Department of Anaesthesia, Austin Hospital, Melbourne, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Australia.
Acta Anaesthesiol Scand. 2023 Jan;67(1):4-11. doi: 10.1111/aas.14150. Epub 2022 Sep 27.
Surgical trauma-induced inflammation during major surgery may disrupt endothelial integrity and affect plasma concentrations of glycocalyx constituents, such as syndecan-1 and heparan sulphate. To date, no studies have focused on their perioperative temporal changes.
As part of a trial, we obtained plasma and urine specimens sampled during the perioperative period in 72 patients undergoing major abdominal surgery. The plasma concentration of syndecan-1 and heparan sulphate was measured on five occasions, from baseline to the second postoperative day. Plasma and urinary creatinine and urinary syndecan-1 concentrations were measured before surgery and on the first postoperative morning.
We observed three different temporal patterns of plasma syndecan-1 concentration. Group 1 'low' (64% of patients) showed only minor changes from baseline despite a median heparan sulphate increase of 67% (p < .005). Group 2 'increase' (21% of patients) showed a marked increase in median plasma syndecan-1 from 27 μg/L to 118 μg/L during the first postoperative day (p < .001) with a substantial (+670%; p < .005) increase in median plasma heparan sulphate from 279 to 2196 μg/L. Group 3 'high' (14% of patients) showed a constant elevation of plasma syndecan-1 to >100 μg/L, but low heparan sulphate levels. The plasma C-reactive protein concentration did not differ across the three groups and 90% of colon surgeries occurred in Group 1. Treatment with dexamethasone was similar across the three groups. Surgical blood loss, duration of surgery and liver resection were greatest in Group 2.
Changes in syndecan-1 and heparan sulphate after surgery appear to show three different patterns, with the greatest increases in those patients with greater blood loss, more liver surgery and longer operations. These observations suggest that increases in syndecan-1 and heparan sulphate reflect the degree of surgical injury.
大手术引起的外科创伤性炎症可能会破坏内皮完整性，并影响糖萼成分（如 syndecan-1 和硫酸乙酰肝素）的血浆浓度。迄今为止，尚无研究关注其围手术期的时间变化。
作为一项试验的一部分，我们在 72 例行大腹部手术的患者中采集了围手术期的血浆和尿液标本。在五个时间点测量了 syndecan-1 和硫酸乙酰肝素的血浆浓度，从基线到术后第二天。在手术前和术后第一个早上测量了血浆和尿肌酐以及尿 syndecan-1 浓度。
我们观察到血浆 syndecan-1 浓度有三种不同的时间模式。第 1 组“低”（64%的患者）尽管硫酸乙酰肝素中位数增加了 67%（p<0.005），但基线时仅发生轻微变化。第 2 组“增加”（21%的患者）在术后第一天，血浆 syndecan-1 的中位数从 27μg/L 显著增加至 118μg/L（p<0.001），血浆硫酸乙酰肝素的中位数从 279μg/L 增加至 2196μg/L（+670%；p<0.005）。第 3 组“高”（14%的患者）表现为血浆 syndecan-1 持续升高至>100μg/L，但硫酸乙酰肝素水平较低。三组间血浆 C 反应蛋白浓度无差异，90%的结肠癌手术发生在第 1 组。三组间地塞米松治疗相似。第 2 组的手术出血量、手术时间和肝切除术最大。
手术后 syndecan-1 和硫酸乙酰肝素的变化似乎表现出三种不同的模式，在失血较多、肝手术较多和手术时间较长的患者中增加最多。这些观察结果表明，syndecan-1 和硫酸乙酰肝素的增加反映了手术损伤的程度。
