短期给予脂肪乳对 ICU 患者内皮糖萼完整性的影响：一项微血管和生化的初步研究。

Department of Anesthesiology and Intensive Care, Faculty of Medicine in Hradec Kralove, Charles University, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.

Centre for Research and Development, University Hospital of Hradec Kralove, Hradec Kralove, Czech Republic.

Clin Hemorheol Microcirc. 2019;73(2):329-339. doi: 10.3233/CH-190564.

BACKGROUND

Endothelial glycocalyx (EG) is a carbohydrate-rich vascular lining of the apical surface of endothelial cells. It has been proved to have an essential role in vascular homeostasis. Lipid emulsions as part of parenteral nutrition (PN) are widely used in patients in the setting of critical care and perioperative medicine. Due to their structure, lipids may potentially interact with EG. The aim of the study was to evaluate the effect of lipid emulsion on EG.

OBJECTIVE

To assess the influence of lipid emulsion on EG integrity in ICU patients using a videomicroscopic and biochemical methods.

METHODS

Patients in surgical ICU after major abdominal surgery or cardio surgery and in general ICU were assessed for eligibility for this pilot observational study in University Hospital. The study was performed during the first day of adding lipids as a part of their PN. The patients were given the SMOFlipid 20% for 6 hours in prescribed dose of approx. 1 g/kg of body weight. EG integrity was measured indirectly by automated sublingual videomicroscopy calculating a parameter PBR which describes the amount of lateral deviation of red blood cells from the central column and by levels of syndecan-1 and syndecan-4 in plasma as EG degradational products. Measurements were performed before lipid administration (T0) and 30 minutes after (T6) the infusion of lipid emulsion was completed. The statistical analysis was performed at the level of significance p < 0.05, data are expressed as mean ± standard deviation (SD) and for PBR as median and interquartile range (IQR).

RESULTS

Fifteen patients were studied, from them 9 included in final analysis. PBR (expressed in μm) increased after the lipid infusion with no statistical significance (T0 = 2.10; 1.97-2.33 vs. 2.28; 2.11-2.45, p = 0.13). At T6 both syndecans showed statistically significant decrease in their particular levels. Syndecan-1 at T0 = 2580±1013 ng/l, resp. at T6 = 2365±1077 ng/l, p = 0.02; syndecan-4 at T0 = 134±29 ng/l, resp. at T6 = 123±43 ng/l, p = 0.04.

CONCLUSION

In our study, we showed that six hours long SMOFlipid 20% infusion had no detrimental effect on the EG integrity as assessed by PBR value and by syndecan-1 and syndecan-4 plasmatic levels. Observed decrease of syndecans shortly after lipid infusion allows us to hypothesize even possibly protecting effect of lipids on EG.

背景

内皮糖萼（EG）是内皮细胞顶表面富含碳水化合物的血管衬里。它已被证明在血管稳态中具有重要作用。脂肪乳剂作为肠外营养（PN）的一部分，在重症监护和围手术期医学环境中广泛用于患者。由于其结构，脂质可能与 EG 发生潜在相互作用。本研究的目的是评估脂肪乳剂对 EG 的影响。

目的

使用视频显微镜和生化方法评估脂肪乳剂对 ICU 患者 EG 完整性的影响。

方法

对接受大腹部手术或心脏手术后的外科 ICU 患者和普通 ICU 患者进行评估，以确定其是否适合参加这项在大学医院进行的试点观察性研究。该研究在开始添加脂肪作为 PN 的第一天进行。患者给予 SMOFlipid 20%，每天约 1g/kg 体重，输注 6 小时。EG 完整性通过自动舌下视频显微镜间接测量，计算参数 PBR，该参数描述了红细胞从中央柱侧向偏离的程度，并通过血浆中 syndecan-1 和 syndecan-4 的水平作为 EG 降解产物进行测量。在开始输注脂肪乳剂之前（T0）和输注完成后 30 分钟（T6）进行测量。统计分析在显著性水平 p<0.05 进行，数据以平均值±标准差（SD）表示，PBR 以中位数和四分位距（IQR）表示。

结果

共纳入 15 名患者进行研究，其中 9 名患者最终纳入分析。脂肪输注后 PBR（以 μm 表示）增加，但无统计学意义（T0=2.10；1.97-2.33 与 T6=2.28；2.11-2.45，p=0.13）。在 T6 时，两种 syndecan 水平均显著下降。T0 时 syndecan-1 为 2580±1013ng/l，T6 时为 2365±1077ng/l，p=0.02；T0 时 syndecan-4 为 134±29ng/l，T6 时为 123±43ng/l，p=0.04。