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Objective: To observe the cardiopulmonary bypass (CPB) heart surgery under S-100β protein and neuron-specific enolase (NSE) the dynamic changes, and inhalation of different concentrations of sevoflurane pretreatment on their content; explore seven halothane preconditioning cerebral protection. Methods: elective valve replacement surgery under cardiopulmonary bypass 40 patients, male or female, ASA Ⅱ ~ Ⅲ grade, aged 45 to 65 years old. Sevoflurane were randomly divided into control group (C group) and pre-treatment group (S), which by inhalation of sevoflurane preconditioning group from low to high concentration into S 1 (0.5MAC) , S 2 (1.0MAC), S 3 (1.5MAC) three sub-groups of 10 cases. All patients underwent preoperative intramuscular 30min 0.3mg scopolamine and morphine 10mg. Burglary after radial artery puncture under local anesthesia, followed by intravenous sufentanil 0.8μg/kg, etomidate 0.2mg/kg, piperazine rocuronium 0.1mg/kg, lidocaine 0.1mg/kg, midazolam 0.1mg / kg rapid induction of endotracheal intubation. Continuous intravenous infusion of propofol 6 ~ 8mg/kg/h, sufentanil 3 ~ 10μg/kg/h. Intermittent intravenous midazolam and piperazine rocuronium to maintain anesthesia. Continuous monitoring of MAP, HR, SpO 2 , PETCO 2 , CVP, NPT. Mechanical ventilation control PETCO 2 35 ~ 45mmHg. Jin vein puncture and retrograde jugular bulb catheter to the Ministry. Tracheal intubation after the burglary that 0.5,1.0,1.5 MAC sevoflurane inhalation, inhalation time 40 ~ 60min. CPB start stop inhalation; throughout the period until the end of surgery without CPB any gas inhalation anesthetics. Control group throughout the surgery does not any gas inhalation anesthetics. Collected according to the following six point jugular vein: T 1 (CPB ago), T 2 (CPB began 30min), T 3 (CPB end immediately), T 4 (CPB after lh), T 5 (CPB after 6h), T 6 (CPB After 24h). Plasma S-100β and NSE concentration. And preoperative and postoperative 24h, MMSE score, calculate the difference before and after surgery. Statistical analysis SPSS13.0 software package. Measurement data were expressed as mean (X) ± standard deviation (s) that the groups were compared using paired t-test, analysis of variance was used to compare the group. To P lt; 0.05 was considered statistically significant, with P lt; 0.01 was considered statistically significant. Results: The comparison shows four groups MMSE scores were lower than the preoperative postoperative 24h 24h (P lt; 0.05); pretreatment group S 2 and S 3 group after 24h score and the difference is less than C group (P lt; 0.05). Four groups of patients before CPB, S-100β and NSE concentrations were within the normal range (P gt; 0.05). After beginning CPB, S-100β and NSE concentration appeared first and then decreased in the process, the peak occurred at the end of CPB; CPB began 30min, S 2 and S 3 group S-100β and NSE concentrations lower than C group (P lt; 0.05); CPB end immediately, after 1h, 6h, S 2 and S 3 group S-100β and NSE concentrations were lower than in group C (P lt; 0.05); CPB after 24h, S 2 and S 3 concentrations of NSE C group, the difference was statistically significant (P lt; 0.05), S-100β protein concentrations compared with C group difference was significant (P lt; 0.01). Conclusion: 1.S-100β and NSE concentration decreases indicate sevoflurane during cardiopulmonary bypass patients had cerebral protection. 2.MMSE score changes indicate that sevoflurane improve cognitive function in patients recovery. 3 Sevoflurane has neuroprotective effect was concentration-dependent, that is, with increasing concentrations of sevoflurane, cerebral protective effect gradually.
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