Siekmann W, Eintrei C, Magnuson A, Sjölander A, Matthiessen P, Myrelid P, Gupta A
Department of Anaesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, County Council of Östergötland, Linköping, Sweden.
Colorectal Dis. 2017 Jun;19(6):O186-O195. doi: 10.1111/codi.13643.
Epidural analgesia reduces the surgical stress response. However, its effect on pro- and anti-inflammatory cytokines in the genesis of inflammation following major abdominal surgery remains unclear. Our main objective was to elucidate whether perioperative epidural analgesia prevents the inflammatory response following colorectal cancer surgery.
Ninety-six patients scheduled for open or laparoscopic surgery were randomized to epidural analgesia (group E) or patient-controlled intravenous analgesia (group P). Surgery and anaesthesia were standardized in both groups. Plasma cortisol, insulin and serum cytokines [interleukin 1β (IL-1β), IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumour necrosis factor α, interferon γ, granulocyte-macrophage colony-stimulating factor, prostaglandin E and vascular endothelial growth factor] were measured preoperatively (T0), 1-6 h postoperatively (T1) and 3-5 days postoperatively (T2). Mixed model analysis was used, after logarithmic transformation when appropriate, for analyses of cytokines and stress markers.
There were no significant differences in any serum cytokine concentration between groups P and E at any time point except for IL-10 which was 87% higher in group P [median and range 4.1 (2.3-9.2) pg/ml] compared to group E [2.6 (1.3-4.7) pg/ml] (P = 0.002) at T1. There was no difference in plasma cortisol and insulin between the groups at any time point after surgery. A significant difference in median serum cytokine concentration was found between open and laparoscopic surgery with higher levels of IL-6, IL-8 and IL-10 at T1 in patients undergoing open surgery compared to laparoscopic surgery. No difference in serum cytokine concentration was detected between the groups or between the surgical technique at T2.
Open surgery, compared to laparoscopic surgery, has greater impact on these inflammatory mediators than epidural analgesia vs intravenous analgesia.
硬膜外镇痛可减轻手术应激反应。然而，其对腹部大手术后炎症发生过程中促炎和抗炎细胞因子的影响尚不清楚。我们的主要目的是阐明围手术期硬膜外镇痛是否能预防结直肠癌手术后的炎症反应。
96例计划行开放手术或腹腔镜手术的患者被随机分为硬膜外镇痛组（E组）和患者自控静脉镇痛组（P组）。两组的手术和麻醉均标准化。在术前（T0）、术后1 - 6小时（T1）和术后3 - 5天（T2）测量血浆皮质醇、胰岛素和血清细胞因子[白细胞介素1β（IL - 1β）、IL - 4、IL - 5、IL - 6、IL - 8、IL - 10、IL - 12p70、IL - 13、肿瘤坏死因子α、干扰素γ、粒细胞 - 巨噬细胞集落刺激因子、前列腺素E和血管内皮生长因子]。在适当进行对数转换后，使用混合模型分析来分析细胞因子和应激标志物。
除IL - 10外，P组和E组在任何时间点的任何血清细胞因子浓度均无显著差异，在T1时，P组的IL - 10比E组高87% [中位数及范围4.1（2.3 - 9.2）pg/ml]，而E组为[2.6（1.3 - 4.7）pg/ml]（P = 0.002）。术后任何时间点两组的血浆皮质醇和胰岛素均无差异。开放手术和腹腔镜手术之间血清细胞因子浓度中位数存在显著差异，与腹腔镜手术相比，开放手术患者在T1时的IL - 6、IL - 8和IL - 10水平更高。在T2时，两组之间或手术技术之间未检测到血清细胞因子浓度的差异。
与腹腔镜手术相比，开放手术对这些炎症介质的影响大于硬膜外镇痛与静脉镇痛之间的影响。
