Takeda Shinhiro, Takeda Shinhiro, Kim Chol, Ikezaki Hiroyuki, Nakanishi Kazuhiro, Sakamoto Atsuhiro, Okawa Kei-ichi, Miyashita Masao, Sasajima Koji, Tajiri Takashi, Tanaka Keiji, Ogawa Ryo
Division of Intensive Care Unit and Coronary Care Unit, Nippon Medical School Hospital and Department of Anesthesiology, Nippon Medical School, Tokyo, Japan.
J Nippon Med Sch. 2003 Feb;70(1):16-20. doi: 10.1272/jnms.70.16.
Proinflammatory cytokines have been implicated in mediating respiratory failure associated with major surgery. We investigated the effect of giving glucocorticoids preoperatively for the prophylaxis of surgical stress and the association of cytokine levels, such as interleukin-6 (IL-6) and interleukin-8 (IL-8), with oxygenation after esophagectomy. We studied 17 patients who underwent subtotal esophagectomy. Seven patients (steroid group) were chosen at random to be given methylprednisolone (10 mg/kg) and 10 patients (control group) to be given saline intravenously before operation. Plasma and bronchoalveolar lavage fluid (BALF) IL-8 levels in the control group were significantly higher than those in the steroid group. In both groups, plasma IL-6 levels were significantly higher than those in BALF, but in contrast, BALF IL-8 levels were significantly higher than plasma levels of IL-8 postoperatively. The PaO(2)/FiO(2) ratio was significantly reduced in the control group. The PaO(2)/FiO(2) ratio of the control group had significantly lower values than that of the steroid group. There was significant correlation between BALF IL-8 levels and the PaO(2)/FiO(2) ratio postoperatively. We conclude that preoperative administration of methylprednisolone may attenuate postoperative reduction of arterial oxygen saturation by suppressing the release of cytokines.
促炎细胞因子被认为在介导与大手术相关的呼吸衰竭中起作用。我们研究了术前给予糖皮质激素预防手术应激的效果，以及细胞因子水平（如白细胞介素-6（IL-6）和白细胞介素-8（IL-8））与食管癌切除术后氧合的关系。我们研究了17例行食管次全切除术的患者。随机选择7例患者（类固醇组）在术前静脉给予甲泼尼龙（10mg/kg），10例患者（对照组）给予生理盐水。对照组血浆和支气管肺泡灌洗液（BALF）中的IL-8水平显著高于类固醇组。两组中，血浆IL-6水平均显著高于BALF中的水平，但相反，术后BALF中的IL-8水平显著高于血浆中的IL-8水平。对照组的PaO₂/FiO₂比值显著降低。对照组的PaO₂/FiO₂比值显著低于类固醇组。术后BALF中的IL-8水平与PaO₂/FiO₂比值之间存在显著相关性。我们得出结论，术前给予甲泼尼龙可能通过抑制细胞因子的释放来减轻术后动脉血氧饱和度的降低。
