Journal of cardiothoracic and vascular anesthesia · 2025
Effect of Dexmedetomidine on Endothelial Glycocalyx in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Fan Yuxiu, Chen Beini, Fang Fuquan, Gao Wei, Wu Qiaolin, Wang WeiJian, He Guoliang
Аннотация
OBJECTIVE: To evaluate the protective role of dexmedetomidine on endothelial glycocalyx in cardiac surgery patients undergoing cardiopulmonary bypass (CPB).
DESIGN: Randomized controlled trial.
SETTING: Single-center study conducted from June 2022 to December 2022.
PARTICIPANTS: Fifty-eight patients who underwent elective valvular cardiac surgery with CPB.
INTERVENTIONS: Patients were randomly assigned to either the dexmedetomidine group (n = 29) or the saline group (n = 29), with infusion starting 10 minutes before anesthesia induction and continuing throughout the maintenance phase.
MEASUREMENTS AND MAIN RESULTS: Radial artery blood samples were collected at 4 time points: T1, before anesthesia induction; T2, 5 minutes after aortic unclamping; T3, 1 hour postoperatively; and T4, 24 hours postoperatively. The primary endpoint was plasma syndecan-1 concentration, and secondary endpoints were heparin sulfate and tumor necrosis factor-alpha (TNF-α) levels, and long-term clinical outcomes. Compared with controls, the dexmedetomidine group showed significantly less glycocalyx shedding, an effect that persisted throughout CPB and recovery. TNF-α levels were significantly lower at T2-T3, along with reduced lactate levels on aortic unclamping.
CONCLUSIONS: Dexmedetomidine preserves endothelial glycocalyx integrity and attenuates systemic inflammation in CPB patients.
DESIGN: Randomized controlled trial.
SETTING: Single-center study conducted from June 2022 to December 2022.
PARTICIPANTS: Fifty-eight patients who underwent elective valvular cardiac surgery with CPB.
INTERVENTIONS: Patients were randomly assigned to either the dexmedetomidine group (n = 29) or the saline group (n = 29), with infusion starting 10 minutes before anesthesia induction and continuing throughout the maintenance phase.
MEASUREMENTS AND MAIN RESULTS: Radial artery blood samples were collected at 4 time points: T1, before anesthesia induction; T2, 5 minutes after aortic unclamping; T3, 1 hour postoperatively; and T4, 24 hours postoperatively. The primary endpoint was plasma syndecan-1 concentration, and secondary endpoints were heparin sulfate and tumor necrosis factor-alpha (TNF-α) levels, and long-term clinical outcomes. Compared with controls, the dexmedetomidine group showed significantly less glycocalyx shedding, an effect that persisted throughout CPB and recovery. TNF-α levels were significantly lower at T2-T3, along with reduced lactate levels on aortic unclamping.
CONCLUSIONS: Dexmedetomidine preserves endothelial glycocalyx integrity and attenuates systemic inflammation in CPB patients.