From the The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (FQ-F) and The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China (JH-S, QL-W, LY-F, YX-F, JX-Y, W-G, GL-H, WJ-W).
Eur J Anaesthesiol. 2021 May 1;38(5):477-486. doi: 10.1097/EJA.0000000000001429.
The glycocalyx plays an important physiological role and may be damaged during cardiopulmonary bypass. Sevoflurane can protect the glycocalyx; however, its relevance in a clinical setting is unknown.
Glycocalyx degradation during cardiopulmonary bypass in patients was investigated. On the basis of the available experimental data, we hypothesised that sevoflurane-based anaesthesia would confer additional protection against cardiopulmonary bypass-induced glycocalyx damage.
Randomised controlled study.
Clinical study at The First Affiliated Hospital of Wenzhou Medical University between June 2018 and March 2019.
Fifty-one patients.
After intubation and mechanical ventilation, patients undergoing elective heart valve surgery were maintained under general anaesthesia with either propofol or sevoflurane during surgery.
Glycocalyx markers (such as syndecan-1, heparan sulphate and hyaluronan), sheddases responsible for the degradation of the endothelial glycocalyx (such as matrix metalloproteinase-9 and cathepsin-B), urine albumin-to-creatinine ratio and levels of lactic acid and myocardial enzymes were all measured. Postoperative mechanical ventilation time and length of stay in the cardiac care unit and hospital were also measured. Morbidity and mortality after 30 days and 1 year were evaluated.
The vascular endothelial glycocalyx was damaged during cardiopulmonary bypass. The glycocalyx damage in the sevoflurane group was less extensive than that in the propofol group. The urine albumin-to-creatinine ratio increased in both groups but was lower in the sevoflurane group. Enzymes including matrix metalloproteinase-9 and cathepsin-B were positively correlated with glycocalyx marker concentrations. After operation, the sevoflurane group showed lower levels of lactic acid and myocardial enzyme, as well as shorter duration of postoperative mechanical ventilation than the propofol group.
Sevoflurane can decrease glycocalyx degradation in patients undergoing heart valve surgery under cardiopulmonary bypass.
Chinese Clinical Trial Registry, chictr.org.cn, identifier: ChiCTR1800016367.
糖萼在生理上发挥着重要作用，在体外循环过程中可能会受损。七氟醚可以保护糖萼；然而，其在临床环境中的相关性尚不清楚。
研究体外循环过程中心脏手术患者糖萼的降解情况。基于现有的实验数据，我们假设七氟醚为基础的麻醉将为体外循环引起的糖萼损伤提供额外的保护。
随机对照研究。
温州医科大学附属第一医院 2018 年 6 月至 2019 年 3 月期间的临床研究。
51 例患者。
患者行择期心脏瓣膜手术后，在插管和机械通气后，接受异丙酚或七氟醚维持全身麻醉。
糖萼标志物（如 syndecan-1、硫酸乙酰肝素和透明质酸）、负责降解内皮糖萼的脱落酶（如基质金属蛋白酶-9 和组织蛋白酶-B）、尿白蛋白/肌酐比值以及乳酸和心肌酶水平均进行测量。还测量了术后机械通气时间和心脏监护病房及医院的住院时间。术后 30 天和 1 年评估死亡率和发病率。
体外循环过程中血管内皮糖萼受损。七氟醚组糖萼损伤较异丙酚组轻。两组尿白蛋白/肌酐比值均升高，但七氟醚组较低。基质金属蛋白酶-9 和组织蛋白酶-B 等酶与糖萼标志物浓度呈正相关。手术后，七氟醚组乳酸和心肌酶水平较低，机械通气时间较异丙酚组短。
在体外循环下心脏瓣膜手术患者中，七氟醚可减少糖萼降解。
中国临床试验注册中心， chictr.org.cn，注册号：ChiCTR1800016367。
