术前预防性使用甲泼尼龙对食管癌根治术患者细胞因子及预后的影响
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摘要
目的探讨术前预防性使用甲泼尼龙对食管癌根治术患者细胞因子及预后的影响。方法选取接受全麻择期开胸食管癌根治术患者70例。年龄18～80岁,ASA分级Ⅰ～Ⅲ级。患者分为甲泼尼龙组(Met组)和对照组(C组)各35例。Met组患者于术前30 min静脉滴注甲泼尼龙10 mg/kg。C组患者静脉滴注等量生理盐水。两组患者于术前(T0)、术毕(T1)、术后1 d(T2)、术后3 d(T3)、术后7 d(T4)抽静脉血检测白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)水平。记录患者术后7 d内心力衰竭、呼吸衰竭、肝肾功能衰竭等各器官衰竭情况,同时记录两组患者术后切口感染、吻合口瘘发生率。结果Met组患者术后7 d内呼吸衰竭发生率显著低于C组,差异有统计学意义(P <0. 05)。两组患者术后7 d内切口感染发生率差异无统计学意义(P> 0. 05)。Met组患者T1、T2、T3时点IL-6、IL-8水平显著低于C组,差异有统计学意义(P <0. 05)。Met组患者T1、T2时点IL-10水平显著高于C组,差异有统计学意义(P <0. 05)。结论甲泼尼龙能够有效降低食管癌根治术患者细胞因子水平,降低呼吸衰竭发生率,改善患者预后。
引文
[1]刘孝民,李玮,张伟民,等.胸腹腔镜联合Ivor Lewis食管癌根治术的疗效及对肺功能的影响[J].广东医学,2013,34(17):2681-2683.
[2]Hirahara N,Matsubara T,Kawahara D,et al.Prognostic significance of preoperative inflammatory response biomarkers in patients undergoing curative thoracoscopic esophagectomy for esophageal squamous cell carcinoma[J].Eur J Surg Oncol,2017,43(2):493-501.
[3]Swisher SG,Hunt KK,Holmes EC,et al.Changes in the surgical management of esophageal cancer from 1970 to 1993[J].Am JSurg,1995,169(6):609-614.
[4]Isono K,Sato H,Nakayama K.Results of nationwide study on the three-field lymph node dissection of esophageal cancer[J].Oncology,1991,48(5):411-420.
[5]Fok M,Law SY,Wong J.Operable esophageal carcinoma:Current results from Hong Kong[J].World J Surg,1994,18(3):355-360.
[6]Sauerland S,Nagelschmidt M,Mallmann P,et al.Risks and benefits of preoperative high-dose methylprednisolone in surgical patients[J].Drug Safety,2000,23(5):449-461.
[7]Donneyong MM,Kulik A,Gagne JJ.Trends and Patterns of Corticosteroid Use During Coronary Artery Bypass Grafting Surgery in the United States[J].J Cardiovasc Pharmacol Ther,2018,23(3):226-236.
[8]Komatsu R,You J,Rajan S,et al.Steroid Administration after Anaesthetic Induction with Etomidate does not Reduce In-hospital Mortality or Cardiovascular Morbidity after Non-cardiac Surgery[J].Br J Anaesth,2018,120(3):501-508.
[9]Parkin DM,Bray F,Ferlay J,et al.Global cancer statistics.2002[J].CA Cancer J Clin,2005,55(2):74-108.
[10]Law S,Wong J.Current management of esophageal cancer[J].JGastrointest Surg,2005,9(2):291-310.
[11]Leigh Y,Goldacre M,Mc Culloch P.Surgical specialty,surgical unit volume and mortality after oesophageal cancer surgery[J].Eur J Surg Oncol,2009,35(8):820-825.
[12]Tanaka T,Narazaki M,Kishimoto T.IL-6 in Inflammation,Immunity,and Disease[J].Cold Spring Harb Perspect Biol,2014,6(10):a016295.
[13]Okamura A,Takeuchi H,Matsuda S,et al.Factors Affecting Cytokine Change After Esophagectomy for Esophageal Cancer[J].Ann Surg Oncol,2015,22(9):3130-3135.
[14]Mannino MH,Zhu Z,Xiao H,et al.The paradoxical role of IL-10 in immunity and cancer[J].Cancer Lett,2015,367(2):103-107.
[15]Doyle SL,Mongan AM,Donohoe CL,et al.Impact of visceral obesity and metabolic syndrome on the postoperative immune,inflammatory,and endocrine response following surgery for esophageal adenocarcinoma[J].Dis Esophagus,2017,30(6):1-11.
[16]Wakabayashi S,Yamaguchi K,Kumakura S,et al.Effects of anesthesia with sevoflurane and propofol on the cytokine/chemokine production at the airway epithelium during esophagectomy[J].Int J Mol Med,2014,34(1):137-144.
[17]Horikoshi Y,Goyagi T,Kudo R,et al.The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia,and plasma IL-6 elevation in patients undergoing esophageal surgery:A randomized controlled clinical trial[J].J Clin Anesth,2017,38(5):111-116.
[18]Skroubis G,Theofanis G,Spyropoulos C,et al.Preoperative High Dose of Methylprednisolone Improves Early Postoperative Pulmonary Function,in Super-Obese Patients Undergoing Open Surgery;a Prospective,Comparative Study[J].J Gastrointest Surg,2016,20(12):1959-1965.
[19]Morita M,Yoshida R,Ikeda K,et al.Acute lung injury following an esophagectomy for esophageal cancer,with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid[J].Dis Esophagus,2008,21(1):30-36.
