Department of Anesthesiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
Reg Anesth Pain Med. 2011 Jan-Feb;36(1):36-40. doi: 10.1097/AAP.0b013e31820306c5.
Interleukin 6 (IL-6), a marker of inflammation, is one of the major cytokines released during joint replacement. In the orthopedic patient population, high levels have been linked to many adverse effects including acute respiratory distress syndrome, postoperative mental status changes, and fever. We looked to assess the efficacy of low-dose steroids on the postinflammatory response as measured by IL-6 in patients undergoing bilateral total knee replacement (BTKR). The role of steroids has never been evaluated before in that setting.
Double-blind, randomized, placebo-controlled study of 30 patients undergoing BTKR. The study was powered in order to detect at least a 25% decrease in IL-6 from control. Hydrocortisone (100 mg) or placebo was given at 2 doses 8 hrs apart to the study and control group respectively. Clinical outcome was assessed as well.
Levels of IL-6 were 40% lower in the study group by 10 hrs (P = 0.0037) but were similar to the control group at 24 hrs. Greater hemodynamic stability was noted in the study group with fewer episodes of hypotension postoperatively (P = 0.031). Range of motion gained on discharge was also greatest in the study group (P = 0.049). Absence of infection and normal wound healing were noted in all patients.
The use of hydrocortisone significantly decreased the inflammatory response in patients undergoing BTKR as measured by IL-6 production. Further studies looking at clinical implications of such findings in a larger patient population and with a longer course of steroids are warranted.
白细胞介素 6（IL-6）是一种炎症标志物，是关节置换过程中释放的主要细胞因子之一。在骨科患者群体中，高水平的白细胞介素 6 与许多不良反应有关，包括急性呼吸窘迫综合征、术后精神状态改变和发热。我们试图评估低剂量类固醇对接受双侧全膝关节置换术（BTKR）患者的炎症后反应的疗效，通过测量白细胞介素 6 来评估。在这种情况下，类固醇的作用从未被评估过。
对 30 例接受 BTKR 的患者进行双盲、随机、安慰剂对照研究。该研究具有足够的效力，以便检测到对照组中白细胞介素 6 至少降低 25%。分别在研究组和对照组中，在 8 小时的间隔内给予氢化可的松（100mg）或安慰剂。同时评估临床结果。
研究组的白细胞介素 6 水平在 10 小时时降低了 40%（P=0.0037），但在 24 小时时与对照组相似。研究组的血流动力学更稳定，术后低血压发作次数更少（P=0.031）。研究组出院时的活动范围也最大（P=0.049）。所有患者均无感染和正常伤口愈合。
氢化可的松的使用显著降低了接受 BTKR 患者的炎症反应，这可通过白细胞介素 6 的产生来衡量。需要进一步研究在更大的患者群体中，以及使用更长时间的类固醇后，这些发现对临床的影响。
