Department of Anesthesiology and Pain Medicine, Incheon St Mary's Hospital, Catholic University of Korea, Medical College, Incheon, Korea.
J Cardiothorac Vasc Anesth. 2009 Oct;23(5):639-45. doi: 10.1053/j.jvca.2009.01.025. Epub 2009 Apr 10.
During reperfusion after cardiopulmonary bypass, leukocytes are retained in the lungs. The purpose of this study was to examine the effect of sevoflurane on the inflammatory responses of the lungs after cardiopulmonary bypass.
A prospective, randomized clinical investigation.
A university hospital.
Thirty patients undergoing valve replacement surgery using cardiopulmonary bypass.
Fifteen patients in whom anesthesia was maintained with sevoflurane and the priming solution was saturated with sevoflurane were randomly assigned to the sevoflurane group. Similarly, 15 patients in whom anesthesia was maintained with sufentanil and the priming solution was mixed with sufentanil were randomly assigned to the sufentanil group
After induction, an arterial blood sample was obtained for the baseline leukocyte count. Blood was collected from the pulmonary artery (PA) and vein (PV) before cardiopulmonary bypass and 10 minutes after the restoration of heart beats. The leukocyte count, levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-alpha were measured. The PV/PA ratio of each parameter was determined for the assessment of inflammatory response of the lung. The leukocyte counts and plasma levels of cytokines increased more in the sufentanil group than the sevoflurane group. The PV/PA ratio of neutrophils decreased after the restoration of heart beats in the sufentanil group but was unchanged in the sevoflurane group. The PV/PA ratio of IL-6 was higher in the sufentanil group. The PV/PA ratio of interleukin-8 and interleukin-10 increased after the restoration of the pulmonary circulation in the sufentanil group but decreased in the sevoflurane group. The PV/PA ratio of tumor necrosis factor alpha increased in the sufentanil group but remained unchanged in the sevoflurane group.
Sevoflurane attenuates the pulmonary sequestration of neutrophil and leukocytes and also preserves the pulmonary consumption of cytokines at the time of early pulmonary reperfusion. Sevoflurane attenuates the systemic inflammatory response induced by cardiopulmonary bypass.
体外循环复灌时白细胞在肺部滞留。本研究旨在观察七氟醚对体外循环后肺炎症反应的影响。
前瞻性、随机临床研究。
一所大学医院。
30 例行体外循环瓣膜置换术的患者。
15 例麻醉维持用七氟醚，预充液用七氟醚饱和的患者被随机分配到七氟醚组；同样，15 例麻醉维持用舒芬太尼，预充液混合舒芬太尼的患者被随机分配到舒芬太尼组。
诱导后，采集动脉血进行白细胞计数的基线值。体外循环前和心脏复跳后 10 分钟分别从肺动脉（PA）和静脉（PV）采血。测量白细胞计数、白细胞介素-6、白细胞介素-8、白细胞介素-10 和肿瘤坏死因子-α水平。每个参数的 PV/PA 比值用于评估肺炎症反应。舒芬太尼组白细胞计数和细胞因子的血浆水平升高较七氟醚组更明显。心脏复跳后舒芬太尼组 PV/PA 比值的中性粒细胞下降，但七氟醚组无变化。舒芬太尼组 IL-6 的 PV/PA 比值较高。舒芬太尼组肺循环恢复后白细胞介素-8 和白细胞介素-10 的 PV/PA 比值增加，但七氟醚组下降。舒芬太尼组肿瘤坏死因子-α的 PV/PA 比值增加，但七氟醚组不变。
七氟醚可减轻中性粒细胞和白细胞在肺部的隔离，同时在肺复灌早期也能保持细胞因子的肺摄取。七氟醚可减轻体外循环引起的全身炎症反应。
