Kawashima T, Kamisawa O, Fuse K, Misawa Y, katoh M, Hasegawa N, Saitoh T, Konishi H, Ohki S, Hasegawa T
Department of Thoracic and Cardiovascular Surgery, Jichi Medical School, Tochigi, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Apr;45(4):531-5.
Between June, 1993 and January, 1995 a gelatin-sealed knitted Dacron (Gelseal) (g-G0, n = 7) and a collagen-sealed knitted Dacron graft (Hemashield) (g-H0, n = 8) were randomly implanted to 15 patients (pts) for replacement of thoracic aorta. We evaluated postoperative inflammatory responses and levels of Toxicolor and Endospecy which are the measurements of endotoxin. Five pts in g-G0 and 3 pts in g-H0 showed that a body temperature (BT) were above 37.5 degrees C on the 7th postoperative day (POD). In three of them (2 in g-G0 and 1 in g-H0), BT above 37.5 degrees C continued until POD 14 due to the bacterial infection. The other causes of elevation of BT were pleural effusion (2), pericardial effusion (1) and unknown origin (2). Patients without evidence of infection (n = 12) were divided into 2 groups (g-G: pts with Gelseal, n = 5, g-H: pts with Hemashield, n = 7). On POD3, postoperative BT in g-H was significantly higher than in g-G. And, on POD7, BT in g-G rose up more than in g-H. However, on POD14, BT decreased to the normal range in both groups. The values of WBC in g-G were slightly higher than in g-H and they became normal after POD7 in both groups. The levels of CRP in g-H were higher than in g-G after POD3 and in both groups they were still high on POD14. In terms of endotoxin., Toxicolor was already above the normal range from POD1 and decreased to the normal range after POD14. However, the level of Endospecy kept within normal range. In conclusion, Toxicolor-reactive substance elevates by using Gelseal and Hemashield. Its substance is not endotoxin. It would not be appropriate to consider that endotoxin is an origin of fever between POD7 and 14.
1993年6月至1995年1月期间，将15例患者随机植入明胶密封针织涤纶移植物（Gelseal）（g-G0，n = 7）和胶原密封针织涤纶移植物（Hemashield）（g-H0，n = 8），用于替换胸主动脉。我们评估了术后炎症反应以及内毒素测量指标Toxicolor和Endospecy的水平。g-G0组中的5例患者和g-H0组中的3例患者在术后第7天体温（BT）高于37.5℃。其中3例（g-G0组2例，g-H0组1例）因细菌感染，体温高于37.5℃持续至术后第14天。体温升高的其他原因包括胸腔积液（2例）、心包积液（1例）和不明原因（2例）。无感染证据的患者（n = 12）分为2组（g-G：使用Gelseal的患者，n = 5；g-H：使用Hemashield的患者，n = 7）。在术后第3天，g-H组的术后体温显著高于g-G组。并且，在术后第7天，g-G组的体温升幅大于g-H组。然而，在术后第14天，两组体温均降至正常范围。g-G组的白细胞值略高于g-H组，两组在术后第7天后均恢复正常。术后第3天后，g-H组的CRP水平高于g-G组，两组在术后第14天仍处于高位。在内毒素方面，Toxicolor从术后第1天起就已高于正常范围，术后第14天后降至正常范围。然而，Endospecy水平保持在正常范围内。总之，使用Gelseal和Hemashield会使Toxicolor反应性物质升高。其物质不是内毒素。认为内毒素是术后第7天至14天发热的根源是不合适的。
