搏动灌注对体外循环期间血流剪切力及血管内皮糖萼功能的影响

目的研究应用搏动灌注对体外循环期间血流剪切力(FSS)及血管内皮糖萼(VEG)功能的影响。方法选取体外循环下瓣膜置换手术患者40名,随机分为搏动灌注组及平流灌注组,每组患者20名,比较两组患者临床预后指标、FSS、VEG及炎症反应标志物多配体蛋白聚糖-1(syndecan-1)、硫酸乙酰肝素及趋化因子C-C型配体2(CCL2)],分析血管壁峰值剪切力(PWSS)与VEG标志物的相关性。结果两组患者ICU停留时间、住院时间等临床指标无明显差异;在主动脉开放前、停机后两个时间点,搏动组患者的PWSS均较平流组显著较高(P<0.05);搏动组患者停机后syndecan-1及CCL2的水平较低(P<0.05);搏动组患者在主动脉开放前、停机后硫酸乙酰肝素水平较低(P<0.05);PWSS与syndecan-1及硫酸乙酰肝素的水平呈负相关(P<0.01)。结论搏动灌注有利于维持体外循环期间FSS,对于VEG的保护及缓解血管内皮炎症反应具有积极意义。

The effect of pulsatile perfusion on flow shear stress and the function of vascular endothelial glycocalyx during extracorporeal circulation

Objective To investigate the effects of pulsatile perfusion on flow shear stress(FSS)and the function of vascular endothelial glycocalyx(VEG)during extracorporeal circulation.Methods 40 patients with valve replacement underwent cardiopulmonary bypass(CPB)were randomly divided into two groups:the pulsatile group(n=20)and the non-pulsatile group(n=20).The clinical prognostic indicators,FSS,VEG and vascular inflammatory biomarkers(syndecan-1,heparan sulfate and CCL2)were compared between the two groups,and the correlation between peak wall shear stress(PWSs)and VEG markers were also analyzed.Results There was no significant difference in ICU stay,hospital stay and other clinical indicators between the two groups.PWSs in pulsatile group was significantly higher than that in non-pulsatile group at two time-points during CPB:before aortic de-clamping and after the CPB(P<0.05).In the pulsatile group,lower levels of syndecan-1 and CCL2 were observed at the off-pump time point(P<0.05),while the heparan sulfate levels were significantly higher at the aortic de-clamping and off-pump time points(P<0.05).Furthermore,a negative correlation was observed between PWSs and the concentration of syndecan-1 or heparan sulfate(P<0.01).Conclusion Pulsatile perfusion maintains flow shear stress during CPB,protects VEG,and attenuates vascular inflammatory responses.