术中使用碳酸氢钠林格氏液代替乳酸钠林格氏液以减少心肺旁路心脏手术的内皮糖萼降解并改善术后恢复：单中心前瞻性队列研究》。

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2024-12-10 eCollection Date: 2024-01-01 DOI:10.2147/DDDT.S501657

Yujie Shi, Yuan Shi, Yujia Tao, Bingyan Xu, Xiaoming Wang, Yanhu Xie, Min Zhang

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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). 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引用次数: 0

摘要

目的研究碳酸氢钠林格氏液（BRS）对心脏手术中心肺旁路（CPB）患者内皮糖萼成分降解的影响，并评估其对内皮糖萼保存和术后恢复的影响：共纳入八名计划接受择期 CPB 心脏手术的患者，并将其随机分为两组：乳酸钠林格氏液（LRS）组和 BRS 组。在预先设定的时间点，采用 ELISA 方法测量血浆中辛迪加-1、基质金属蛋白酶-9 (MMP-9)、基质金属蛋白酶-3 (MMP-3)、IL-6、IL-8、TNF-α 和 TGF-β 的浓度：T0（麻醉诱导前）、T3（CPB 断流后立即）、T5 和 T6（术后 24 小时和 72 小时）。术后 48 小时内测量血清肌酐浓度。术后三天评估术后谵妄（POD）的发生率。此外，还记录了术后机械通气时间、重症监护室停留时间和住院时间：与 LRS 组相比，BRS 组在 T3（7.98 [7.43, 8.92] ng/mL vs 9.54 [8.4, 10.73] ng/mL，P < 0.001）和 T5（4.20 [3.31, 4.96] ng/mL vs 5.40 [3.95, 6.55] ng/mL，P = 0.001）时的辛迪加-1 血浆浓度明显较低（PP > 0.05）。此外，BRS 组的 MMP-9、MMP-3、IL-6 和 IL-8 在 T3 和 T5 显著降低（PPP > 0.05）：结论：BRS 有可能减少使用 CPB 进行心脏瓣膜手术的患者的糖萼降解。结论：BRS 有可能减少 CPB 下心脏瓣膜手术患者的糖萼降解，但两组患者术后的临床结果相似，包括 AKI 和 POD 的发生率。

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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.

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.