Martin Jonathan V, Liberati David M, Diebel Lawrence N
Michael and Marian Ilitch Department of Surgery, Wayne State University, Detroit, MI, USA.
Am J Surg. 2017 Dec;214(6):1166-1172. doi: 10.1016/j.amjsurg.2017.09.018. Epub 2017 Sep 22.
Geriatric trauma patients have high circulating norepinephrine (NE) levels but attenuated release of epinephrine (Epi) in response to increasing severity of injury. We hypothesized that NE and Epi have different effects on the endothelial and glycocalyx components of the vascular barrier following shock.
Human umbilical vein endothelial cells (HUVEC) were treated with varying concentrations of NE or Epi and exposed to simulated shock conditions (HR). Relevant biomarkers were sampled to index glycocalyx injury and endothelial cell activation.
NE was associated with significantly greater glycocalyx damage and endothelial activation/injury vs. Epi treatment groups. There were minimal changes in PAI-1 with either NE or Epi ± H/R. However NE ± H/R was associated with significantly higher tPA levels.
NE favors a profibrinolytic state. Our study supports investigating liberal use of the anti-fibrinolytic agent tranexamic acid in the severely injured geriatric trauma patient.
老年创伤患者循环去甲肾上腺素（NE）水平较高，但随着损伤严重程度的增加，肾上腺素（Epi）的释放减弱。我们假设，休克后NE和Epi对血管屏障的内皮和糖萼成分有不同影响。
用人脐静脉内皮细胞（HUVEC）处理不同浓度的NE或Epi，并使其暴露于模拟休克条件（HR）下。采集相关生物标志物以指示糖萼损伤和内皮细胞活化情况。
与Epi治疗组相比，NE导致更严重的糖萼损伤和内皮细胞活化/损伤。无论NE还是Epi±H/R，纤溶酶原激活物抑制剂-1（PAI-1）变化均极小。然而，NE±H/R与显著更高的组织型纤溶酶原激活物（tPA）水平相关。
NE有利于促纤溶状态。我们的研究支持对严重受伤的老年创伤患者大量使用抗纤溶药物氨甲环酸进行研究。
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