Pan Xiaoyun, Ye Luyou, Liu Zhongtang, Wen Hong, Hu Yuezheng, Xu Xinxian
The Osteopathy Department, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Arch Orthop Trauma Surg. 2015 Aug;135(8):1131-9. doi: 10.1007/s00402-015-2246-2. Epub 2015 May 17.
This study was designed to evaluate the influence of irrigation fluid on the patients' physiological response to arthroscopic shoulder surgery.
Patients who were scheduled for arthroscopic shoulder surgery were prospectively included in this study. They were randomly assigned to receive warm arthroscopic irrigation fluid (Group W, n = 33) or room temperature irrigation fluid (Group RT, n = 33) intraoperatively. Core body temperature was measured at regular intervals. The proinflammatory cytokines TNF-α, IL-1, IL-6, and IL-10 were measured in drainage fluid and serum.
The changes of core body temperatures in Group RT were similar with those in Group W within 15 min after induction of anesthesia, but the decreases in Group RT were significantly greater after then. The lowest temperature was 35.1 ± 0.4 °C in Group RT and 35.9 ± 0.3 °C in Group W, the difference was statistically different (P < 0.05). Hypothermia occurred in 31 out of 33 subjects in Group RT (31/33; 94 %), but was significantly lower in Group W (9/24; 27 %; P < 0.05). Serum TNF-α changes were undetectable postoperatively. No statistical significant differences in serum IL-1 and serum IL-10 levels were observed between groups. Serum IL-6 levels were significantly lower in Group W (P < 0.05). The levels of the above cytokines in drainage fluid were all significantly lower in Group W after surgery (P < 0.05).
Hypothermia occurs more often in arthroscopic shoulder surgery by using room temperature irrigation fluid compared with warm irrigation fluid. And local inflammatory response is significantly reduced by using warm irrigation fluid. It seems that warm irrigation fluid is more recommendable for arthroscopic shoulder surgery.
本研究旨在评估冲洗液对肩关节镜手术患者生理反应的影响。
本研究前瞻性纳入计划接受肩关节镜手术的患者。术中，他们被随机分配接受温热的关节镜冲洗液（W组，n = 33）或室温冲洗液（RT组，n = 33）。定期测量核心体温。在引流液和血清中测量促炎细胞因子TNF-α、IL-1、IL-6和IL-10。
RT组核心体温的变化在麻醉诱导后15分钟内与W组相似，但之后RT组的下降幅度明显更大。RT组最低体温为35.1±0.4°C，W组为35.9±0.3°C，差异有统计学意义（P < 0.05）。RT组33名受试者中有31名发生体温过低（31/33；94%），但W组明显更低（9/24；27%；P < 0.05）。术后血清TNF-α变化未检测到。两组间血清IL-1和血清IL-10水平无统计学显著差异。W组血清IL-6水平显著更低（P < 0.05）。术后W组引流液中上述细胞因子水平均显著更低（P < 0.05）。
与温热冲洗液相比，肩关节镜手术中使用室温冲洗液更常发生体温过低。使用温热冲洗液可显著降低局部炎症反应。对于肩关节镜手术，温热冲洗液似乎更值得推荐。
