Wu Xinhui, Hu Zhenjie, Yuan Hufang, Chen Lei, Li Yong, Zhao Congcong
Departments of ICU, the Fourth Hospital of Hebei Medical University, ShijiazhuangHebei, China.
Departments of Gastrointestinal Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang050011, Hebei, China.
Open Med (Wars). 2017 Dec 22;12:409-416. doi: 10.1515/med-2017-0059. eCollection 2017.
The aim of this study was to determine the relationship between fluid resuscitation and glycocalyx degradation in severe sepsis.
15 post-thoracotomy patients with severe sepsis and 11 patients in recovery after open chest surgery (controls) were enrolled.
Plasma syndecan-1 concentrations were significantly higher in the sepsis group than that in control group, and were correlated with fluid balance in the sepsis group (P=0.026). Survival was not related to trends in plasma syndecan-1 concentrations (ascending/descending) in the sepsis group (P = 0.409). Fluid balance at 24 h was significantly higher in sepsis patients who died than in those who survived (P = 0.010). Acute Physiology and Chronic Health Evaluation II scores, Sequential Organ Failure Assessment scores, duration of mechanical ventilation, and length of intensive care unit stay did not differ with the trend of plasma syndecan-1 concentrations. Compared with plasma syndecan-1 concentrations, lactate clearance at a cutoff of 0.40% had a higher diagnostic value.
In patients with severe sepsis, the glycocalyx plays an important role in liquid distribution in different phases. With time, it changes as well. At present, lactate clearance has greater diagnostic value than plasma syndecan-1 concentrations in severe sepsis. A better indicator of endothelial glycocalyx is therefore required.
本研究旨在确定严重脓毒症中液体复苏与糖萼降解之间的关系。
纳入15例开胸术后严重脓毒症患者和11例开胸手术后恢复中的患者（对照组）。
脓毒症组血浆syndecan-1浓度显著高于对照组，且与脓毒症组的液体平衡相关（P = 0.026）。脓毒症组的生存率与血浆syndecan-1浓度的变化趋势（上升/下降）无关（P = 0.409）。死亡的脓毒症患者24小时时的液体平衡显著高于存活患者（P = 0.010）。急性生理与慢性健康状况评分系统II评分、序贯器官衰竭评估评分、机械通气时间和重症监护病房住院时间与血浆syndecan-1浓度的变化趋势无关。与血浆syndecan-1浓度相比，乳酸清除率截断值为0.40%时具有更高的诊断价值。
在严重脓毒症患者中，糖萼在不同阶段的液体分布中起重要作用。随着时间推移，它也会发生变化。目前，在严重脓毒症中，乳酸清除率比血浆syndecan-1浓度具有更大的诊断价值。因此，需要一个更好的内皮糖萼指标。
