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目的观察异丙酚对重症脓毒症患者血管内皮细胞损伤的影响。方法构建重症脓毒症患者血清攻击脐静脉模型,监测异丙酚对重症脓毒症患者培养上清血循环血管内皮细胞(CEC)的数量、血管性假血友病因子(von willebrand factor,v WF)和可溶性血栓调节素(soluble thrombomodulin,s TM)水平的影响。结果重症脓毒症患者血清CEC数量、v WF和s TM水平明显高于健康对照组(P<0.05)。进一步体外实验发现重症脓毒症患者血清可损伤脐静脉内皮,造成培养上清CEC数量、v WF和s TM水平显著升高(P<0.05)。异丙酚可明显减少CEC数量(P<0.05),同时下调v WF和s TM水平(P<0.05)。体外实验也发现异丙酚对重症脓毒症患者血清引起的脐静脉内皮损伤具有保护作用,其培养上清的CEC数量明显减少,同时v WF和s TM水平显著下降(P<0.05)。结论重症脓毒症患者存在严重内皮细胞损伤,异丙酚对重症脓毒症患者内皮细胞损伤具有保护作用。
Objective To investigate the effect of propofol on the injury of vascular endothelial cells in patients with severe sepsis. Methods The sera from patients with severe sepsis were challenged with the serum of umbilical vein to monitor the number of circulating vascular endothelial cells (CECs), the von willebrand factor (v WF) ) And soluble thrombomodulin (s TM) levels. Results Serum CEC levels, v WF and s TM levels in severe sepsis patients were significantly higher than those in healthy controls (P <0.05). Further in vitro experiments showed that sera of patients with severe sepsis could damage the umbilical vein endothelium, resulting in the increase of the number of CEC and the levels of v WF and s TM in the culture supernatant (P <0.05). Propofol significantly reduced the number of CECs (P <0.05) and vWF and s TM levels (P <0.05). In vitro experiments also found that propofol has a protective effect on serum umbilical vein endothelial cells induced by sepsis in severe sepsis patients. The number of CECs in the culture supernatant decreased significantly, while v WF and s TM levels decreased significantly (P <0.05). Conclusion Severe endothelial cell injury exists in severe sepsis patients. Propofol has a protective effect on endothelial cell injury in severe sepsis patients.