Objective To evaluate the effect of sevoflurane preconditioning on the left ventricular function in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods Thirty ASA physical status Ⅱ or Ⅲ patients,aged 42-70 yr,with body height 152-181 cm,weighing 43-78 kg,scheduled for elective CABG under CPB,were randomly divided into 2 groups (n =15 each) using a random number table:control group (group C) and sevoflurane preconditioning group (group SP).Group SP inhaled sevoflurane with the end-tidal concentration corresponding to 1 MAC for 30 min after endotracheal intubation.Before sevoflurane preconditioning (T0) and at 60 min after termination of CPB (T1),mean arterial pressure (MAP),stroke volume index (SVI),pulmonary artery obstruction pressure and the TEE variables including left ventricular ejection fraction (LVEF),peak E wave velocity (E),systolic wave velocity (S),and diastolic wave velocity (D),and low propagation velocity (Vp) were recorded.S/D ratio and E/Vp ratio were calculated.Extubation time and duration of ICU stay were also recorded.Results Compared with the baseline value at T0,HR was significantly increased at T1 (P ＜ 0.05 or 0.01),and no significant change was found in the other parameters of the left ventricle function in the two groups (P ＞ 0.05).There was no significant difference in the parameters of the left ventricle function,extubation time and duration of ICU stay between SP group and C group (P ＞ 0.05).Conclusion Preconditioning with inhalation of sevoflurane with the end-tidal concentration corresponding to 1 MAC before CPB does not produce myocardial protection in terms of the left ventricular function or exerts little effect on the short-term outcomes.

Objective To analyze the sensitivity and specificity of several volume parameters regarding volume responsiveness.The studied volume parameters include pulmonary artery obstruc-tion pressure (PAOP),central venous pressure (CVP),right ventricular end-diastolic volume (RV-EDV)measured by Swan-Ganz pulmonary artery catheter and left ventricular end-diastolic area (LVEDA),inferior vena cava diameter (IVC)measured by transesophageal echocardiography (TEE). Methods Twelve patients with ASA Ⅱ or Ⅲ,scheduled for coronary artery bypass grafting were studied.After anesthesia induction,the TEE probe was put into the esophagus and Swan-Ganz cathe-ter was placed in right internal jugular venous.Measurements were made at the time before cutting the skin (T0 ),20 min after divorcing from cardiopulmonary bypass or finishing vascular anastomosis in off-pump surgery(T1 ),10 min after rapid infusion (T2 )and 30 min after rapid infusion (T3 ),re-spectively.Results The values of PAOP,IVC,LVEDA,COLVOT at time T2 increased significantly compared to those at time T1 (P <0.01).No obvious correlation (r=-0.298 5、r=-0.091 8、r=-0.243 6)was observed between △CVP、△PAOP、△RVEDV and △COLVOT (the difference between T2 and T1 );Meanwhile,△IVC and △LVEDA were well correlated to △COLVOT (r= 0.445 0、r=0.612 0).Using more than 1 5% change of COLVOT after volume expansion as definition of positive re-sponse,the areas under the receiver operating characteristic curves of CVP,PAOP,RVEDV,IVC and LVEDA were 0.389 (95% CI 0.035-0.743 ),0.458 (95% CI 0.109-0.807 ),0.333 (95% CI 0-0.671 ), 0.903 (95% CI 0.701-1.000 ) and 0.889 (95% CI 0.661-1.000 ), respectively. Conclusion PAOP,IVC,LVEDA,CO are more sensitive to the change of volume;while CVP and RVEDV have weak responses to volume changes.This indicates that IVC and RVEDA have more ad-vantage to estimate cardiac output increase and guide volume therapy.

Objective To evaluate the changes in the right ventricular systolic and diastolic function during the early period after cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG).Methods Eighteen ASA physical status Ⅱ or Ⅲ patients of both sexes,with coronary heart disease (NYHA Ⅱ or Ⅲ),aged 50-80 yr,weighing 51-96 kg,with left ventricular ejection fraction≥50％,scheduled for elective CABG under CPB,were enrolled in this study.Before splitting of sternum and at 5 min after termination of CPB,the parameters of hemodynamics,cardiac output (CO)and variables of right ventricular function (using transesophageal echocardiography) including tricuspid annular plane systolic excursion (TAPSE),right ventricular fractional area change (RVFAC),tricuspid annular peak velocity during isovolumic contraction (IVV),peak velocity during ejection phases (St),early diastolic peak velocity (Et),late diastolic peak velocity (At),E/Et ratio and Et/At ratio were recorded.Results Compared with the baseline value before splitting of sternum,TAPSE,IVV,St,RVFAC,CO,E,Et and At were significantly increased,and no significant change was found in the parameters of hemodynamics and E/Et and Et/At ratios at 5 min after termination of CPB.Conclusion For the patients undergoing CABG,the right ventricular systolic function is significantly enhanced,and there is no obvious improvement in the right ventricular diastolic function during the early period after CPB.