[20]Kehlet H.Glucocorticoids for peri-operative analgesia:how far are we from general recommendations?[J].Acta Anaesthesiol Scand,2007,51(9):1133-1135.
[21]Gan TJ,Meyer TA,Apfel CC,et al.Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2007,105(6):1615-1628.
[22]Takeda S,Takeda S,Kim C,et al.Preoperative administration of methylprednisolone attenuates cytokine-induced respiratory failure after esophageal resection[J].J Nippon Med Sch,2003,70(1):16-20.
[23]Matsutani T,Onda M,Sasajima K,et al.Glucocorticoid attenuates a decrease of antithrombin III following major surgery[J].JSurg Res,1998,79(2):158-163.
[24]Chiller TM,Roy M,Nguyen D,et al.Clinical findings for fungal infections caused by methylprednisolone injections[J].N Engl JMed,2013,369(17):1610-1619.
[2]Hirahara N,Matsubara T,Kawahara D,et al.Prognostic significance of preoperative inflammatory response biomarkers in patients undergoing curative thoracoscopic esophagectomy for esophageal squamous cell carcinoma[J].Eur J Surg Oncol,2017,43(2):493-501.
[3]Swisher SG,Hunt KK,Holmes EC,et al.Changes in the surgical management of esophageal cancer from 1970 to 1993[J].Am JSurg,1995,169(6):609-614.
[4]Isono K,Sato H,Nakayama K.Results of nationwide study on the three-field lymph node dissection of esophageal cancer[J].Oncology,1991,48(5):411-420.
[5]Fok M,Law SY,Wong J.Operable esophageal carcinoma:Current results from Hong Kong[J].World J Surg,1994,18(3):355-360.
[6]Sauerland S,Nagelschmidt M,Mallmann P,et al.Risks and benefits of preoperative high-dose methylprednisolone in surgical patients[J].Drug Safety,2000,23(5):449-461.
[7]Donneyong MM,Kulik A,Gagne JJ.Trends and Patterns of Corticosteroid Use During Coronary Artery Bypass Grafting Surgery in the United States[J].J Cardiovasc Pharmacol Ther,2018,23(3):226-236.
[8]Komatsu R,You J,Rajan S,et al.Steroid Administration after Anaesthetic Induction with Etomidate does not Reduce In-hospital Mortality or Cardiovascular Morbidity after Non-cardiac Surgery[J].Br J Anaesth,2018,120(3):501-508.
[9]Parkin DM,Bray F,Ferlay J,et al.Global cancer statistics.2002[J].CA Cancer J Clin,2005,55(2):74-108.
[10]Law S,Wong J.Current management of esophageal cancer[J].JGastrointest Surg,2005,9(2):291-310.
[11]Leigh Y,Goldacre M,Mc Culloch P.Surgical specialty,surgical unit volume and mortality after oesophageal cancer surgery[J].Eur J Surg Oncol,2009,35(8):820-825.
[12]Tanaka T,Narazaki M,Kishimoto T.IL-6 in Inflammation,Immunity,and Disease[J].Cold Spring Harb Perspect Biol,2014,6(10):a016295.
[13]Okamura A,Takeuchi H,Matsuda S,et al.Factors Affecting Cytokine Change After Esophagectomy for Esophageal Cancer[J].Ann Surg Oncol,2015,22(9):3130-3135.
[14]Mannino MH,Zhu Z,Xiao H,et al.The paradoxical role of IL-10 in immunity and cancer[J].Cancer Lett,2015,367(2):103-107.
[15]Doyle SL,Mongan AM,Donohoe CL,et al.Impact of visceral obesity and metabolic syndrome on the postoperative immune,inflammatory,and endocrine response following surgery for esophageal adenocarcinoma[J].Dis Esophagus,2017,30(6):1-11.
[16]Wakabayashi S,Yamaguchi K,Kumakura S,et al.Effects of anesthesia with sevoflurane and propofol on the cytokine/chemokine production at the airway epithelium during esophagectomy[J].Int J Mol Med,2014,34(1):137-144.
[17]Horikoshi Y,Goyagi T,Kudo R,et al.The suppressive effects of landiolol administration on the occurrence of postoperative atrial fibrillation and tachycardia,and plasma IL-6 elevation in patients undergoing esophageal surgery:A randomized controlled clinical trial[J].J Clin Anesth,2017,38(5):111-116.
[18]Skroubis G,Theofanis G,Spyropoulos C,et al.Preoperative High Dose of Methylprednisolone Improves Early Postoperative Pulmonary Function,in Super-Obese Patients Undergoing Open Surgery;a Prospective,Comparative Study[J].J Gastrointest Surg,2016,20(12):1959-1965.
[19]Morita M,Yoshida R,Ikeda K,et al.Acute lung injury following an esophagectomy for esophageal cancer,with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid[J].Dis Esophagus,2008,21(1):30-36.
[20]Kehlet H.Glucocorticoids for peri-operative analgesia:how far are we from general recommendations?[J].Acta Anaesthesiol Scand,2007,51(9):1133-1135.
[21]Gan TJ,Meyer TA,Apfel CC,et al.Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2007,105(6):1615-1628.
[22]Takeda S,Takeda S,Kim C,et al.Preoperative administration of methylprednisolone attenuates cytokine-induced respiratory failure after esophageal resection[J].J Nippon Med Sch,2003,70(1):16-20.
[23]Matsutani T,Onda M,Sasajima K,et al.Glucocorticoid attenuates a decrease of antithrombin III following major surgery[J].JSurg Res,1998,79(2):158-163.
[24]Chiller TM,Roy M,Nguyen D,et al.Clinical findings for fungal infections caused by methylprednisolone injections[J].N Engl JMed,2013,369(17):1610-1619.