Objective To observe the effect of sevoflurane preconditioning on serum cTnI and the nuclear factor ery-throid 2-related factor 2( Nrf2) expression in peripheral blood mononuclear cells ( PBMCs) of patients undergoing cardiac valve replacement with CPB, and to investigate its influence on the myocardial protection and oxidative stress of body. Methods In this randomized controlled trial, thirty patients who received valve replacement were randomly divided into two groups (n=15): the control group (group C) and sevoflurane preconditioning group (group S).In the group S, 1.0%sevoflurane was inhaled for 20 min from skin incision, and followed with oxygen elution for 10 min, it repeated twice.The artery blood samples were collected for the measurements of serum concentrations of cTnI, MDA and SOD im-mediately before anesthesia induction ( T1 ) , at 2 h ( T2 ) , 24 h ( T3 ) and 48 h ( T4 ) after aorta declamping respectively. The expression of Nrf2 protein from PBMC was detected by Western blotting at T1 and T3 .Linear correlation between the expression of Nrf2 protein and MDA concentration, SOD activity was analyzed.Results Compared with that before opera-tion, the concentration of serum cTnI was increased significantly in both groups(P<0.05) at T2-4.However, it was much lower in the group S than in the group C(P<0.05).The expression of Nrf2 protein in PBMC was increased significantly in both groups at T3 as compared with that before operation (P<0.05).However, it was much higher in the group S than in the group C (P<0.05).Compared with group C, the serum MDA concentration was decreased, while SOD activity was significantly higher at T2-4 in the group S (P<0.05).There was linear correlation between the expression of Nrf2 protein and MDA concentration, SOD activity (r=-0.694 and 0.739, all P<0.05).Conclusion Sevoflurane preconditioning can alleviate myocardial injury and reduce oxidative stress injury in patients undergoing cardiac valve replacement with CPB, which might be associated with the increased Nrf2 expression.%目的 观察七氟醚预处理对心肺转流术( CPB)下心脏瓣膜置换术患者血清中cTnI和外周血单核细胞( PBMC)核蛋白Nrf2表达的影响,探讨其对心肌的保护作用和机体氧化应激的影响.方法 选择择期CPB下行心脏瓣膜置换术患者30例,随机分为未吸入七氟醚对照组( C组)和七氟醚预处理组( S组) ,每组15例. S组切皮至主动脉阻断前吸入1.0%七氟醚20 min,随后予以10 min洗脱期,如此重复2次. 于麻醉诱导前( T1 )、主动脉开放后2 h( T2 )、24 h( T3 )和48 h( T4 )采集动脉血,检测血清cTnI水平、MDA水平和SOD活性;于T1 和T3 用Western blotting检测外周血PBMC核蛋白Nrf2表达水平;MDA水平、SOD活性与Nrf2蛋白表达水平进行直线相关性分析.结果 与术前比较,T2~4时两组血清中cTnI浓度均明显升高(P均<0.05),但S组明显低于C组(P均<0.05).与术前比较,T3 时两组PBMC核蛋白Nrf2表达均显著升高(P均<0.05),但S组明显高于C组(P均<0.05). 与C组比较,T2~4时血清MDA水平降低,SOD活性升高( P<0.05). MDA水平、SOD活性均与Nrf2蛋白表达具有相关性(r分别为-0.694、0.739,P均<0.05). 结论 七氟醚预处理可以减轻CPB下心脏瓣膜置换术患者心肌损伤,减弱体内氧化应激反应,以上作用可能与增强Nrf2蛋白的表达有关.
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