Buvanendran Asokumar, Kroin Jeffrey S, Berger Richard A, Hallab Nadim J, Saha Chiranjeev, Negrescu Corina, Moric Mario, Caicedo Marco S, Tuman Kenneth J
Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois 60612, USA.
Anesthesiology. 2006 Mar;104(3):403-10. doi: 10.1097/00000542-200603000-00005.
The central and peripheral inflammatory response to surgery may influence patient outcomes. This study examines the time course and clinical relevance of changes in prostaglandin E2 and cytokines in cerebrospinal fluid, local tissue (surgical site), and circulating blood during and after total hip replacement.
Thirty osteoarthritis patients undergoing primary total hip arthroplasty with spinal anesthesia were randomly allocated to three groups (n = 10/group): placebo for 4 days before surgery and on the morning of surgery; placebo for 4 days before surgery and oral rofecoxib 50 mg on the morning of surgery; oral rofecoxib 50 mg for 4 days before surgery and the morning of surgery. Cerebrospinal fluid and plasma were collected before surgery and up to 30 h after incision for measurement of prostaglandin E2 and interleukins. When hip replacement was complete, a drain was placed in the hip wound and exudates were collected at 3 to 30 h after incision.
Cerebrospinal fluid showed an initial increase in interleukin 6 and a later rise in prostaglandin E2 concentration after surgery; interleukin 1beta and tumor necrosis factor alpha were undetectable. Hip surgical site fluid evidenced an increase in prostaglandin E2, interleukin 6, interleukin 8, and interleukin 1beta; tumor necrosis factor alpha decreased at 24 and 30 h. Preoperative administration of the cyclooxygenase 2 inhibitor rofecoxib reduced cerebrospinal fluid and surgical site prostaglandin E2 and cerebrospinal fluid interleukin 6. Cerebrospinal fluid prostaglandin E2 was positively correlated with postoperative pain and cerebrospinal fluid interleukin 6 with sleep disturbance. Poorer functional recovery was positively correlated with increased surgical site prostaglandin E2.
These results suggest that upregulation of prostaglandin E2 and interleukin 6 at central sites is an important component of surgery induced inflammatory response in patients and may influence clinical outcome.
手术引起的中枢和外周炎症反应可能会影响患者的预后。本研究探讨了全髋关节置换术中及术后脑脊液、局部组织（手术部位）和循环血液中前列腺素E2和细胞因子变化的时间进程及临床相关性。
30例接受脊髓麻醉下初次全髋关节置换术的骨关节炎患者被随机分为三组（每组n = 10）：术前4天及手术当天早晨给予安慰剂；术前4天给予安慰剂，手术当天早晨口服50 mg罗非昔布；术前4天及手术当天早晨口服50 mg罗非昔布。术前及术后至切口后30小时采集脑脊液和血浆，测定前列腺素E2和白细胞介素。全髋关节置换完成后，在髋关节伤口处放置引流管，于切口后3至30小时收集渗出液。
脑脊液显示术后白细胞介素6最初升高，随后前列腺素E2浓度升高；未检测到白细胞介素1β和肿瘤坏死因子α。髋关节手术部位渗出液中前列腺素E2、白细胞介素6、白细胞介素8和白细胞介素1β增加；肿瘤坏死因子α在24小时和30小时时降低。术前给予环氧化酶2抑制剂罗非昔布可降低脑脊液和手术部位的前列腺素E2以及脑脊液中的白细胞介素6。脑脊液前列腺素E2与术后疼痛呈正相关，脑脊液白细胞介素6与睡眠障碍呈正相关。功能恢复较差与手术部位前列腺素E2增加呈正相关。
这些结果表明，中枢部位前列腺素E2和白细胞介素6的上调是手术诱导患者炎症反应的重要组成部分，可能会影响临床结局。
