Comparison of the Effect between 6% HES130/0.4 and succinylated gelatin on S100 β levels and inflammatory cell factors in open cardiac surgery under CPB

Objective:To observe the effect of 6% hydroxyethyl starch 130/0.(4HES130/0.4)on S100 β levels and inflammatory cell factors TNF-α, IL-6 and IL-10 in open cardiac surgery under cardiopulmo-nary bypas(CPB). To evaluate the protective effect of 6% HES130/0.4 as volume replacement on cerebral injury during CPB and explore the probable mechanism. Methods: Forty ASAⅡ～Ⅲ patients scheduled for elective surgical repair of atrioseptal defect (ASD) or ventricular septal defect (VSD) under CPB with moderate hypothermia were randomly divided into two groups of twenty patients per each group, namely HES130/0.4 group and Succinylated Gelatin (or gelofusine) group. Premedication consisted of intramus-cular pethidine 1mg·kg-1 and scopola-mine 6 μg·kg-1.There are no obvious difference in the methods of anesthesia and CPB between two groups. When CPB began, moderate hypothermia was carried and while the primary operation procedures were completed rewarming began. ECG, HR, BP, MAP, CVP, SpO2, PetCO2 and body temperature (naso-pharyngeal and rectal) were continuously monitored during operation. Ten ml blood samples were obtained from central vein for determination of blood concentrations of S100B protein, tumor necrosis factor-alpha(TNF-α), interleukin-6(IL-6) and interleukin-10(IL-10) on the following time points: before CPB(T0), 20 minutes after CPB (T1), immediately after termination of CPB (T2), 60 minutes after termination of CPB (T3) and 24 hours after termination of CPB (T4). The serum S100B protein levels and those cell factor were measured with ELISA. Results: The demographic data, including age and body weight, duration of CPB (ranged from 25 min to 50 min), total colloid infusion volume, duration of surgery were compared between the two groups. Compared with the time point of immediately before CPB (T0), S100B protein in two groups, all began to increase with CPB beginning (T1), reached climax at CPB termination point (T2), decreased gradually after termination of CPB (T3), and could not restore to the level before CPB at T4( 24 hours after termination of CPB). However, at time point of T1、T2 and T3 S100B, TNF-α andIL-6 in group HES130/0.4 were significantly lower than those in group gelofusine (P0.05 or P0.01), while IL-10 was just on the opposite side. Conclusion: 6% HES130/0.4 can lower the S100B levels from CPB starting to one hour after termination of CPB by reducing the inflammatory response. Volume replacement with HES 130/0.4 may play a protective role on cerebral injury by modulating the balance between the proinflammatory factor and inhibit-inflammatory factor during CPB and open cardiac surgery.