【罂粟摘要】七氟醚对心脏瓣膜手术患者血管内皮细胞的保护作用：一项随机对照试验
七氟醚对心脏瓣膜手术患者血管内皮细胞的保护作用：一项随机对照试验
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
糖萼在体外循环中起着重要的生理作用，在体外循环过程中可能会受到损伤。七氟醚可以对糖萼起到保护作用；然而，它在临床中的与糖萼保护的相关性尚不清楚。
对体外循环期间患者的糖萼降解情况进行了研究。根据现有的实验数据，我们假设七氟醚吸入麻醉会对体外循环引起的糖萼损伤提供额外的保护。
随机对照研究。
2018年6月至2019年3月在温州医科大学第一附属医院的临床病例。
51名患者。
在气管插管和机械通气后，患者在丙泊酚或七氟醚的全麻下接受择期心脏瓣膜手术。
测定糖萼标志物(如：Syndecan-1、硫酸乙酰肝素、透明质酸)、内皮糖萼降解脱落酶(如：基质金属蛋白酶-9、组织蛋白酶-B)、尿白蛋白/肌酐比值、乳酸和心肌酶水平。也对术后机械通气时间和在心脏监护病房的监护时间及总住院时间进行测量。评估30天和1年后的发病率和死亡率。
体外循环期间血管内皮细胞糖萼受损。七氟醚组的糖萼损伤小于丙泊酚组。两组的尿白蛋白/肌酐比值均升高，但七氟醚组的尿白蛋白/肌酐比值升高得较慢。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。术后七氟醚组乳酸和心肌酶水平低于丙泊酚组，术后机械通气时间短于丙泊酚组。
七氟醚可减少体外循环心脏瓣膜手术患者的糖萼降解。
中国临床试验注册中心，chictr.org.cn，ID：ChiCTR1800016367。
Protective effect of sevoflurane on vascular endothelial glycocalyx in patients undergoing heart valve surgery: A randomised controlled trial
BACKGROUND 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.
OBJECTIVE 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.
DESIGN Randomised controlled study.
SETTING Clinical study at The First Affiliated Hospital of Wenzhou Medical University between June 2018 and March 2019.
PATIENTS Fifty-one patients.
INTERVENTIONS After intubation and mechanical ventilation, patients undergoing elective heart valve surgery were maintained under general anaesthesia with either propofol or sevoflurane during surgery.
MAIN OUTCOME MEASURES 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.
RESULTS 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.
CONCLUSION Sevoflurane can decrease glycocalyx degradation in patients undergoing heart valve surgery under cardiopulmonary bypass. TRIAL
REGISTRATION Chinese Clinical Trial Registry, chictr.org.cn, identifier: ChiCTR1800016367.
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