禁烟对Gustilo Ⅱ型开放性骨折急诊手术术后并发症、氧化应激和炎症因子的影响
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摘要
目的探讨禁烟对GustiloⅡ型开放性骨折急诊手术术后并发症以及氧化应激和炎症因子水平的影响。方法选取我院四肢GustiloⅡ型开放性骨折拟行急诊手术患者128例,分成对照组和观察组,每组64例。入院后,观察组患者术前及术后6周内严格禁烟,必要时可提供酒石酸伐尼克兰片帮助患者禁烟。对照组患者术前术后不行任何干预吸烟措施。记录两组患者一般资料、术后6周内出现的并发症,检测患者术前和术后6周血浆丙二醛(MDA)、谷胱苷肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)、血浆炎症因子白介素(IL-6)和肿瘤坏死因子(TNF-α)水平。结果观察组患者术后切口感染发生率和术后并发症总发生率显著低于对照组患者(P<0.05)。观察组患者术后6周MDA水平显著低于术前水平和对照组患者术后6周水平(P<0.05),GSH-Px和SOD水平显著高于术前水平和对照组患者术后6周水平(P<0.05)。同时,观察组患者术后6周IL-6和TNF-α水平均显著低于对照组患者(P<0.05)。结论 GustiloⅡ型开放性骨折骨折急诊手术患者禁烟后术后并发症发生率显著降低,体内氧化应激水平和炎症水平降低,抗氧化应激水平上升。
Objective To explore the effect of smoking cessation on postoperative complications,oxidative stress and inflammatory cytokines in open fracture of Gustilo type Ⅱ patients.Methods 128 open fracture of Gustilo type II patients needed acute fracture surgery were randomly assigned to the control group and the observation group(n=64).After admission,patients in the control group were demanded to cease smoking until 6 weeks after the surgery,and varenicline was provided to patients if needed.Patients in the control group did not cease smoking.Patients′ general Information and postoperative complication were recorded,and patients′ malondialdehyde(MDA),glutathioneperoxidase(GSH-Px),superoxidedismutase(SOD),interleukin(IL)-6 and tumor necrosis factor(TNF)-α were tested before the surgery and at postoperative sixth week.Results Incidence rate ofpostoperative incision infection and total postoperative complication were significantly lower in the observation group than that in the control group(P<0.05).Serum MDA level was significantly lower and serum GSH-Px and SOD level were sigficantly higher in the observation group than that in the control group at 6 weeks after surgery(P<0.05).Moreover,serumIL-6 and TNF-α levels were significantly lower in the observation group than that in the control group at postoperative 6 weeks(P<0.05).Conclusion Smoking cessation could decrease incidence rate of postoperative complications,oxidative stress and inflammatory cytokines in open fracture of Gustilo type II patients.
Objective To explore the effect of smoking cessation on postoperative complications,oxidative stress and inflammatory cytokines in open fracture of Gustilo type Ⅱ patients.Methods 128 open fracture of Gustilo type II patients needed acute fracture surgery were randomly assigned to the control group and the observation group(n=64).After admission,patients in the control group were demanded to cease smoking until 6 weeks after the surgery,and varenicline was provided to patients if needed.Patients in the control group did not cease smoking.Patients′ general Information and postoperative complication were recorded,and patients′ malondialdehyde(MDA),glutathioneperoxidase(GSH-Px),superoxidedismutase(SOD),interleukin(IL)-6 and tumor necrosis factor(TNF)-α were tested before the surgery and at postoperative sixth week.Results Incidence rate ofpostoperative incision infection and total postoperative complication were significantly lower in the observation group than that in the control group(P<0.05).Serum MDA level was significantly lower and serum GSH-Px and SOD level were sigficantly higher in the observation group than that in the control group at 6 weeks after surgery(P<0.05).Moreover,serumIL-6 and TNF-α levels were significantly lower in the observation group than that in the control group at postoperative 6 weeks(P<0.05).Conclusion Smoking cessation could decrease incidence rate of postoperative complications,oxidative stress and inflammatory cytokines in open fracture of Gustilo type II patients.
引文
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[22]Porter SE,Hanley EJ.The musculoskeletal effects of smoking[J].J Am Acad Orthop Surg,2001,9(1):9-17.
[23]Gaston MS,Simpson AH.Inhibition of fracture healing[J].JBone Joint Surg Br,2007,89(12):1553-1560.
