Ivascu Robert, Dutu Madalina, Corneci Dan, Nitipir Cornelia
Anesthesia and Critical Care, Dr. Carol Davila University Emergency Central Military Hospital, Bucharest, ROU.
Anesthesia and Critical Care, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU.
Cureus. 2024 Mar 24;16(3):e56822. doi: 10.7759/cureus.56822. eCollection 2024 Mar.
Surgical stress response in colorectal surgery consists of a neurohormonal and an immunological response and influences oncological outcomes. The intensity of surgical trauma influences mortality, morbidity, and metastasis' occurrence in colorectal neoplasia. Energy expenditure (EE) stands for the body's energy consumed to keep its homeostasis and can be either calculated or measured by direct or indirect calorimetry.
The present study attempted to evaluate surgical stress response using EE measurement and compare it to the postoperative cortisol dynamic.
A prospective, monocentric study was conducted over a period of one year in the Anesthesiology Department including 21 patients from whom serum cortisol values were collected in the preoperative period and on the first postoperative day, and EE was measured and recorded every 15 minutes throughout surgery using the indirect calorimetry method. The study compared EE values' dynamic registered 30 minutes after intubation and 30 minutes before extubating (after abdominal closure) to cortisol perioperative dynamic.
We enrolled 21 patients and 84 measurements were recorded, 42 probes of serum cortisol and 42 measurements of EE. The mean value of the first measurement of serum cortisol was 13.60±3.6 µg and the second was 16.21±6.52 µg. The average value of the first EE recording was 1273.9±278 kcal and 1463.4±398.2 kcal of the second recording. The bivariate analysis performed showed a good correlation between cortisol variation and EE's variation (Spearman coefficient=0.666, p<0.001, CI=0.285, 0.865). In nine cases (42.85%), cortisol value at 24 hours reached the baseline or below the baselines preoperative value. In eight cases (38.09%), patients' EE at the end of the surgery was lower than that recorded at the beginning of the surgery.
Intraoperative EE variation correlated well with cortisol perioperative dynamic and stood out in this study as a valuable and accessible predictor of surgical stress in colorectal surgery.
结直肠手术中的手术应激反应包括神经激素反应和免疫反应，并影响肿瘤学结局。手术创伤的强度影响结直肠肿瘤的死亡率、发病率和转移的发生。能量消耗（EE）代表身体为维持内环境稳定所消耗的能量，可以通过直接或间接量热法进行计算或测量。
本研究试图通过测量EE来评估手术应激反应，并将其与术后皮质醇动态变化进行比较。
在麻醉科进行了一项为期一年的前瞻性单中心研究，纳入21例患者，在术前和术后第一天收集血清皮质醇值，并在整个手术过程中每隔15分钟使用间接量热法测量并记录EE。该研究将插管后30分钟和拔管前30分钟（腹部关闭后）记录的EE值动态变化与围手术期皮质醇动态变化进行比较。
我们纳入了21例患者，记录了84次测量值，其中42次血清皮质醇检测和42次EE测量。血清皮质醇首次测量的平均值为13.60±3.6µg，第二次为16.21±6.52µg。EE首次记录的平均值为1273.9±278千卡，第二次记录为1463.4±398.2千卡。进行的双变量分析显示皮质醇变化与EE变化之间存在良好的相关性（Spearman系数=0.666，p<0.001，CI=0.285，0.865）。在9例（42.85%）患者中，24小时时的皮质醇值达到基线或低于术前基线值。在8例（38.09%）患者中，手术结束时的EE低于手术开始时记录的值。
术中EE变化与围手术期皮质醇动态变化密切相关，在本研究中是结直肠手术中手术应激的一个有价值且易于获得的预测指标。
