Effect of sevoflurane preconditioning on serum GDF-15,TNF-α,cTnI expression during perioperative pe-riod in patients in congenital heart diseases combined with pulmonary artery hypertension / 实用医学杂志

ABSTRACT

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.