Objective To evaluate the effect of sevoflurane-based anesthesia on the interventricular synchronization in the patients undergoing coronary artery bypass grafting (CABG) with cardiopuhnonary bypass (CPB).Methods Twenty-four Amnerican Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 52-75 yr,with body mass index of 17-31 kg/m2,with body surface area of 1.7-2.2 m2,of New York Heart Association Ⅱ or Ⅲll,with left ventricular ejection fraction (LVEF) ≥45％,scheduled for elective CABG with CPB,were divided into 2 groups (n=12 each) using a random number table:propofol combined with remifentanil anesthesia group (group C) and sevoflurane combined with propofol and remifentanil anesthesia group (group S).After induction of general anesthesia,the patients were en-dotracheally intubated and mechanically ventilated.Anesthesia was maintained by Ⅳ infusion of propofol,remifentanil and cisatracurium,and the cerebral state index value was maintained at 40-60.In group S,the patients inhaled sevoflurane (the end-tidal concentration was 1.80％ for 50-59 yr and 1.60％ for 60-75 yr) for 60 min starting from 15 min after termination of CPB.After induction of anesthesia and before splitting of sternum,immediately before inhaling sevoflurane and at 30 and 60 min of sevoflurane inhalation,heart rate,cardiac index,LVEF,right ventricular eject fraction,QRS width and interventricular mechanical delay were recorded,and the occurrence of interventricular dyssynchrony was recorded.Results There were no significant differences between group C and group S in the heart rate,cardiac index,LVEF,right ventricular eject fraction,QRS width,interventricular mechanical delay or incidence of interventricular dyssynchrony (P＞0.05).Conclusion Sevoflurane-based anesthesia exerts no marked effect on interventricular synchronization in the patients undergoing CABG with CPB.

Objective To evaluate the effects of sevoflurane on right ventricular systolic function after cardiopulmonary bypass in patients undergoing coronary artery bypass grafting(CABG). Methods Eighteen patients with coronary heart disease,13 males,5 females,ASA Ⅱ or Ⅲ,aged 50-80 years,measuring 1 50-182 cm in height,weighing 5 1-96 kg,scheduled for CABG under CPB were enrolled in this study.Anesthesia was maintained with intravenous anesthesia, and 1 MAC sevoflurane inhalation lasted for 60 min after CPB.Hemodynamic indicators such as HR,MAP, CVP,cardiac output (CO),Systemic vascular resistance (SVR)and right ventricular parameters in-cluding tricuspid annular plane systolic excursion (TAPSE)and velocity (TAPSV)were recorded be-fore sternotomy (T2 ),30 min after CPB (T3 ),60 min after CPB (T4 ).Results Compared with T1 , CO was increased at T2 (P <0.05);compared with T2 ,CO was decreased at T3 and T4 (P <0.05 or P <0.01),with a statistical significance;compared with T1 ,TAPSE and TAPSV were increased at T2 (P <0.05 or P <0.01);compared with T2 ,TAPSE and TAPSV were decreased at T3 and T4 (P<0.05);with a statistical significance in TAPSE and TAPSV.Conclusion For the patients undergo-ing CABG under CPB,1 MAC sevoflurane inhalation after CPB can reduce right ventricular systolic function,which,however,is within the normal ranges.

Objective To investigate the effect of nicardipine on the hepatic blood flow in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Twenty-six patients of both sexes,aged 30-64 yr,weighing 50-90 kg,with New York Heart Association Ⅱ or Ⅲ,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective mitral or aortic valve replacement,were randomly divided into either nicardipine group (group P,n =13) or control group (group C,n =13) using a random number table.Transesophageal echocardiography was used to measure the indexes of blood flow in the hepatic vein.Nicardipine 0.2-0.5 μg · kg-1 · min-1 was infused intravenously starting from beginning of CPB,and the infusion was stopped at termination of CPB in group P.After induction of general anesthesia,at 30 min after beginning of CPB,at 10 min before termination of CPB,and at 30 min after termination of CPB,the diameter of the right and middle hepatic veins (DR and DM),blood flow index in the right hepatic vein (QIR),blood flow index in the middle hepatic vein (QIM),and total blood flow index in the hepatic vein (QIR+M) were recorded,and the percentage of QIR+M in cardiac index (CI) (QIR+M/CI) or in QICPB (QIR+M/QICPB) was calculated.Before operation,and at 1 and 2 days after operation,blood samples were obtained from the median cubital vein for determination of total bilirubin,alanine aminotransferase,and aspartate aminotransferase (AST) levels in serum.Results Compared with group C,the serum levels of AST at 1 day after operation and serum levels of AST at 1 day after operation were significantly decreased (P＜0.05),and no significant change was found in DR,DM,QIR,QIM,QIR+M,QIR+M/CI and QIR+M/QICPB at each time point in group P (P＞0.05).Conclusion Nicardipine (0.2-0.5 μg · kg-1 · min-1) infused intravenously during CPB exerts no effect on the hepatic blood flow,and it is not related to the improvement in hepatic function in the patients undergoing cardiac valve replacement.

