体外循环围术期血管内皮多糖-蛋白复合物层损伤动态变化研究  

The dynamics of perioperative vascular endothelial glycocalyx damage in extracorporeal circulation

作　　者：罗远志 赵雷 耿弘 籍强[1] 左坤 周锴 何庚戌 Luo Yuanzhi;Zhao Lei;Geng Hong;Ji Qiang;Zuo Kun;Zhou Kai;He Gengxu(Department of Thoracic and Cardiovascular Surgery,the First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院胸心血管外科,张家口075000

出　　处：《中国体外循环杂志》2024年第5期387-394,共8页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 研究体外循环围术期血管内皮多糖-蛋白质复合物层(EGL)损伤标志物动态变化及其临床意义。方法 对连续44例行体外循环下心血管手术患者在术前(麻醉诱导前)、体外循环开始、体外循环结束、术后6 h、术后1 d、术后3 d、术后5 d、术后7 d分别测量血浆血管EGL损伤标志物多配体蛋白复合物-1(Syndecan-1)、透明质酸(HA)、硫酸肝素(HS)、硫酸软骨素(CS)的浓度,在手术前后不同时间点测量动脉血气并记录乳酸浓度。采用方差分析比较各个时间点Syndecan-1、HA、HS、CS的浓度以及乳酸浓度是否具有统计学差异,并采用Pearson相关性分析比较EGL损伤标志物峰值浓度、乳酸峰值浓度、主动脉阻断时间、体外循环时间之间的相关性。结果 血管EGL损伤标志物Syndecan-1、HA、HS、CS的浓度在体外循环开始后即明显升高,在术后6 h均达到峰值,后逐渐下降并在术后7 d均降到与术前相近水平。患者动脉血乳酸浓度在术后6 h达到峰值,并在术后48 h恢复到术前水平。Syndecan-1、HA、HS、CS峰值浓度与主动脉阻断时间、体外循环时间、动脉血乳酸峰值水平呈正相关。结论 体外循环引起的血管EGL损伤可持续到术后一周的时间,且损伤的严重程度与体外循环时间、主动脉阻断时间、血浆乳酸峰值水平相关。Objective To study the dynamic changes in markers of vascular endothelial glycocalyx layer(EGL)injury during the perioperative period of extracorporeal circulation and their clinical significance.Methods We recruited 44 patients carried out cardiovascular surgery under cardiopulmonary bypass(CPB).Plasma was obtained at different time to measure syndecan-1,hyaluronic acid(HA),heparin sulfate(HS),chondroitin sulfate(CS)levels as EGL injury markers.Time points were settled as before anesthesia,initiation of CPB,end time of CPB,6 hours after operation,1 day after operation,3 days after operation,5 days after operation,and 7 days after operation.Arterial blood gas analysis was monitored perioperatively and blood lactate levels were also recorded.Analysis of variance(ANOVA)was used to compare whether the concentrations of Syndecan-1,HA,HS,and CS as well as the lactate concentration were statistically different at each time point.Pearson correlation analysis was also used to compare the correlation between peak concentrations of EGL injury markers,peak lactate concentrations,aortic occlusion time,and extracorporeal circulation time.Results The plasma levels of syndecan-1,HA,HS,and CS began to increase after initiation of CPB,and reach their highest levels 6 hours after operation,then decrease gradually during the postoperative time,and to its preoperative levels at the 5th day after operation or 7th day.Patients’arterial blood lactate concentration peaked at 6 h postoperatively and returned to preoperative levels at 48 h postoperatively.Syndecan-1,HA,HS,and CS peak concentrations were positively correlated with aortic occlusion time,duration of extracorporeal circulation,and peak arterial blood lactate levels.Conclusion The initiation of CPB can damage the vascular endothelial glycocalyx layer(EGL),which may persist for 5-7 days post-operation.The severity of injury is correlated with CPB time,aortic occlusion time,and plasma lactate peak level.

关 键 词：体外循环 内皮多糖-蛋白质复合物层 乳酸 微循环 体外循环时间 主动脉阻断时间 

分 类 号：R654.1[医药卫生—外科学]