影响腹膜后肿瘤切除患者多糖包被脱落的相关因素分析  

Analysis on related factors affecting glycocalyx shedding in patients with retroperitoneal tumor resection

作　　者：王晓宇 谷洁 丁琳 姚兰 高志峰 WANG Xiaoyu;GU Jie;DING Lin;YAO Lan;GAO Zhifeng(Department of Anesthesiology,Peking University International Hospital,Beijing 102206,China;Tsinghua Changgung Hospital/School of Clinical Medicine Tsinghua University,Beijing 102206,China)

机构地区：[1]北京大学国际医院麻醉科,北京102206 [2]清华大学附属北京清华长庚医院/清华大学临床医学院,102206

出　　处：《重庆医学》2019年第4期581-585,共5页Chongqing medicine

基　　金：北京大学国际医院科研基金(YN2016QN09)

摘　　要：目的观察腹膜后肿瘤切除患者围术期血清炎症因子的变化及血管内皮多糖包被脱落的情况,分析影响多糖包被脱落的独立危险因素。方法选择择期行腹膜后肿瘤切除术的患者80例,分别检测患者术前(T0)、手术开始1h(T1)、手术开始4h(T2)、手术结束24h(T3)以及手术结束72h(T4)血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、蛋白聚糖-1(SDC-1)、透明质酸(HA)及硫酸乙酰肝素(HS)的水平,比较各时间点每个指标的变化趋势,并对影响多糖包被脱落的相关因素进行回归分析。结果与T0相比,T1、T2、T3和T4时间点患者血清IL-6、TNF-α、SDC-1、HA及HS的水平均有不同程度升高,其中T2、T3升高显著(P<0.01)。△SDC-1与△IL-6、△TNF-α及输液量呈正相关;△HA、△HS均只与△TNF-α及输液量呈正相关。围术期TNF-α的变化对术后多糖包被脱落的影响更大。结论腹膜后肿瘤切除患者围术期血清IL-6、TNF-α、SDC-1、HA及HS的水平明显升高,TNF-α的变化和输液量是围术期多糖包被脱落的独立危险因素。Objective To observe the changes of serum inflammatory cytokines and vascular endothelial glycocalyx shedding during perioperative period in the patients undergoing retroperitoneal tumor resection,and to analyze the independent risk factors affecting glycocalyx shedding. Methods Eighty patients with elective retroperitoneal resection were enrolled in this study.The serum concentrations of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),syndecan-1(SDC-1),hyaluronic acid(HA) and heparan sulfate(HS) before surgery(T0),at 1 h after the surgery begin (T1),4 h after the surgery begin (T2),24 h after surgery end (T3) and 72 h after surgery end (T4) were detected respectively.The change trend at each time point was compared among various indexes.The regression analysis was performed on the related factors affecting glycocalyx shedding. Results Compared with T0,the concentrations of serum IL-6,TNF-α,SDC-1,HA and HS at T1,T2,T3 and T4 were increased to different extents,in which the T2 and T3 increase was significant( P <0.01).△ SDC-1 was positively correlated with △IL-6,△TNF-α and infusion volume;△HA and △HS were only positively correlated with △TNF-α and infusion volume.The perioperative TNF-α changes had greater impact on postoperative glycocalyx shedding. Conclusion The concentrations of serum IL-6,TNF-α,SDC-1,HA and HS during perioperative period are significantly increased,and the TNF-α change and infusion volume are the independent risk factors of perioperative glycocalyx shedding.

关 键 词：腹膜后肿瘤 多糖包被 炎症因子 

分 类 号：R735.4[医药卫生—肿瘤]