Abstract:

Objective    To compare the effects of morphine and fentanyl on systemic inflammatory reaction and myocardial function in patients undergoing cardiovalve replacement under cardiopulmonary bypass(CPB).  Methods    Thirty patients (ASAⅡ-Ⅲ) undergoing cardio-valve replacement surgery under CPB were randomly divided into two groups (n=15). Anesthesia was induced with intravenous injection of midazolam, morphine (group M) or fentanyl (group F) and subsequently pipecuronium, and was maintained with interval injection of morphine (group M) or fentanyl (group F) and pipecuronium. Serum SOD, MDA, TNF-α, IL-6, IL-8, IL-10, CK-MB and cTnI was detected before anesthesia (T0), before skin incision (T1), before aortic-clamping (T2), 2h(T3) and 6h (T4) after CPB and 24hafter surgery (T5). Results    Serum levels of SOD activity, MDA, TNF-α, IL-6, IL-8, IL-10,  CK-MB activity andcTnI increased at different time points of post-CPB (P<0.05-0.01), and the extent, except for serum SOD activity, in group M was lower than that in group F (P<0.05). There were no differences in cardiac recovery and usage of cardiovascular activators between the two groups. Conclusion    The findings of the present study demonstrate that morphine can inhibit the release of oxygen free radicals and the inflammatory response, and protect the myocardium more than fentanyl in patients undergoing cardiovalve replacement under CPB.

Key words: Morphine; Fentanyl; Oxide free radicals; Inflammatory response; Myocardial protection