全身麻醉与脊髓麻醉对全髋关节置换术患者围手术期固有免疫功能的影响。
The effect of general versus spinal anesthesia on perioperative innate immune function in patients undergoing total hip arthroplasty.
作者信息
Jacobs Lotte M C, Bijkerk Veerle, van Eijk Lucas T, Joosten Leo A B, Keijzer Christiaan, Visser Jetze, Warlé Michiel C
机构信息
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands.
出版信息
BMC Anesthesiol. 2025 Jan 7;25(1):10. doi: 10.1186/s12871-024-02883-1.
BACKGROUND
Increasing evidence shows that postoperative innate immune dysregulation is associated with delayed recovery and infectious complications. The aim of this study was to compare the effects of general versus spinal anesthesia on innate immune function during and after total hip arthroplasty (THA).
METHODS
This comparative matched cohort study used data from two single-center randomized-controlled trials. Patients from the control group of the HIPPO study received general anesthesia and were matched to control patients from the MAGIC study who received spinal anesthesia in a 2:1 ratio (general(n = 18); spinal(n = 9)). Immune function was assessed by determination of ex vivo cytokine production capacity upon whole blood stimulation with E. coli lipopolysaccharides (LPS) and measurement of plasma cytokines and danger-associated molecular patterns (DAMPs).
RESULTS
In the general anesthesia group, ex vivo cytokine production capacity of IL-1β was significantly lower shortly after induction (p = 0.02) and both IL-1β and IL-6 were significantly lower at the end of surgery compared to the spinal anesthesia group (p = 0.002 and p = 0.02, respectively). On postoperative day 1 (POD1), no differences were observed. Plasma cytokine concentrations did not differ between the spinal and general anesthesia group at most timepoints, except for IL-10 at the end of surgery (p = 0.04) and TNF on POD1 (p = 0.04), which were higher in the general anesthesia group. Plasma concentrations of DAMPs did not differ between the groups.
CONCLUSIONS
General anesthesia has a transient impact on innate immune function in patients undergoing THA, but the clinical significance of anesthesia-induced innate immune dysregulation might be limited as no differences were observed on POD1.
TRIAL REGISTRATION
The HIPPO study (NCT05562999, date of registration 2022-10-03) and MAGIC study (NCT05723406, date of registration 2023-02-10) are registered at ClinicalTrials.gov.
背景
越来越多的证据表明，术后先天性免疫失调与恢复延迟和感染性并发症有关。本研究的目的是比较全身麻醉与脊髓麻醉对全髋关节置换术（THA）期间及术后先天性免疫功能的影响。
方法
这项比较匹配队列研究使用了两项单中心随机对照试验的数据。HIPPO研究对照组的患者接受全身麻醉，并与MAGIC研究中接受脊髓麻醉的对照患者按2:1的比例匹配（全身麻醉组(n = 18)；脊髓麻醉组(n = 9)）。通过测定大肠杆菌脂多糖（LPS）刺激全血后的体外细胞因子产生能力以及测量血浆细胞因子和危险相关分子模式（DAMPs）来评估免疫功能。
结果
在全身麻醉组中，诱导后不久IL-1β的体外细胞因子产生能力显著降低（p = 0.02），与脊髓麻醉组相比，手术结束时IL-1β和IL-6均显著降低（分别为p = 0.002和p = 0.02）。术后第1天（POD1），未观察到差异。除手术结束时的IL-10（p = 0.04）和POD1时的TNF（p = 0.04）外，脊髓麻醉组和全身麻醉组在大多数时间点的血浆细胞因子浓度无差异，全身麻醉组中这两项指标较高。两组间DAMPs的血浆浓度无差异。
结论
全身麻醉对接受THA的患者的先天性免疫功能有短暂影响，但由于在POD1未观察到差异，麻醉诱导的先天性免疫失调的临床意义可能有限。
试验注册
HIPPO研究（NCT05562999，注册日期2022-10-03）和MAGIC研究（NCT05723406，注册日期2023-02-10）已在ClinicalTrials.gov注册。
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