Pulitanò Carlo, Aldrighetti Luca, Arru Marcella, Finazzi Renato, Catena Marco, Guzzetti Eleonora, Soldini Laura, Comotti Laura, Ferla Gianfranco
Department of Surgery-Liver Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
Shock. 2007 Oct;28(4):401-5. doi: 10.1097/shk.0b013e318063ed11.
Alterations in hemostatic parameters are a common finding after major hepatic resection. There is growing evidence that inflammation has a significant role in inducing coagulation disarrangement that follows major surgery. To determine whether preoperative methylprednisolone administration has a protective effect against the development of coagulation disorders, we evaluated the effect of preoperative steroids administration on changes in hemostatic parameters and plasma levels of inflammatory cytokines in patients undergoing liver surgery. Seventy-three patients undergoing liver resection were randomized to a steroid group or to a control group. Patients in the steroid group received 500 mg of methylprednisolone preoperatively. Serum levels of coagulation parameters (prothrombin time, platelets, fibrinogen, plasma fibrin degradation products [D-dimer], antithrombin III) and inflammatory mediators (IL-6 and TNF-alpha) were measured before and immediately after the operation and on postoperative days 1, 2, and 5. Multivariate analysis was performed to identify factors related to the characteristics of the patients and surgery affecting coagulation parameters between the two groups. Decreases in antithrombin III, platelet count and fibrinogen levels, prolongation of prothrombin time, and increases in the plasma fibrin degradation products were significantly suppressed by the administration of methylprednisolone. Cytokines production was also significantly suppressed by the administration of methylprednisolone, and there was significant correlation between plasma levels of cytokines and coagulation alterations. These findings suggest that preoperative methylprednisolone administration inhibits the development of coagulation disarrangements in patients undergoing liver resection, possibly through suppressing the production of inflammatory cytokines.
主要肝脏切除术后止血参数的改变是常见现象。越来越多的证据表明，炎症在导致大手术后凝血紊乱方面起重要作用。为了确定术前给予甲泼尼龙是否对凝血障碍的发生具有保护作用，我们评估了术前给予类固醇对肝手术患者止血参数变化及炎症细胞因子血浆水平的影响。73例行肝脏切除术的患者被随机分为类固醇组和对照组。类固醇组患者术前接受500mg甲泼尼龙。在手术前、术后即刻以及术后第1、2和5天测量凝血参数（凝血酶原时间、血小板、纤维蛋白原、血浆纤维蛋白降解产物[D-二聚体]、抗凝血酶III）和炎症介质（IL-6和TNF-α）的血清水平。进行多变量分析以确定与患者特征和手术相关的影响两组凝血参数的因素。甲泼尼龙的给药显著抑制了抗凝血酶III、血小板计数和纤维蛋白原水平的降低、凝血酶原时间的延长以及血浆纤维蛋白降解产物的增加。甲泼尼龙的给药也显著抑制了细胞因子的产生，并且细胞因子血浆水平与凝血改变之间存在显著相关性。这些发现表明，术前给予甲泼尼龙可能通过抑制炎症细胞因子的产生来抑制肝切除患者凝血紊乱的发生。