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[25]Adams CI,Keating JF,Court-Brown CM.Cigarette smoking and open tibial fractures[J].Injury,2001,32(1):61-65.2019-02-11
[2]Kuri M,Nakagawa M,Tanaka H,et al.Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery[J].Anesthesiology,2005,102(5):892-896.
[3]Little CP,Burston BJ,Hopkinson-Woolley J,et al.Failure of surgery for scaphoid non-union is associated with smoking[J].J Hand Surg Br,2006,31(3):252-255.
[4]Sorensen LT,Jorgensen T,Kirkeby LT,et al.Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery[J].Br J Surg,1999,86(7):927-931.
[5]Tonnesen H,Nielsen PR,Lauritzen JB,et al.Smoking and alcohol intervention before surgery:evidence for best practice[J].Br J Anaesth,2009,102(3):297-306.
[6]蔡兴志,于爱兰,张平,等.尼古丁依赖程度对术后阿片类镇痛药需求量的影响[J].国际麻醉学与复苏杂志,2014,35(10):909-914.
[7]Cdc P.Vital signs:current cigarette smoking among adults aged≥18 years--United States,2005-2010[J].MMWR Morb Mortal Wkly Rep,2011,60(35):1207-1212.
[8]Czernin J,Waldherr C.Cigarette smoking and coronary blood flow[J].Prog Cardiovasc Dis,2003,45(5):395-404.
[9]Turan A,Mascha EJ,Roberman D,et al.Smoking and perioperative outcomes[J].Anesthesiology,2011,114(4):837-846.
[10]Wipfli H,Samet JM.Global economic and health benefits of tobacco control:part 1[J].Clin Pharmacol Ther,2009,86(3):263-271.
[11]Mills E,Eyawo O,Lockhart I,et al.Smoking cessation reduces postoperative complications:a systematic review and meta-analysis[J].Am J Med,2011,124(2):144-154.
[12]Kuri M,Nakagawa M,Tanaka H,et al.Determination of the duration of preoperative smoking cessation to improve wound healing after head and neck surgery[J].Anesthesiology,2005,102(5):892-896.
[13]Lindstrom D,Sadr A O,Wladis A,et al.Effects of a perioperative smoking cessation intervention on postoperative complications:a randomized trial[J].Ann Surg,2008,248(5):739-745.
[14]Wong J,Lam DP,Abrishami A,et al.Short-term preoperative smoking cessation and postoperative complications:a systematic review and meta-analysis[J].Can J Anaesth,2012,59(3):268-279.
[15]Whiteford L.Nicotine,CO and HCN.the detrimental effects of smoking on wound healing[J].Br J Community Nurs,2003,8(12):S22-S26.
[16]Zevin S,Gourlay SG,Benowitz NL.Clinical pharmacology of nicotine[J].Clin Dermatol,1998,16(5):557-564.
[17]Hoogendoorn JM,Simmermacher RK,Schellekens PP,et al.Adverse effects if smoking on healing of bones and soft tissues[J].Unfallchirurg,2002,105(1):76-81.
[18]Sorensen LT,Nielsen HB,Kharazmi A,et al.Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes[J].Surgery,2004,136(5):1047-1053.
[19]Sorensen LT,Toft BG,Rygaard J,et al.Effect of smoking,smoking cessation,and nicotine patch on wound dimension,vitamin C,and systemic markers of collagen metabolism[J].Surgery,2010,148(5):982-990.
[20]Guan R,Wang J,Li Z,et al.Sodium tanshinone IIA sulfonate decreases cigarette smoke-induced inflammation and oxidative stress via blocking the activation of MAPK/HIF-1alpha signaling pathway[J].Front Pharmacol,2018,9:263.
[21]Ramos CO,Campos K,Costa GP,et al.Taurine treatment decreases inflammation and oxidative stress in lungs of adult mice exposed to cigarette smoke[J].Regul Toxicol Pharmacol,2018,98:50-57.
[22]Porter SE,Hanley EJ.The musculoskeletal effects of smoking[J].J Am Acad Orthop Surg,2001,9(1):9-17.
[23]Gaston MS,Simpson AH.Inhibition of fracture healing[J].JBone Joint Surg Br,2007,89(12):1553-1560.
[24]Castillo RC,Bosse MJ,Mackenzie EJ,et al.Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures[J].J Orthop Trauma,2005,19(3):151-157.
[25]Adams CI,Keating JF,Court-Brown CM.Cigarette smoking and open tibial fractures[J].Injury,2001,32(1):61-65.2019-02-11