烟草暴露与头颈部手术伤口的愈合
Tobacco exposure and wound healing in head and neck surgical wounds.
作者信息
Lassig Amy Anne D, Bechtold Joan E, Lindgren Bruce R, Pisansky Andrew, Itabiyi Abayo, Yueh Bevan, Joseph Anne M
机构信息
Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin County Medical Center, Minneapolis, Minnesota, U.S.A.
出版信息
Laryngoscope. 2018 Mar;128(3):618-625. doi: 10.1002/lary.26813. Epub 2017 Sep 20.
OBJECTIVE
Smoking impairs wound healing, yet the underlying pathophysiological mechanisms are unclear. We evaluated tobacco-altered healing in head and neck surgery by studying the association between biomarkers and tobacco exposure, as well as cutaneous perfusion by smoking status.
STUDY DESIGN
Prospective cohort study, tertiary/academic care center, 2011 to present.
METHODS
Patients who required head and neck surgery were enrolled prospectively. Postsurgical drain fluid was collected 24 hours postoperatively. Biomarkers associated with postulated mechanisms of smoking-impaired healing were assayed. These included interleukin-1, -6, and -8; tumor necrosis factor- alpha; transforming growth factor-beta; epidermal growth factor (EGF); basic fibroblastic growth factor (bFGF); C-reactive protein; vascular endothelial growth factor; soluble FMS-like tyrosine kinase-1 (sFLT-1); and placental growth factor. Tobacco exposure and clinical outcomes were recorded. Two sample two-sided t tests evaluated the differences in cytokine levels by tobacco exposure. In a second cohort, cutaneous vascular assessment via indocyanine green angiography was compared by smoking status.
RESULTS
Twenty-eight patients were enrolled with drain fluid collection. Twenty-one subjects were current/former smokers, whereas seven were never smokers. EGF was higher in never smokers than smokers in a statistically significant manner (P = 0.030). Likewise, sFLT-1 was significantly higher in never smokers (P = 0.011). Cutaneous angiography revealed nonsmokers to have significantly higher cutaneous perfusion than smokers.
CONCLUSION
In this head and neck surgical cohort, significantly higher EGF and sFLT-1 levels in wound fluid were associated with never smoking, suggesting that smoking has adverse effects on the inflammatory phase of wound healing. Cutaneous angiography supports the detrimental effect of smoking on skin perfusion. These findings suggest the need for further study as well as therapeutic targets for smokers undergoing surgery.
LEVEL OF EVIDENCE
2b. Laryngoscope, 128:618-625, 2018.
目的
吸烟会损害伤口愈合，但其潜在的病理生理机制尚不清楚。我们通过研究生物标志物与烟草暴露之间的关联以及吸烟状态对皮肤灌注的影响，评估了头颈外科手术中烟草对愈合的影响。
研究设计
前瞻性队列研究，三级/学术医疗中心，2011年至今。
方法
前瞻性纳入需要进行头颈外科手术的患者。术后24小时收集手术引流液。检测与吸烟损害愈合的假定机制相关的生物标志物。这些标志物包括白细胞介素-1、-6和-8；肿瘤坏死因子-α；转化生长因子-β；表皮生长因子（EGF）；碱性成纤维细胞生长因子（bFGF）；C反应蛋白；血管内皮生长因子；可溶性FMS样酪氨酸激酶-1（sFLT-1）；以及胎盘生长因子。记录烟草暴露情况和临床结果。采用双样本双侧t检验评估烟草暴露对细胞因子水平的差异。在第二个队列中，通过吲哚菁绿血管造影术比较吸烟状态对皮肤血管的评估。
结果
纳入28例患者并收集引流液。21例受试者为当前/既往吸烟者，7例为从不吸烟者。从不吸烟者的EGF水平显著高于吸烟者（P = 0.030）。同样，从不吸烟者的sFLT-1水平也显著更高（P = 0.011）。皮肤血管造影显示，不吸烟者的皮肤灌注显著高于吸烟者。
结论
在这个头颈外科队列中，伤口液中EGF和sFLT-1水平显著升高与从不吸烟相关，这表明吸烟对伤口愈合的炎症阶段有不利影响。皮肤血管造影支持吸烟对皮肤灌注的有害作用。这些发现表明需要进一步研究，并为接受手术的吸烟者提供治疗靶点。
证据级别
2b。《喉镜》，2018年，第128卷，第618 - 625页。
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