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,vWF)和可溶性血栓调节素(soluble thrombomodulin,sTM)水平的影响。结果 重症脓毒症患者血清CEC数量、vWF和sTM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、vWF和sTM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vWF和sTM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vWF和sTM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 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.

全军医药卫生科研项目重点专项(10BJZ09);广东省科技计划项目(2012A061400010);广东省广州市科研条件建设项目(穗科信字[2012]224-5号)