sevoflurane on plasma levels of endothelin-1 and nitric oxide and pulmonary function in patients undergoing cardiac valve replacement with cardiopulmonary bypass

doi:10.3877/cma.j.issn.1674-0785.2017.18.001

Abstract

Abstract:

Objective

To evaluate the effect of sevoflurane inhalation in the early stage of ischemia and reperfusion on pulmonary function and plasma levels of endothelin-1 (ET-1) and nitric oxide (NO) in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).

Methods

Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into two groups (n=20 each): control group (group C) and sevoflurane group (group S). All patients were treated with total intravenous anesthesia. In group S, 2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked, and before and after the ascending aorta was opened. Sevoflurane inhalation was not given in group C. The time points used were after anesthesia and before skin incision (T₀), immediately before CPB (T₁), immediately after CPB (T₂), 2 h after CPB (T₃), 6 h after CPB (T₄), and 24 h after CPB (T₅). At T₀, T₂, T₃, and T₅, radial artery blood was obtained to detect plasma levels of ET-1 and NO. At T₁ and T₂, pulmonary artery and pulmonary vein blood was obtained to detect neutrophil count and SP-A to calculate the difference between the vein and artery. At T₀, T₂, T₃, T₄, and T₅, arterial blood gas was measured to calculate P_(A-a)O₂, OI, and Cst.

Results

Plasma levels of ET-1 (pg/mL) were significantly higher at T₂ (6.6±1.8), T₃ (5.9±1.4), and T₅ (4.3±1.2) than at T₀ (2.2±1.5) in group S (P<0.05), and at T₂ (7.9±0.7), T₃ (7.1±1.3), and T₅ (5.8±0.9) than at T₀ (2.3±1.1) in group C (P<0.05); compared with group C, e plasma ET-1 levels were significantly decreased in group S at T₂, T₃, and T₅ (P<0.05). Plasma levels of NO (nmol/mL) were significantly higher at T₂ (8.6±1.8), T₃ (8.2±1.4), and T₅ (6.9±1.7) than at T₀ (5.9±1.2) in group S (P<0.05), and at T₂ (7.3±1.1), T₃ (7.0±1.1), and T₅ (6.1±1.4) than at T₀ (5.1±0.8) in group C (P<0.05); compared with group C, plasma NO levels were significantly higher in group S at T₂, T₃, and T₅ (P<0.05). The neutrophil count in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly higher at T₂ than at T₀ in both groups (P<0.05); compared with group C, the neutrophil count in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly decreased in group S at T₂ (P<0.05). SP-A levels in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly higher at T₂ than at T₀ in both groups (P<0.05); compared with group C, SP-A levels in blood samples from the pulmonary artery and pulmonary vein and the difference between the vein and artery were significantly decreased in group S at T₂ (P<0.05). P_(A-a)O₂ was significantly higher at T₂, T₃, T₄, and T₅ than at T₀ in both groups (P<0.05). OI was significantly lower at T₂, T₃, T₄, and T₅ than at T₀ in both groups (P<0.05). Cst was significantly decreased at T₂, T₃, and T₄ than at T₀ in both groups (P<0.05). Compared with group C, P_(A-a)O₂ was significantly decreased in group S at T₂, T₃, and T₄ (P<0.05), and OI and Cst were significantly higher in group S at T₂, T₃, and T₄ (P<0.05).

Conclusion

Pulmonary injury and ET-1/NO disorder may occur during cardiac valve replacement with CPB, which can be improved by sevoflurane inhalation in the early stage of ischemia and reperfusion.

Key words: Sevoflurane, Endothelin-1, Nitric oxide, Cardiopulmonary bypass

Jieping Lyu, Shouyuan Tian, Lixia Nie, Qian Hao, Li Zhou. Effect of sevoflurane on plasma levels of endothelin-1 and nitric oxide and pulmonary function in patients undergoing cardiac valve replacement with cardiopulmonary bypass[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(18): 2211-2216.

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References 19

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组别	例数	年龄（岁）	体重（kg）	CPB时间（min）	主动脉阻断时间（min）
S组	20	50±8.1	66.5±7.2	112±28.1	80.5±19.5
C组	20	48±6.8	69.3±8.1	115±30.6	82.8±21.6

组别	例数	年龄（岁）	体重（kg）	CPB时间（min）	主动脉阻断时间（min）
S组	20	50±8.1	66.5±7.2	112±28.1	80.5±19.5
C组	20	48±6.8	69.3±8.1	115±30.6	82.8±21.6

项目	组别	T₀	T₂	T₃	T₅
ET-1（pg/ml）	S组	2.2±1.5	6.6±1.8^ab	5.9±1.4^ab	4.3±1.2^ab
?	C组	2.3±1.1	7.9±0.7^a	7.1±1.3^a	5.8±0.9^a
NO（nmol/ml）	S组	5.9±1.2	8.6±1.8^ab	8.2±1.4^ab	6.9±1.7^ab
?	C组	5.1±0.8	7.3±1.1^a	7.0±1.1^a	6.1±1.4^a

项目	组别	T₀	T₂	T₃	T₅
ET-1（pg/ml）	S组	2.2±1.5	6.6±1.8^ab	5.9±1.4^ab	4.3±1.2^ab
?	C组	2.3±1.1	7.9±0.7^a	7.1±1.3^a	5.8±0.9^a
NO（nmol/ml）	S组	5.9±1.2	8.6±1.8^ab	8.2±1.4^ab	6.9±1.7^ab
?	C组	5.1±0.8	7.3±1.1^a	7.0±1.1^a	6.1±1.4^a

项目	T₁		T₂
项目	S组	C组	S组	C组
中性粒细胞V（×10⁹/L）	3.1±1.0	3.2±0.8	8.9±4.5^ab	11.4±5.3^a
中性粒细胞A（×10⁹/L）	3.0±0.9	3.1±0.9	8.6±5.2^ab	10.2±6.1^a
中性粒细胞V-A（×10⁹/L）	0.1±0.2	0.1±0.2	0.3±2.4^ab	1.2±3.2^a
SP-AV（pg/ml）	79.68±21.1	83.12±23.2	185.36±35.3^ab	250.56±42.1^a
SP-AA（pg/ml）	79.20±20.5	82.59±23.9	178.24±37.2^ab	225.78±53.2^a
SP-AV-A（pg/ml）	0.48±9.1	0.53±11.8	8.12±15.5^ab	24.78±20.3^a

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