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Microvascular reactivity and endothelial glycocalyx degradation when administering hydroxyethyl starch or crystalloid during off-pump coronary artery bypass graft surgery
체외순환 없는 관상동맥 우회술에서 하이드록시에틸 스타치와 정질액 사용에 따른 미세혈관 반응성 및 내피당질층의 분해

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Authors
김태경
Advisor
전윤석
Major
의과대학 의학과
Issue Date
2017-02
Publisher
서울대학교 대학원
Keywords
off-pump coronary artery bypass graftcrystalloidglycocalyxhydroxyethyl starchmicrocirculation
Description
학위논문 (박사)-- 서울대학교 대학원 : 의학과, 2017. 2. 전윤석.
Abstract
Introduction: Fluid infusion may affect tissue microcirculation and endothelial glycocalyx. However, the effects of hydroxyethyl starch and crystalloid on endothelial glycocalyx degradation and microvascular reactivity have not been evaluated in detail. We hypothesized that hydroxyethyl starch may cause less endothelial glycocalyx degradation and better microvascular reactivity than that caused by crystalloid.
Methods: We randomly allocated 120 patients undergoing off-pump coronary artery bypass graft surgery to receive up to 20 ml/kg of either hydroxyethyl starch 670/0.75 or crystalloid for intra-operative fluid resuscitation. Crystalloid was then infused to meet ongoing fluid requirements. During the peri-operative period, vascular occlusion tests were performed to assess microvascular reactivity, and serum syndecan-1 was measured as an index of endothelial glycocalyx degradation.
Results: The median (IQR [range]) fluid infused during surgery was significantly less in the hydroxyethyl starch group than the crystalloid group
2800 (2150-3550 [1400-7300]) vs. 3925 (3100-4725 [1900-6700]) ml, respectively, p < 0.001. Vascular occlusion test parameters, including tissue oxygen saturation, occlusion and recovery slope did not differ significantly between the groups. Peri-operative changes in syndecan-1 were not significantly different between the groups.
Conclusions: We conclude that, in patients undergoing off-pump coronary artery bypass graft surgery, compared with crystalloid, the use of hydroxyethyl starch 670/0.75 did not result in significant differences in microvascular reactivity or endothelial glycocalyx degradation.
Language
English
URI
https://hdl.handle.net/10371/122227
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)Theses (Ph.D. / Sc.D._의학과)
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