ангиопоетин-2 与毛细血管泄漏有关,并预测心脏手术后的并发症
Jakob Wollborn1,2,3, Zilu Zhang4, Julie Gaa5,6
1Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. jwollborn@bwh.harvard.edu.
Annals of intensive care
|August 8, 2023
概括
内皮损伤的标记物,如血管蛋白-2,与心脏手术后的毛细血管泄漏和液体过载有关. 这些标记物,以及细胞外水,可以帮助预测术后并发症.
科学领域:
- 心血管外科心血管外科
- 关键护理医学 关键护理医学
- 生物标志物研究 生物标志物研究
背景情况:
- 心脏手术患者面临许多并发症,血管透性增加可能导致发病率和死亡率.
- 血液动力学不稳定性,液体过载和是心脏手术后的重要问题.
- 内皮损伤和炎症标志物可能表明毛细血管泄漏,增加术后并发症风险.
研究的目的:
- 研究心脏外科手术患者的血管蛋白-2水平,细胞外水和术后并发症之间的关联.
- 为了确定内皮损伤和炎症的标志物是否与毛细血管泄漏相关.
- 探索这些标志物对不良结果的预测潜力.
主要方法:
- 在高等学术医疗中心对405名心脏手术患者进行前性观察性研究.
- 每天使用生物阻抗分析,超声波,静脉内显微镜和血清生物标志物分析进行评估.
- 多变量和机器学习模型分析血管蛋白-2与细胞外水和并发症的关联.
主要成果:
- 外细胞水在术后显著增加 (20 L 到 29 L),与血管蛋白-2水平上升相关 (r=0.959,P=0.041).
- 炎症和内皮细胞生物标志物升高表明毛细血管泄漏.
- 增加的 ангиопоэтин-2 (1 ng/mL) 与0.24 L增加的细胞外水 (P<0.001) 相关,并预测了急性损伤,延迟的输出,更长的ICU停留,以及长时间的血管活性药物依赖.
结论:
- 毛细血管泄漏和是心脏手术后的重要问题.
- 血管蛋白-2 度和细胞外水的测量显示在预测术后并发症方面有前途.
- 识别毛细血管泄漏标记可以改善心脏手术后的风险分层和患者管理.
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