The dynamics of perioperative vascular endothelial glycocalyx damage in extracorporeal circulation
Luo Yuanzhi
Zhao Lei
Geng Hong
Ji Qiang
Zuo Kun
Zhou Kai
He Gengxu
Abstract：Objective To study the dynamic changes in markers of vascular endothelial glycocalyx layer (EGL) injury during the perioperative period of extracorporeal circulation and their clinical significance. Methods We recruited 44 patients carried out cardiovascular surgery under cardiopulmonary bypass (CPB). Plasma was obtained at different time to measure syndecan-1,hyaluronic acid (HA),heparin sulfate (HS),chondroitin sulfate (CS) levels as EGL injury markers. Time points were settled as before anesthesia,initiation of CPB,end time of CPB,6 hours after operation,1 day after operation,3 days after operation,5 days after operation,and 7 days after operation. Arterial blood gas analysis was monitored perioperatively and blood lactate levels were also recorded. Analysis of variance (ANOVA) was used to compare whether the concentrations of Syndecan-1,HA,HS,and CS as well as the lactate concentration were statistically different at each time point. Pearson correlation analysis was also used to compare the correlation between peak concentrations of EGL injury markers,peak lactate concentrations,aortic occlusion time,and extracorporeal circulation time. Results The plasma levels of syndecan-1,HA,HS,and CS began to increase after initiation of CPB,and reach their highest levels 6 hours after operation,then decrease gradually during the postoperative time,and to its preoperative levels at the 5th day after operation or 7th day. Patients' arterial blood lactate concentration peaked at 6 h postoperatively and returned to preoperative levels at 48 h postoperatively. Syndecan-1,HA,HS,and CS peak concentrations were positively correlated with aortic occlusion time,duration of extracorporeal circulation,and peak arterial blood lactate levels. Conclusion The initiation of CPB can damage the vascular endothelial glycocalyx layer (EGL),which may persist for 5-7 days post-operation. The severity of injury is correlated with CPB time,aortic occlusion time,and plasma lactate peak level.
Keywords：Cardiopulmonary bypassEndothelial glycocalyx layerLactateMicrocirculationDuration of cardiopulmonary bypassAortic occlusion time
Publication Date：2024-10-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：8( 387-394 )