关注罂粟花，共同学习麻醉学最新文献
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游霄 编辑：赵游霄 审校：曹莹
探讨心脏手术期间碳酸氢钠林格液（BRS）对体外循环（CPB）患者内皮糖萼成分降解的影响，评价其对内皮糖萼保存和术后恢复的影响。
BRS 组在 T3（7.98 [7.43, 8.92] ng/mL 对比 9.54 [8.4, 10.73] ng/mL，P < 0.001）和 T5（4.20 [3.31, 4.96]）时 Syndecan-1 血浆浓度显着降低 纳克/毫升 vs 5.40 [3.95, 6.55] ng/mL，P = 0.001）与 LRS 组相比（P<0.01）。T6 时两组的 Syndecan-1 水平相似（3.18 [2.88, 3.5]ng/mL vs 3.12 [2.77, 3.45] ng/mL，P > 0.05）。此外，BRS 组 T3 和 T5 时 MMP-9、MMP-3、IL-6 和 IL-8 显着降低（分别为 P<0.05 和 P<0.01）。但两组急性肾损伤（AKI）或POD发生率差异无统计学意义（P>0.05）。
BRS 具有减少 CPB 心脏瓣膜手术患者糖萼降解的潜力。然而，两组均表现出相似的术后临床结果，包括 AKI 和 POD 发生率。
原始文献：
英文原文：
Intraoperative Use of Sodium Bicarbonate Ringer’s Solution Instead of Sodium Lactate Ringer’s Solution to Reduce Endothelial Glycocalyx Degradation and Improve Postoperative Recovery During Cardiopulmonary Bypass Cardiac Surgery: A Single-Center Prospective Cohort Study
Objective:
To investigate the effect of sodium bicarbonate Ringer’s solution (BRS) on the degradation of endothelial glycocalyx components in patients undergoing cardiopulmonary bypass (CPB) during cardiac surgery, and to evaluate its impact on endothelial glycocalyx preservation and postoperative recovery.
Patients and Methods:
A total of eight patients scheduled for elective CPB heart surgery were included and randomly divided into two groups: the sodium lactate Ringer’s solution (LRS) group and the BRS group. ELISA was used to measure plasma concentrations of syndecan-1, matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase-3 (MMP-3), IL-6, IL-8, TNF-α, and TGF-β at predefined time points: T0 (before induction of anesthesia), T3 (immediately after weaning from CPB), T5 and T6 (24 and 72 hours postoperatively). Serum creatinine concentrations were measured within 48 hours postoperatively. The incidence of postoperative delirium (POD) was assessed three days after surgery. Postoperative mechanical ventilation time, duration of stay in the intensive care unit and hospital stay were also documented.
Results:
The BRS group had significantly lower plasma concentrations of syndecan-1 at T3 (7.98 [7.43, 8.92] ng/mL vs 9.54 [8.4, 10.73] ng/mL, P < 0.001) and T5 (4.20 [3.31, 4.96] ng/mL vs 5.40 [3.95, 6.55] ng/mL, P = 0.001) in comparison with the LRS group (P<0.01). Syndecan-1 levels in both groups were similar at T6 (3.18 [2.88, 3.5]ng/mL vs 3.12 [2.77, 3.45] ng/mL, P > 0.05). Additionally, MMP-9, MMP-3, IL-6 and IL-8 were significantly lower at T3 and T5 in the BRS group (P<0.05 and P<0.01, respectively). However, no significant differences were observed between the two groups in the incidence of acute kidney injury (AKI) or POD (P > 0.05).
Conclusion:
BRS has the potential to reduce glycocalyx degradation in patients undergoing heart valve surgery with CPB. However, both groups demonstrated similar post-postoperative clinical outcomes, including the rates of AKI and POD.
