Development of perioperative blood glucose control methods for prevention of postoperative vascular endothelial glycocalyx disorders

开发围手术期血糖控制方法以预防术后血管内皮糖萼疾病

• 批准号: 22K09093
• 负责人: 江木 盛時
• 金额: $ 2.66万
• 依托单位: Kyoto University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2022
• 资助国家: 日本
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-22K09093/
• 关键词: 血管内皮グリコカリックス障害; 心臓手術患者; 術後急性腎障害; 持続血糖測定; 周術期血糖管理

本年度は、人工心肺を用いた心臓手術患者52名の周術期血液検体を用い、血管内皮グリコカリックス障害のマーカーとしてシンデカン-1値を測定した。患者群の平均年齢は69.8歳、男性63.5％、平均Euro score3.97であった。75％の患者に弁膜症手術が行われ、38％の患者に大動脈手術が施行された。周術期推移の評価のために、手術前、人工心肺開始1時間後、人工心肺開始２時間後、人工心肺終了後２時間後、術翌日のシンデカン値を測定した。周術期におけるシンデカン値の中央値は、手術前35.4ng/ml、人工心肺開始1時間後196.6ng/ml、人工心肺開始２時間後227.1ng/ml、人工心肺終了後２時間後251.2ng/ml、術翌日65.4ng/mlであり、人工心肺開始後からシンデカン-1は増加し、翌日には低下した。臓器障害の一つとして術後急性腎障害（AKI)との関連は、術翌実におけるシンデカン-1に認め、AKI非発生群における中央値で53.3ng/ml、AKI発生群における中央値で97.1ng/ml（p<0.05)であった。術後48時間以内に発生したせん妄の有無で二群に分けて、周術期シンデカンー１の値を検討した。手術前、人工心肺開始1時間後、人工心肺開始２時間後、人工心肺終了後２時間後、術翌日のいずれにおいても有意差はなかった。本年度も患者数集積を継続し、持続血糖測定から得られた血糖指標との関連を検討していく予定である。

This year, 52 patients undergoing cardiopulmonary bypass surgery were evaluated for their blood and vascular endothelial dysfunction. The average age of the patient group was 69.8 years, male 63.5%, and average Euro score 3.97. 75% of patients underwent systemic surgery and 38% underwent arterial surgery. The evaluation of the duration of the operation, before the operation, 1 time after the start of the artificial heart and lung, 2 time after the start of the artificial heart and lung, and the next day of the operation were measured. During the operation period, the concentration of CPD was 35.4 ng/ml before operation, 196.6 ng/ml after the start of artificial heart and lung, 227.1 ng/ml after the start of artificial heart and lung, 251.2 ng/ml after the end of artificial heart and lung, 65.4 ng/ml after operation, and increased to-1 after the start of artificial heart and lung. The correlation between organ dysfunction and postoperative acute renal impairment (AKI) was significantly higher than that between AKI and postoperative acute renal impairment (AKI). The median value of AKI non-onset group was 53.3 ng/ml, and that of AKI onset group was 97.1 ng/ml (p<0.05). There are two groups of patients who are born within 48 hours after operation, and the first group of patients who are born within 48 hours after operation are discussed. Before operation, 1 hour after artificial cardiopulmonary start, 2 hours after artificial cardiopulmonary end, the next day after operation The number of patients in this year's study was increased, and the relationship between blood glucose measurement and blood glucose measurement was determined.