Preoperative endothelial dysfunction is a predictor of myocardial injury and major adverse cardiac events. Non-cardiac surgery is known to induce acute endothelial changes. The aim of this explorative cohort study was to assess the extent of systemic endothelial dysfunction after major emergency abdominal surgery and the potential association with postoperative myocardial injury. Patients undergoing major emergency abdominal surgery were included in this prospective cohort study. The primary outcome was the change in endothelial function expressed as the reactive hyperemia index from 4-24 h after surgery until postoperative day 3–5. The reactive hyperemia index was assessed by non-invasive digital pulse tonometry. Secondary outcomes included changes in biomarkers of nitric oxide metabolism and bioavailability. All assessments were performed at the two separate time points in the postoperative period. Clinical outcomes included myocardial injury within the third postoperative day and major adverse cardiovascular events within 30 days of surgery. Between October 2016 and June 2017, 83 patients were included. The first assessment of the endothelial function, 4–24 h, was performed 15.8 (SD 6.9) hours after surgery and the second assessment, postoperative day 3–5, was performed 83.7 (SD 19.8) hours after surgery. The reactive hyperemia index was suppressed early after surgery and did not increase significantly; 1.64 (95% CI 1.52–177) at 4–24 h after surgery vs. 1.75 (95% CI 1.63–1.89) at postoperative day 3–5, p = 0.34. The L-arginine/ADMA ratio, expressing the nitric oxide production, was reduced in the perioperative period and correlated significantly with the reactive hyperemia index. A total of 16 patients (19.3%) had a major adverse cardiovascular event, of which 11 patients (13.3%) had myocardial injury. The L-arginine/ADMA ratio was significantly decreased at 4–24 h after surgery in patients suffering myocardial injury. This explorative pathophysiological study showed that acute systemic endothelial dysfunction was present early after major emergency abdominal surgery and remained unchanged until day 3–5 after the procedure. Early postoperative disturbances in the nitric oxide bioavailability might add to the pathogenesis of myocardial injury. This pathophysiological link should be confirmed in larger studies. clinicaltrials.gov no. NCT03010969.

中文翻译：

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重大急诊腹部手术后的内皮功能障碍和心肌损伤：一项前瞻性队列研究。

术前内皮功能障碍是心肌损伤和主要不良心脏事件的预测指标。已知非心脏手术会引起急性内皮改变。这项探索性队列研究的目的是评估重大急诊腹部手术后系统性内皮功能障碍的程度以及与术后心肌损伤的潜在关系。这项前瞻性队列研究包括接受重大紧急腹部手术的患者。主要结果是内皮功能的变化，表示为术后4-24小时至术后3-5天的反应性充血指数。反应性充血指数通过无创数字脉冲眼压计评估。次要结果包括一氧化氮代谢和生物利用度的生物标志物变化。所有评估均在术后两个不同的时间点进行。临床结果包括术后第三天的心肌损伤和手术后30天内的主要不良心血管事件。在2016年10月至2017年6月之间，共纳入83名患者。首次对内皮功能的评估是在手术后的15.8（SD 6.9）小时进行的4-24小时，第二次评估是在术后的3-5天，在手术后的83.7（SD 19.8）小时进行的第二次评估。术后早期反应性充血指数被抑制，并没有显着增加。术后4–24 h为1.64（95％CI 1.52–177），而术后3-5天为1.75（95％CI 1.63–1.89），p = 0.34。L-精氨酸/ ADMA比值，表示一氧化氮的产生，围手术期的血红蛋白降低，与反应性充血指数显着相关。共有16名患者（19.3％）患有严重的心血管不良事件，其中11名患者（13.3％）患有心肌损伤。患有心肌损伤的患者在手术后4–24小时L-精氨酸/ ADMA比值显着降低。这项探索性的病理生理研究表明，重大腹部急诊手术后较早出现急性系统性内皮功能障碍，直至手术后第3-5天一直保持不变。术后早期一氧化氮的生物利用度紊乱可能会增加心肌损伤的发病机制。这种病理生理联系应在更大的研究中得到证实。Clinicaltrials.gov号 NCT03010969。3％）有严重的不良心血管事件，其中11名患者（13.3％）患有心肌损伤。患有心肌损伤的患者在手术后4–24 h L-精氨酸/ ADMA比值显着降低。这项探索性的病理生理研究表明，重大腹部急诊手术后早期就出现了急性全身性内皮功能障碍，直到手术后的第3-5天一直没有改变。术后早期一氧化氮的生物利用度紊乱可能会增加心肌损伤的发病机制。这种病理生理联系应在更大的研究中得到证实。Clinicaltrials.gov号 NCT03010969。3％）有严重的不良心血管事件，其中11名患者（13.3％）患有心肌损伤。患有心肌损伤的患者在手术后4–24小时L-精氨酸/ ADMA比值显着降低。这项探索性的病理生理研究表明，重大腹部急诊手术后早期就出现了急性全身性内皮功能障碍，直到手术后的第3-5天一直没有改变。术后早期一氧化氮的生物利用度紊乱可能会增加心肌损伤的发病机制。这种病理生理联系应在更大的研究中得到证实。Clinicaltrials.gov号 NCT03010969。这项探索性的病理生理研究表明，重大腹部急诊手术后较早出现急性系统性内皮功能障碍，直至手术后第3-5天一直保持不变。术后早期一氧化氮的生物利用度紊乱可能会增加心肌损伤的发病机制。这种病理生理联系应在更大的研究中得到证实。Clinicaltrials.gov号 NCT03010969。这项探索性的病理生理研究表明，重大腹部急诊手术后较早出现急性系统性内皮功能障碍，直至手术后第3-5天一直保持不变。术后早期一氧化氮的生物利用度紊乱可能会增加心肌损伤的发病机制。这种病理生理联系应在更大的研究中得到证实。Clinicaltrials.gov号 NCT03010969。