| on endothelial glycocalyx,and to explore the optimal volume treatment scheme to guide thePart ?Effects of different preload on endothelial glycocalyx and prognosis of in patients undergoing gastrointestinal surgeryObjective:To explore the effects of different preloadperioperative fluid therapy.Methods:Fifty-four patients for selective gastrointestinal surgery,ASA ???,wihout serious circulation system,respiratory system,endocrine system disorder.According to the sequence of operations,the patients were randomly divided into 3 groups(n=18),respectively:Group H(11%? SVV?14%),Group M(7%?SVV?10%)and Group L(3%<SW<6%).Adjusting the fluid infusing to make the SVV of each group reach the three levels of 11%?14%,7%?10%or 3%?6%respectively under the condition of non-pneumoperitoneum.Venous blood was extracted from patients after admission in operation room(T1),after anesthesia induction(T2)and at the beginning of incision suturing(T3),and the blood was centrifuged for serum.The Elisa was taken to measure the ANP and the EG degration products in serum,such as HA,HS,CD44,syndecan-1.And the BP,HR,Sp02,body temperature,SVV,PPV,CO,CI,and so on was recorded.Arterial blood gas analysis was performed.Postoperative follow-up observation was initiated to record the length of hospital stay,postoperative hospital stay,recovery time of gastrointestinal function,urinary tube indwelling time,bed time,postoperative complications.Results:1.There was no significant difference between syndecan-1,CD44,HA and HS in time T1 and T2(P>0.05).At time point T3,the concentration of HA,HS,CD44 and syndecan-1 was higher than these in T1 and T2(P<0.05).At T3 time point,the concentration of syndecan-1 in group L was higher that that in group H and group M(P<0.05),the concentration of CD44 in group L was higher that that in group H(P<0.05),the concentration of HA in group L was higher that that in group H and group M(P<0.05),the concentration of HS in group L was higher that that in group H(P<0.05)and the concentration of HS in group M was higher that that in group H(P<0.05).2.As the value of SVV decreased,the serum level of atrial natriuretic peptide in patients increased gradually.There was no significance of ANP concentration between three groups at the T1 and T2(P>0.05).ANP concentration at T3 was significantly higher than T1 and T2(P<0.05).At T3,the ANP concentration in group L was higher than that of group H(P<0.05).ANP was moderately correlated with HA,CD44 and syndecan-1(ANP vs.HA:r=0.540,ANP vs.CD44:r=0.676,ANP vs.Syndecan-1:r=0.552),and the correlation between ANP and HS is low(r=0.475).3.There was no significant difference in MAP and HR among the three groups at T1?T2 and T3(P>0.05).There was no significant difference between CO and CI among the three groups at T2(P>0.05).At T3,the values of CO and CI in the group L were higher than these in group H and the group M(P<0.05).4.There was significantly different between the oxygenation index value at T3(418±66)and the oxygenation index at T2(479±86)in group L(P<0.05).5.There was no difference in each group about total hospital stay,postoperative hospital stay,fart time,indwelling gastrointestinal decompression time,fasting time,indwelling time of urinary catheter,and bed rest time of patients(P>0.05).However,in terms of the clinical significance of the statistical results,the postoperative recovery of group M was better than that of group H and group L.Conclusion:When SVV was maintained at 3%?6%,the degradation of EG was more severe.Part ? Effects of different preloads and atrial natriuretic peptides on intestinal microvascular permeability and endothelial glycocalyx in SD ratsObjective:To evaluate the effects of different preloads on the vascular permeability of small intestinal microvessels in SD rats,and to explore the effects of different fluid loads and different doses of atrial natriuretic peptides on endothelial glycocalyx.Methods:(1)One hundred and twenty nine SD rats were randomly divided into 3 groups(n=43)according to the amount of hydroxyethyl starch sodium chloride injection,namely group Sham,group 5 ml/kg(infusing 5ml/kg hydroxyethyl starch sodium chloride injection)and group 25 ml/kg(infusing 25ml/kg hydroxyethyl starch sodium chloride injection)respectively.All of the animal underwent explortory lprotomy,at the same time,5 ml/kg or 25 ml/kg hydroxyethyl starch sodium chloride injection was rapidly injected via femoral vein,and laparotomy was performed only in Sham group.Transmission electron microscopy was employed to observe endothelial glycocalyx of the intestine immediately after infusion(0 hour).And after infusion 0 hours,24 hours,48 hours,72 hours using HE staining to evaluate the rat small intestine mucosa damage,Evans blue method to evaluate intestinal vascular permeability,Elisa to measure serum vascular endothelial glycocalyx components,Western blot to mesure syndecan-1 expression.(2)According to the amount of atrial natriuretic peptide injection,72 SD rats were randomly divided into 4 groups(n=18),namely Sham group(lml normal saline injection),2 group ?g/kg,10 group ?g/kg,and group 20 ?g/kg.According to body weight,1ml normal saline or different doses of atrial natriuretic peptide were injected via tail vein.At 0 h,24 h,and 48 h after the injection of atrial natriuretic peptide,the vascular permeability of the small intestine was evaluated by EB injection,and the expression level of syndecan-1 was measured by Western blot.(3)The primary intestinal microvascular endothelial cells of SD rats were cultured.After identifying the cell purity,the atrial natriuretic peptide(0.1 ?g/ml)was treated for 24 hours,and the expression level of syndecan-1 was measured by western blot.Results:1.The direct damage to intestinal mucosa of small intestine in rats was not obvious by massive rapid infusion.The EG thicknessin the 25ml/kg group[42.06(58.49)nm]was thinner than that in the group Sham[105.02(60.27)nm]and group 5ml/kg[146.10(97.61)nm](P<0.05),and its continuity was interrupted.Intestinal vascular permeability in the group 25ml/kg at all time points(0 h,24 h,48 h,72 h)was significantly higher than that of the Sham group and the 5ml/kg group(P<0.05).Serum concentrations of HS and CS in the group 25ml/kg were higher at 0 h,24 h and 48 h than those in the group Sham and group 5ml/kg(P<0.05).At each time point(0 h,24 h,48 h,72 h),the serum ANP concentration in the group 25ml/kg was higher than that in the group Sham and the group 5ml/kg(P<0.05).In the group 25ml/kg,the expression of syndecan-1 in the small intestinal tissue immediately after infusion(0 h)was lower than that in the group Sham and the group 5ml/kg(P<0.05).Forty eight hour later,the expression of syndecan-1 in the group 25 ml/kg was higher than that in the group Sham and the group 5ml/kg(P<0.05).2.Intestinal vascular permeability of the group 10?g/kg and group 20?g/kg increased at each time point(Oh,24h,72h)compared with the group Sham and the group 2?g/kg after ANP injection(P<0.05).The expression of syndecan-1 in the small intestine of the group 10?g/kg and the group 20?g/kg decreased immediately(0 h)after ANP injection compared with the group Sham and the group 2?g/kg(P<0.05).After 24 hours,the expression of syndecan-1 in the small intestine in the group 10?g/kg and the group 20?g/kg was higher than that of the group Sham and the group 2?g/kg(P<0.05).After 72 hours,the expression of syndecan-1 in each group was basically consistent(P>0.05).3.Treated with 0.1 ?g/ml and 0.4 ?g/ml ANP could reduce the expression of syndecan-1 in intestinal microvascular endothelial cells in rats compared with group Sham and group 0.05?g/ml(P<0.05).Conclusion:Infused with 25 ml/kg hydroxyethyl starch sodium chloride injection and large dose ANP can damage and degrade the endothelial glycocalyx in SD rats by affecting the expression of syndecan-1. |
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