Tang G J, Kuo C D, Yen T C, Kuo H S, Chan K H, Yien H W, Lee T Y
Department of Anesthesiology and Critical Care, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Crit Care Med. 1996 Mar;24(3):423-8. doi: 10.1097/00003246-199603000-00010.
To characterize the sequential plasma concentrations of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) and their relationship with the clinical outcome in patients with intra-abdominal infection who underwent surgical intervention.
A prospective, comparative study.
Surgical intensive care unit of a university hospital.
Fifteen patients with surgically proved intra-abdominal infection were included as the infected group. The comparative noninfected group consisted of ten patients who underwent major abdominal surgery without infection.
Blood samples were obtained from the indwelling arterial catheter before induction of general anesthesia, and 1, 1.5, 2, 3, 4, 6, and 24 hrs after skin incision.
Plasma cytokine concentrations were measured using radioimmunoassay. The hemodynamic and physiologic parameters were recorded for comparison with cytokine concentrations. In the noninfected group, the TNF-alpha concentration was very low throughout the observation period, and the IL-6 concentration increased 4 hrs after skin incision. The infected group had significantly higher TNF-alpha and IL-6 concentrations than the noninfected group. The TNF-alpha concentration increased from 129.2 +/- 46.4 to 1196.0 +/- 445.8 pg/mL and the IL-6 concentration increased from 54.2 +/- 24.3 to 560.3 +/- 187.5 pg/mL 2 hrs after skin incision in the infected group. The postoperative APACHE II score correlated significantly with both peak IL-6 (r2=.39) and peak TNF-alpha (r2=.32) concentrations.
Both TNF-alpha and IL-6 concentrations increased significantly after surgical intervention in patients with intra-abdominal infection. The pulse increase in TNF-alpha concentration and the persistent increase in IL-6 concentration were related to the poor postoperative clinical condition in infected patients.
对接受手术干预的腹腔内感染患者肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）的序贯血浆浓度进行特征分析，并探讨其与临床结局的关系。
一项前瞻性比较研究。
一所大学医院的外科重症监护病房。
15例经手术证实有腹腔内感染的患者作为感染组。比较的非感染组由10例接受无感染的腹部大手术的患者组成。
在全身麻醉诱导前以及皮肤切开后1、1.5、2、3、4、6和24小时，从留置的动脉导管采集血样。
采用放射免疫分析法测定血浆细胞因子浓度。记录血流动力学和生理参数以与细胞因子浓度进行比较。在非感染组中，整个观察期内TNF-α浓度非常低，IL-6浓度在皮肤切开后4小时升高。感染组的TNF-α和IL-6浓度显著高于非感染组。在感染组中，皮肤切开后2小时，TNF-α浓度从129.2±46.4 pg/mL升高至1196.0±445.8 pg/mL，IL-6浓度从54.2±24.3 pg/mL升高至560.3±187.5 pg/mL。术后急性生理与慢性健康状况评分系统（APACHE II）评分与IL-6峰值（r2 = 0.39）和TNF-α峰值（r2 = 0.32）浓度均显著相关。
腹腔内感染患者手术干预后TNF-α和IL-6浓度均显著升高。TNF-α浓度的脉冲式升高和IL-6浓度的持续升高与感染患者术后不良临床状况有关。
