Department of Anaesthesiology and Critical Care Medicine, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Department of Anaesthesiology and Critical Care Medicine, hôpital Pitié-Salpêtrière, Sorbonne University, UPMC université Paris 06, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Anaesth Crit Care Pain Med. 2018 Dec;37(6):565-570. doi: 10.1016/j.accpm.2018.02.013. Epub 2018 Feb 21.
Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response and an endothelial dysfunction, whose qualitative assessment appears to be a major issue. Endocan (ESM-1, endothelial cell specific molecule-1) is a protein preferentially expressed by the endothelium and previously associated with prognosis of septic shock or acute respiratory distress syndrome. In this pilot study, we investigated the kinetic of Endocan in planned coronary artery bypass grafting (CABG) surgery with CPB.
We conducted an observational, prospective, mono centre study. All adult patients with left systolic ejection fraction>50%, undergoing planned on-pump CABG, were screened for inclusion. A written informed consent was obtained. Measurements and main results Serum Endocan concentrations were respectively 2.4 [2.1-3.0] ng. mL, 10.4 [7.4-13.9] ng.mL, 5.7 [4.4-8.2] ng.mL, and 5.4 [4.1-7.5] ng.mL at day 0, day 1, day 3 and day 5. Endocan concentrations increased at day 1, day 3, and day 5 in comparison with preoperative concentration (P<0.001). In the multivariate analysis, age (P=0.002), history of acute coronary syndrome (P=0.024) and the catecholamine-free days at day 28 (P=0.007) were associated to the increase of perioperative Endocan concentrations.
Serum Endocan concentration increases after CABG surgery with CPB until day 1. The norepinephrine support increases the risk of Endocan release, suggesting a relationship between the kinetic of Endocan and the vasoplegic syndrome. At day 3, Endocan concentration decreases slowly but is not normalised at day 5. Further studies should investigate the prognostic value of the magnitude of postoperative Endocan concentration after cardiac surgery.
体外循环（CPB）与全身炎症反应和内皮功能障碍有关，其定性评估似乎是一个主要问题。内皮细胞特异性分子-1（ESM-1，内皮细胞特异性分子-1）是一种优先由内皮细胞表达的蛋白质，先前与脓毒症休克或急性呼吸窘迫综合征的预后相关。在这项初步研究中，我们研究了 CPB 计划冠状动脉旁路移植术（CABG）中内参的动力学。
我们进行了一项观察性、前瞻性、单中心研究。所有左收缩射血分数>50%、计划行体外循环 CABG 的成年患者均进行了纳入筛选。获得书面知情同意。测量和主要结果血清内参浓度分别为 2.4[2.1-3.0]ng.ml、10.4[7.4-13.9]ng.ml、5.7[4.4-8.2]ng.ml 和 5.4[4.1-7.5]ng.ml 于第 0 天、第 1 天、第 3 天和第 5 天。与术前浓度相比，第 1 天、第 3 天和第 5 天内参浓度升高（P<0.001）。多变量分析显示，年龄（P=0.002）、急性冠状动脉综合征史（P=0.024）和第 28 天去甲肾上腺素无支持天数（P=0.007）与围手术期内参浓度升高相关。
CPB 后 CABG 手术血清内参浓度升高至第 1 天。去甲肾上腺素支持增加了内参释放的风险，提示内参动力学与血管扩张性综合征之间存在关系。第 3 天，内参浓度缓慢下降，但第 5 天未恢复正常。进一步的研究应探讨心脏手术后术后内参浓度的幅度对预后的价值。
