Kugisaki Hajime, Sonohata Motoki, Komine Mitsunori, Tsunoda Kenji, Someya Shinsuke, Honke Hidefumi, Mawatari Masaaki, Hotokebuchi Takao
Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Japan.
J Orthop Sci. 2009 Jul;14(4):437-42. doi: 10.1007/s00776-009-1344-9. Epub 2009 Aug 7.
Surgical stress is known to affect body temperature, white blood cell (WBC) count, C-reactive protein (CRP), and interleukin-6 (IL-6). The aim of the present study was to investigate which parameter is most suitable for quantitative analysis of surgical stress.
Unilateral total knee arthroplasty (U-TKA) and bilateral TKA (B-TKA) were selected for the subjects of this study because the B-TKA creates approximately double the surgical stress of the U-TKA. The temperature, WBC count, CRP, and IL-6 in the blood were measured pre- and postoperatively in both groups. The IL-6 in the drainage fluid was also measured after the operation.
The temperature, WBC count, CRP, and IL-6 in the blood significantly increased on the first day after the operation in both groups. There were significant differences between the two groups in the WBC count (P < 0.05) and the IL-6 level in the blood (P < 0.05) on the first day after the surgery. There were no significant differences between the two groups for the CRP and IL-6 levels in the drainage fluid. The relative proportions--(B-TKA/U-TKA) x 100 (%)--were 170.4% for the operating time, 219.4 % for total blood loss, 200.0% for blood transfusion, 100.3% for temperature, 128.9% for WBC count, 127.4% for CRP, and 246.5% for the IL-6 level in the blood.
The serum IL-6 level may best reflect surgical stress and could therefore be a quantitative marker of surgical stress.
已知手术应激会影响体温、白细胞（WBC）计数、C反应蛋白（CRP）和白细胞介素-6（IL-6）。本研究的目的是调查哪个参数最适合用于手术应激的定量分析。
本研究选择单侧全膝关节置换术（U-TKA）和双侧全膝关节置换术（B-TKA）作为研究对象，因为B-TKA产生的手术应激约为U-TKA的两倍。两组患者均在术前和术后测量血液中的温度、WBC计数、CRP和IL-6。术后还测量了引流液中的IL-6。
两组患者术后第一天血液中的温度、WBC计数、CRP和IL-6均显著升高。术后第一天两组患者的WBC计数（P < 0.05）和血液中的IL-6水平（P < 0.05）存在显著差异。两组患者引流液中的CRP和IL-6水平无显著差异。相对比例——（B-TKA/U-TKA）×100（%）——手术时间为170.4%，总失血量为219.4%，输血量为200.0%，体温为100.3%，WBC计数为128.9%，CRP为127.4%，血液中的IL-6水平为246.5%。
血清IL-6水平可能最能反映手术应激，因此可能是手术应激 的定量标志物。
