目的 觀察異丙酚對重癥膿毒癥患者血管內(nèi)皮細胞損傷的影響。方法 構(gòu)建重癥膿毒癥患者血清攻擊臍靜脈模型,監(jiān)測異丙酚對重癥膿毒癥患者培養(yǎng)上清血循環(huán)血管內(nèi)皮細胞(CEC)的數(shù)量、血管性假血友病因子(von willebrand factor,vWF)和可溶性血栓調(diào)節(jié)素(soluble thrombomodulin,sTM)水平的影響。結(jié)果 重癥膿毒癥患者血清CEC數(shù)量、vWF和sTM水平明顯高于健康對照組(P<0.05)。進一步體外實驗發(fā)現(xiàn)重癥膿毒癥患者血清可損傷臍靜脈內(nèi)皮,造成培養(yǎng)上清CEC數(shù)量、vWF和sTM水平顯著升高(P<0.05)。異丙酚可明顯減少CEC數(shù)量(P<0.05),同時下調(diào)vWF和sTM水平(P<0.05)。體外實驗也發(fā)現(xiàn)異丙酚對重癥膿毒癥患者血清引起的臍靜脈內(nèi)皮損傷具有保護作用,其培養(yǎng)上清的CEC數(shù)量明顯減少,同時vWF和sTM水平顯著下降(P<0.05)。結(jié)論 重癥膿毒癥患者存在嚴重內(nèi)皮細胞損傷,異丙酚對重癥膿毒癥患者內(nèi)皮細胞損傷具有保護作用。

Objective To investigate the effect of Propofol on vascular endothelial cell injuries in patients with severe sepsis.. Methods Vascular endothelial damage markers including circulating endothelial cells (CEC), von willebrand factor (vWF), and soluble thrombomodulin (sTM) were tested. Serums derived from the patients with severe sepsis were used to attack the model of umbilical vein as an in vitro model and the effect of Propofol on vascular endothelial cell injury was observed. Results In both in vivo and in vitro studies, CEC, vWF, and sTM showed significantly increased. Furthermore, Propofol can significantly reduce the number of CEC and the serum concentration of vWF and sTM (P<0.05). In vitro studies have found similar results. Conclusion Serious endothelial cell injuries are observed in the severe septic patients. Propofol has the beneficial protection on the endothelial cells in the patients with severe sepsis.

全軍醫(yī)藥衛(wèi)生科研項目重點專項(10BJZ09);廣東省科技計劃項目(2012A061400010);廣東省廣州市科研條件建設(shè)項目(穗科信字[2012]224-5號)