吸入麻醉和全凭静脉麻醉对腰椎手术患者内皮细胞糖萼蛋白脱落的影响

Effects of inhalation anesthesia and total intravenous anesthesia on endothelial glycocalyx shedding in patients undergoing lumbar fusion surgery

目的比较七氟醚吸入麻醉和丙泊酚全凭静脉麻醉对开放腰椎融合手术患者内皮细胞糖萼蛋白syndecan-1、透明质酸和硫酸乙酰肝素脱落的影响。方法择取解放军总医院第六医学中心拟行开放腰椎融合手术患者100例,随机分为吸入麻醉组(n=50)和全凭静脉麻醉组(n=50),分别给予七氟醚/瑞芬太尼和丙泊酚/瑞芬太尼维持麻醉。在术前、手术结束、术后第1天检测血清内皮损伤标记物syndecan-1、透明质酸、硫酸乙酰肝素和炎症因子C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)的表达。结果与术前相比,手术结束时两组患者血清syndecan-1、透明质酸和硫酸乙酰肝素表达明显升高,且术后第1天仍然高于术前基础值。全凭静脉麻醉组在手术结束时syndecan-1[(14.96±2.79)ng/ml]、透明质酸[(195.94±8.64)ng/ml]和硫酸乙酰肝素[(3429.58±310.52)pg/ml]明显低于吸入麻醉组[(17.45±1.65)ng/ml、(203.23±12.93)ng/ml、(3751.12±223.22)pg/ml],(P<0.05),但在术后第1天两组之间没有统计学差异。两组之间CRP、TNF-α和IL-6在各时间点均无统计学差异。结论全凭静脉麻醉在术中保护内皮糖萼方面可能优于吸入性麻醉,但两种麻醉方法均不能阻止开放腰椎融合手术患者内皮细胞syndecan-1、透明质酸和硫酸乙酰肝素的脱落。

Objective To compare the effects of sevoflurane inhalation anesthesia and propofol based total intravenous anesthesia(TIVA)on the shedding of endothelial cell glycocalyx protein syndecan-1,hyaluronic acid and heparan sulfate in patients undergoing open lumbar fusion surgery.Methods A total of 100 patients scheduled for open lumbar fusion surgery in The Sixth Medical Center of Chinese PLA General Hospital were enrolled and randomly divided into inhalation anesthesia group(n=50)and TIVA group(n=50),and anesthesia was maintained with sevoflurane/remifentanil or propofol/remifentanil,respectively.Serum endothelial injury markers syndecan-1,hyaluronic acid and heparan sulfate,and inflammatory mediators including C-reactive protein(CRP),TNF-αand IL-6 were measured before anesthesia,at the end of operation,and on the first day after operation(POD1).Results Compared with the inhalation anesthesia group[(17.45±1.65)ng/ml,(203.23±12.93)ng/ml,(3751.12±223.22)pg/ml],serum syndecan-1[(14.96±2.79)ng/ml],hyaluronic acid[(195.94±8.64)ng/ml],and heparan sulfate levels[(3429.58±310.52)pg/ml]were significantly lower at the end of the surgery in the total intravenous anesthesia group(P<0.05),but there was no significant difference between the two groups on POD1(P>0.05).There was no statistical difference in CRP,TNF-αor IL-6 between the two groups at any time points observed(P>0.05).Conclusions TIVA may be superior to inhalation anesthesia in terms of intraoperative protection of the endothelial glycocalyx,however,neither of the two anesthesia methods can prevent the shedding of endothelial cells syndecan-1,hyaluronic acid and heparan sulfate in patients undergoing open lumbar fusion surgery.