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To investigate the effects of propofol and dexmedetomidine combined anesthesia on cerebral oxygen metabolism indexes, oxidative stress and cell pyroptosis factors in patients undergoing cardiac valve replacement (HVR) under cardiopulmonary bypass. 136 patients who underwent HVR under cardiopulmonary bypass in our hospital from March 2021 to December 2022 were selected. Patients were divided into control group (propofol anesthesia) and study group (dexmedetomidine combined with propofol anesthesia) according to the random number table method, with 68 cases in each group. The hemodynamics, oxidative stress index, myocardial injury index, cerebral oxygen metabolism index, cell pyroptosis factors and incidence of adverse reactions were compared between two groups. Time point after open aorta (T1) to after operation(T3), the heart rate (HR) and mean arterial pressure (MAP) in study group were higher than those in control group (P<0.05). 24 h after operation, the superoxide dismutase (SOD) in study group was higher than that in control group, and the malondialdehyde (MDA) was lower than that in control group (P<0.05). 24 h after operation, creatine kinase isoenzyme (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) in study group were lower than those in control group (P<0.05). 24 h after operation, the levels of NOD-like receptor protein 3 (NLRP3), cyptate protease 1 (Caspase-1), megaphin D (GSDMD) in study group were lower than those in control group (P<0.05). T1~T3 time points, the arterial-jugular venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction rate (CERO2) in study group were higher than those in control group, and the jugular venous oxygen saturation (SjvO2) was lower than that in control group (P<0.05). There was no difference in the incidence of adverse reactions between two groups (P>0.05). Dexmedetomidine combined with propofol can reduce oxidative stress, inflammatory response and myocardial injury in patients with HVR under cardiopulmonary bypass, and improve brain function. [ABSTRACT FROM AUTHOR]