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)的发生率很高,围手术期内皮糖萼层(EGL)破裂可能是诱发因素之一。我们假设EGL脱落发生在OPCABG中更早,这可能影响术后SIRS,七氟醚可能比丙泊酚更好地保存EGL。
方法:我们随机分配50例接受OPCABG的患者,分别接受七氟醚-舒芬太尼或异丙酚-舒芬太尼麻醉。血浆syndecan-1,硫酸乙酰肝素(HS),心钠素(ANP),测量IL-6和心肌肌钙蛋白I(cTnI)。在6个时间点收集血样:诱导(T1),嫁接前(T2),嫁接后(T3),手术完成(T4),术后第1天(POD1,T5)和POD2(T6)。检查SIRS标准和序贯器官衰竭评估(SOFA)评分。
结果:syndecan-1,HS,七氟醚和丙泊酚组之间的IL-6或SIRS标准或SOFA评分。将所有患者合并为一组进行进一步的统计分析,血浆syndecan-1(P<0.001)和IL-6(P<0.001)随时间而显着增加;syndecan-1的增加与冠状动脉吻合时间显着相关(r=0.329,P=0.026)。Syndecan-1(T3)与ANP(T3)(r=0.0.354,P=0.016)、IL-6(T5)(r=0.570,P<0.001)呈正相关。IL-6的最大值与SIRS显著相关(r=0.378,P=0.010),SOFA评分最大值(r=0.399,P=0.006)和ICU天数(r=0.306,P=0.039)。SOFA评分最大值与SIRS发生率(r=0.568,P<0.001)和ICU天数(r=0.338,P=0.022)呈显著正相关。
结论:OPCABG术中早期EGL脱落引起的移植物吻合对术后SIRS和SOFA评分有很大影响,七氟醚在临床上不能更好地保存EGL.
背景:ChiCTR-IOR-17012535。在01/09/2017注册。
BACKGROUND: 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 (T1), before grafting (T2), after grafting(T3), surgery done (T4), postoperative day1 (POD1,T5) and POD2 (T6). 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(T3) correlated significantly with ANP(T3) (r = 0.0.354, P = 0.016) and IL-6 (T5) (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.
BACKGROUND: ChiCTR-IOR-17012535. Registered on 01/09/2017.