大量术中内皮糖萼脱落会影响术后全身炎症反应。

Mass intraoperative endothelial glycocalyx shedding affects postoperative systemic inflammation response.

机构信息

Department of Anesthesiology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China.

出版信息

BMC Anesthesiol. 2024 Feb 26;24(1):76. doi: 10.1186/s12871-024-02459-z.

DOI:10.1186/s12871-024-02459-z

PMID:38408904

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10895804/

Abstract

BACGROUND

Off-pump coronary artery bypass graft (OPCABG) has a high incidence of postoperative systemic inflammation response syndrome (SIRS), and perioperative endothelial glycocalyx layer (EGL) disruption can be one of the predisposing factors. We hypothesized that EGL shedding happened earlier in OPCABG which can influence on postoperative SIRS, and sevoflurane might preserve EGL better than propofol.

METHODS

We randomly allocated 50 patients undergoing OPCABG to receive either sevoflurane-sufentanil or propofol-sufentanil anesthesia. Plasma syndecan-1, heparan sulfate (HS), atrial natriuretic peptide (ANP), IL-6, and cardiac troponin I (cTnI) were measured. Blood samples were collected at 6 timepoints: induction (T), before grafting (T), after grafting(T), surgery done (T), postoperative day1 (POD1,T) and POD2 (T). SIRS criteria and sequential organ failure assessment (SOFA) score were examined.

RESULTS

There were neither differences of syndecan-1, HS, IL-6 nor of SIRS criteria or SOFA score between the sevoflurane and propofol groups. All patients were pooled as a single group for further statistical analyses, plasma syndecan-1 (P < 0.001) and IL-6 (P < 0.001) increased significantly as a function of time; syndecan-1 increasing correlated significantly with the duration of coronary graft anastomosis (r = 0.329, P = 0.026). Syndecan-1(T) correlated significantly with ANP(T) (r = 0.0.354, P = 0.016) and IL-6 (T) (r = 0.570, P < 0.001). The maximum value of IL-6 correlated significantly with SIRS (r = 0.378, P = 0.010), the maximum value of SOFA score (r = 0.399, P = 0.006) and ICU days (r = 0.306, P = 0.039). The maximum value of SOFA score correlated significantly with the occurrence of SIRS (r = 0.568, P < 0.001) and ICU days (r = 0.338, P = 0.022).

CONCLUSIONS

OPCABG intraoperative early EGL shedding caused of grafts anastomosis greatly affected postoperative SIRS and SOFA score, sevoflurane did not clinically preserve EGL better.

TRIAL REGISTRATION

ChiCTR-IOR-17012535. Registered on 01/09/2017.

摘要

背景

非体外循环冠状动脉旁路移植术（OPCABG）术后全身炎症反应综合征（SIRS）发生率较高，围手术期内皮糖萼层（EGL）破坏可能是其诱发因素之一。我们假设 OPCABG 中 EGL 的脱落发生得更早，这可能会影响术后 SIRS，七氟醚可能比丙泊酚更好地保护 EGL。

方法

我们随机将 50 例行 OPCABG 的患者分为接受七氟醚-舒芬太尼或丙泊酚-舒芬太尼麻醉的两组。测量血浆硫酸乙酰肝素（HS）、硫酸乙酰肝素（HS）、心钠肽（ANP）、白细胞介素-6（IL-6）和心肌肌钙蛋白 I（cTnI）。在 6 个时间点采集血液样本：诱导（T）、供体吻合前（T）、供体吻合后（T）、手术完成（T）、术后第 1 天（T）和第 2 天（T）。检查 SIRS 标准和序贯器官衰竭评估（SOFA）评分。

结果

七氟醚组和丙泊酚组的硫酸乙酰肝素（HS）、白细胞介素-6（IL-6）、SIRS 标准或 SOFA 评分均无差异。所有患者均被汇总为一个单独的组进行进一步的统计分析，血浆硫酸乙酰肝素（HS）（P < 0.001）和白细胞介素-6（IL-6）（P < 0.001）随时间显著增加；硫酸乙酰肝素（HS）（P = 0.026）与冠状动脉吻合吻合时间呈显著相关。硫酸乙酰肝素（HS）（T）与 ANP（T）（r = 0.0.354，P = 0.016）和白细胞介素-6（T）（r = 0.570，P < 0.001）显著相关。白细胞介素-6（T）的最大值与 SIRS（r = 0.378，P = 0.010）、SOFA 评分的最大值（r = 0.399，P = 0.006）和 ICU 天数（r = 0.306，P = 0.039）显著相关。SOFA 评分的最大值与 SIRS（r = 0.568，P < 0.001）和 ICU 天数（r = 0.338，P = 0.022）的发生显著相关。