Schilling M K, Gassmann N, Sigurdsson G H, Regli B, Stoupis C, Furrer M, Signer C, Redaelli C, Büchler M W
Department of Visceral and Transplantation Surgery, University of Bern-Inselspital, Switzerland.
Br J Anaesth. 1998 Jan;80(1):36-40. doi: 10.1093/bja/80.1.36.
We have studied prospectively the clinical course and serum concentrations of thromboxane B2 (TxB2) and leukotriene B4 (LTB4) in patients developing adult respiratory distress syndrome (ARDS) after oesophagectomy. The clinical course was assessed according to a validated ARDS score, and intra- and postoperative measurements of TxB2 and LTB4 in pre- and post-pulmonary blood were performed in 18 patients undergoing oesophagectomy for oesophageal carcinoma and 11 control patients undergoing thoracotomy and pulmonary resection. Six of 18 patients undergoing oesophagectomy, but no control patient, developed ARDS. The ARDS score was highest on day 8 after operation. Only patients with ARDS had a significant postoperative increase in post-pulmonary, but not pre-pulmonary, TxB2 concentrations (P < 0.05 vs patients without ARDS). This study provides evidence that TxA2, originating from the lungs, was associated with the development of ARDS after oesophageal resection. In view of the high incidence of ARDS after oesophagectomy (10-30%), prophylactic treatment of patients undergoing oesophageal resection with clinically applicable thromboxane synthetase inhibitors may be warranted.
我们前瞻性地研究了食管癌切除术后发生成人呼吸窘迫综合征（ARDS）患者的临床病程以及血栓素B2（TxB2）和白三烯B4（LTB4）的血清浓度。根据经过验证的ARDS评分评估临床病程，并对18例因食管癌接受食管切除术的患者和11例接受开胸手术及肺切除术的对照患者进行肺前后血液中TxB2和LTB4的术中和术后测量。18例接受食管切除术的患者中有6例发生了ARDS，但对照患者中无1例发生。术后第8天ARDS评分最高。仅ARDS患者术后肺后TxB2浓度显著升高，而肺前TxB2浓度未显著升高（与未发生ARDS的患者相比，P<0.05）。本研究提供了证据表明，源自肺的血栓素A2（TxA2）与食管切除术后ARDS的发生有关。鉴于食管切除术后ARDS的高发生率（10%-30%），对接受食管切除术的患者使用临床适用的血栓素合成酶抑制剂进行预防性治疗可能是必要的。
