Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan.
World J Surg. 2011 Jul;35(7):1573-9. doi: 10.1007/s00268-011-1095-6.
The present study was designed to determine the optimal period for the prophylactic administration of the neutrophil elastase inhibitor, Sivelestat, in patients undergoing transthoracic esophagectomy. Sivelestat is reported to be effective in patients who undergo esophagectomy by providing an increased oxygenation ability and suppressing the serum inflammatory cytokines in the postoperative period. However, the optimal period for the prophylactic administration of Sivelestat remains to be elucidated.
The 30 patients who underwent esophagectomy for thoracic esophageal cancer were enrolled in one of two groups. The initial 15 patients were assigned to group A and received intravenous infusion of Sivelestat sodium hydrate until postoperative day (POD) 2, and the subsequent 15 patients were assigned to group B and received Sivelestat until POD 5. Historical controls without Sivelestat administration were used. The postoperative courses and serum inflammatory cytokines were evaluated.
Sivelestat improved oxygenation in the postoperative period; however, there were no differences between the two groups in terms of duration of mechanical ventilation, intensive care unit stay, systemic inflammatory response syndrome, and postoperative change of oxygenation. In addition, there were no differences in the postoperative changes in the serum interleukin (IL)-6 and high mobility group box chromosomal protein 1. Although the serum IL-8 on POD 3 was lower in group B than in group A, the neutrophil elastase showed no difference between these groups. None of the patients in either group suffered respiratory complications.
The two-day administration of Sivelestat initiated immediately after intrathoracic manipulation was found to be sufficient for prophylactic use to prevent pulmonary complications by suppressing hypercytokinemia after esophagectomy.
本研究旨在确定接受经胸食管切除术患者中性粒细胞弹性蛋白酶抑制剂西维来司他预防性给药的最佳时期。西维来司他可通过增加氧合能力并抑制术后血清炎症细胞因子，对接受食管切除术的患者有效。然而，西维来司他预防性给药的最佳时期仍有待阐明。
将 30 例接受胸段食管癌切除术的患者纳入两组之一。最初的 15 例患者被分配到 A 组，并接受西维来司他钠盐水静脉输注，直至术后第 2 天，随后的 15 例患者被分配到 B 组，并接受西维来司他直至术后第 5 天。使用未给予西维来司他的历史对照。评估术后过程和血清炎症细胞因子。
西维来司他改善了术后的氧合作用；然而，两组在机械通气持续时间、重症监护病房停留时间、全身炎症反应综合征和术后氧合变化方面无差异。此外，血清白细胞介素 (IL)-6 和高迁移率族蛋白 1 的术后变化也无差异。虽然 B 组术后第 3 天的血清 IL-8 低于 A 组，但两组的中性粒细胞弹性蛋白酶无差异。两组均无患者发生呼吸并发症。
在胸腔内操作后立即开始两天的西维来司他给药，被发现足以通过抑制食管切除术后的高细胞因子血症来预防肺部并发症。
