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在肝脏和胰腺切除手术期间,内皮葡萄糖流和血液动力学变量

Foteini Kavezou¹, Eleftheria Soulioti¹, Emmanouil I Kapetanakis²

¹Second Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece.

Medicina (Kaunas, Lithuania)

|November 27, 2025

概括

中枢静脉压力 (CVP) 策略在重大肝脏或胰腺手术期间没有显著影响内皮质糖核的流失. 在非缺血病例中,低CVP (LCVP) 显示了syndecan-1的晚期上升,这表明流体限制的潜在内皮效应.

科学领域:

血管生物学和外科外科医学.
内皮葡萄糖的研究研究
血液动力学管理策略血液动力学管理策略

背景情况:

内皮葡萄糖 (EG) 对于血管屏障功能至关重要,但易受手术压力影响.
术后的中央静脉压 (CVP) 管理和肝脏缺血/再输是影响EG完整性的潜在因素.

研究的目的:

为了研究低 (LCVP) 与正常 (NCVP) 中枢静脉压力策略对外科手术期间内皮质葡萄糖体流的影响.
评估肝切除术期间肝缺血/再输血对内皮葡萄糖体流失标志物的影响.

主要方法:

37名接受选择性肝脏或胰腺切除的成年患者被分配给LCVP (<5 mmHg) 或NCVP (5-12 mmHg) 协议.
血中syndecan-1和heparan sulfate水平在手术前,手术期间和2小时后被测量.
患者根据肝脏缺血/再输的存在或不存在而分层.

主要成果:

在非缺血性手术中,肝肝硫酸盐水平随着时间的推移而增加,CVP组之间没有显著差异.
在LCVP和NCVP组中,Syndecan-1水平与LCVP组相似,但LCVP组的术后2小时显著增加 (非缺血).
两种生物标志物都没有显示CVP组在涉及缺血/再输血的手术中存在显著差异.

结论:

大型肝脏/胰腺手术会导致内皮糖体流,这在很大程度上独立于CVP策略和缺血.
在非缺血病例中,在LCVP下,术后晚期的syndecan-1增加表明,由于激烈的液体限制而导致潜在的内皮损害.
血动力学点应该平衡出血控制与内皮完整性,因为液体和血管压缩剂管理可能会影响葡萄糖的保存.

关键词:

中心静脉压力静脉压力中心静脉压力体内皮质的葡萄糖.肝素硫酸盐是什么肝素硫酸盐肝切除术 (hepatatectomy) 是一种切除肝脏的方法.缺血症/再输血缺血症/再输血胰腺切除术是什么意思这就是Syndekan-1的作用.

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