Objective To explore the association between urinary microalbumin-to-creatinine ratio (ACR) and brachial-ankle pulse wave velocity (baPWV) in hypertensive patients.Methods A total of 877 primary hypertension patients were enrolled in this trial from September 2009 to December 2012,and were randomly recruited and patients were divided into normal ACR group (ACR ＜ 30 mg/g,n =723),microalbuminuria group (30 mg/g ≤ ACR ＜ 300 mg/g,n =136) and macro-albuminuria group (ACR ≥300 mg/g,n =18).baPWV was measure by automatic pulse wave velocity measuring system.Results The baPWV values in patients of micro-albuminuria group and macro-albuminuria group were significantly higher than in the normal ACR group (all P ＜ 0.05).The baPWV value of macro-albuminuria group was significantly higher than in the micro-albuminuria group (P ＜ 0.05).Linear correlation analysis revealed that ACR was positively correlated with baPWV (r =0.413,P ＜ 0.01).Multiple linear regression analysis showed that ACR independently correlated with baPWV in patients with primary hypertension (β =0.29,R2 =0.112,P ＜ 0.01) after adjusting for age,sex,body mass index,systolic blood pressure,diastolic blood pressure,blood glucose,total cholesterol,low density lipoprotein,high density lipoprotein and triglyceride.Using ACR ＜ 30 mg/g and ACR ≥ 30 mg/g as dichotomous variable,binary logistic regression analysis showed that ACR≥30 mg/g was also a risk factor of the ascending baPWV in primary hypertension patients (OR:1.73,95％ CI:1.62-2.98) after adjusting the traditional cardiovascular risk factors.Conclusion ACR is positively correlated to baPWV in primary hypertension patients,and the ascending baPWV is a risk factor of early renal dysfunction in primary hypertension patients.

Objective:To evaluate the effect of inhalation of sevoflurane during cardiopulmonary bypass (CPB) on early postoperative brain injury in the patients undergoing cardiac valve replacement.Methods:Forty-two American Society of Anesthesiaologists physical status Ⅱ or Ⅲ patients of either sex, aged 40-70 yr, weighing 47-86 kg, scheduled for elective single valve replacement under CPB, were divided into 3 groups ( n=14 each) using a random number table method: control group (group C), combined intravenous-inhalational anesthesia group (group CA) and sevoflurane group (group S). During CPB, propofol 4-6 mg·kg -1·h -1 was intravenously infused in group C, propofol 2-3 mg·kg -1·h -1 was intravenously infused, and 0.5 MAC sevoflurane was inhaled via the membrane oxygenator in group CA, and 1.0-1.5 MAC sevoflurane was inhaled via the membrane oxygenator in group S. The anesthesia and sedation index values were maintained at 40-60 during operation in the three groups.Blood samples were taken from arteries before anesthesia induction (T 1), at 30 min and 6 and 24 h after termination of CPB (T 2-4) for determination of plasma concentrations of neuron-specific enolase (NSE) and Tau protein. Results:Compared with group C, the plasma concentration of NSE was significantly decreased at T 2, 3, and plasma concentration of Tau protein was decreased at T 2-4 in group S, and the plasma concentration of Tau protein was decreased at T 2 in group CA ( P<0.05). Compared with group CA, the plasma concentration of NSE was significantly decreased at T 2, 3, and the plasma concentration of Tau protein was decreased at T 2-4 in group S ( P<0.05). Conclusions:Inhalation of sevoflurane during CPB can reduce early postoperative brain injury to a certain extent in the patients undergoing cardiac valve replacement.

Objective To determine whether four-and-a-half LIM-only protein 2(FHL2)can affect macrophage foa-ming by regulating nuclear factor kappa-B(NF-κB)signaling pathway.Methods FHL2 over-expression plasmids and siRNA of FHL2 were constructed and transfected into human monocyte/macrophages cell line THP-1.Western blot was used to detect the expression of FHL2.The cells were stimulated with oxidized low density lipoprotein(ox-LDL)and the expression of IL-6,IL-1β,TNF-α and other cytokines were detected by ELISA.Oil red O staining was used to detect the degree of cell foaming.The protein expression of NF-κB signaling pathway was detected by Western blot.Results The expression of FHL2 increased after transfected with FHL2 over-expression plasmids while decreased in si-FLH2 transfected cells.FHL2 down-regulated secretion of inflammatory cytokines.Down-regulation of FHL2 allevi-ated THP-1 macrophage foaming.The down-regulation of FHL2 inhibited activation of NF-κB signaling pathway,while the over-expression FHL2 showed an opposite trend.Conclusions FHL2 down-regulation inhibits the activation of NF-κB signaling pathway,reduces the secretion of inflammatory cytokines and alleviates foaming of macrophages.